COLORECTAL DISORDERS IN CHILDREN: TYPES, TREATMENT, AND PREVENTION

INTRODUCTION

Colorectal disorders significantly affect the quality of life and often lead to embarrassment. Improper toilet training and relative inexperience in such practices have made children highly vulnerable to these disorders. Although many of the colorectal disorders are due to anatomical deformities, condition becomes even more complex by indulging in unhealthy practices. Further, hesitation in sharing such problems also adds to complexity of symptoms resulting in delayed treatment.

WHAT ARE THE COLORECTAL DISORDERS IN CHILDREN?

Colorectal disorders are the ailments associated with colon and rectum. Colon and rectum combined together to form a large intestine and these disorders are also termed as intestinal disorders. The colorectal disorders range from common problems such as constipation and irritable bowel syndrome, manageable by implementing proper treatment strategy, to serious life-threatening condition such as colorectal cancer. Types of colorectal disorders include:

A) Anorectal Malformations: These problems are present right from birth (congenital). Anus or rectum of the baby is not developed properly causing various abnormalities such as absence of a connection between anus and rectum (imperforate anus), rectum connected to urinary tract by way of fistula, narrowing of anal passage and blocking of anal opening due to membranous growth.

B) Cloacal deformities: In healthy individuals, urethra, genital tract, and rectum opens on the skin surface through separate, well-defined openings. However, in the babies with cloacal deformities, there is a single opening due to merging of the three tracts i.e. urethra, genital tract, and anus. Such deformities affect urinary control, poor control over bowel movement and may lead to sexual dysfunction.

C) Hirschsprung Disease: Muscles of intestinal system helps in controlling bowel movement. These are controlled by nerve cells innervated in the muscles. In Hirschsprung Disease, nerve cells are absent in a particular part of the colon due to developmental deformity causing obstruction of bowel movement.

D) Colonic Inertia Disorders: Dominic inertia disorders are a group of disorders related to poor bowel movement or obstruction in a bowel movement in the colon. These conditions include Idiopathic Constipation, Intestinal Neuronal Dysplasia, and Intestinal Pseudo-obstruction.

E) Rectal Prolapse: Lower portion of the intestine is known as the rectum. It is attached with the help of muscles and ligaments to the pelvis. Rectal prolapse is a condition in which muscles and ligaments become weakened and the rectum lining protrudes outside the body through anus.

F) Pseudo-Fecal and True Fecal Incontinence: Although a common problem in the elderly, fecal incontinence is also registering its presence in children. The condition is characterized by presence of repetitive and untimely passage of stools even after they are trained for toilet habits. True fecal incontinence is present in those children with incomplete or absence of mechanisms required for controlling bowel movement. Pseudo-fecal incontinence is developed due to severe or chronic constipation that leads to passing of infrequent stools.

TREATMENT

Various treatment options are available for managing the symptoms and overall conditions related to colorectal disorders. These are:

1) Mild rectal prolapse can be treated by pushing prolapse back into its place, however, severe and frequent prolapse requires surgical intervention. The surgical options available are laparoscopic sigmoid resection, Thiersch cerclage, trans-anal resection, and sclerotherapy.

2) Treatment for an anorectal malformation is done on the basis of type of malformation. Anal dilation is done for narrow anal passage, while surgical removal of the membrane is required in membranous growth. The rectal connection is cured through a serious of surgeries i.e. colostomy, attaching rectum to the anus and finally closing colostomy.

3) Surgical intervention is required in treating Hirschsprung Disease as it includes removal of affected part of the intestine.

PREVENTION

•    Diet should contain high-fibers to prevent constipation.

•    Drink plenty of water.

•    Maintain a healthy diet.

•    Do not hesitate to share problem with your doctor. This will help in diagnosing and treating the problem at an early stage.

•    Do exercise regularly.

CONCLUSION

Colorectal disorders in children are conditions in which the bowel movement is largely affected. Some of the conditions such as Hirschsprung disease are due to congenital abnormalities while other conditions such as pseudo-fecal incontinence are due to poor toilet practices. Any delay in treatment, whether required through medications or surgery, may negatively impact the health of children.