1992 Volume 28 Issue 4 Pages 843-850
Management of the fecal incontinence is most important aspect of postoperative care of the patients with high-type imperaforate anus. In our institution, patients with the anomalies are treated with the enema progarm after the definitive surgery, under which they are expected to defecate habitually by the everyday enema unitl they achieve satisfactory bowel control. Effect of the habitual enema on the postoperative fecal continence was investigated on 30 patients over 4 years of age, who were operated during the past 20 years. They were evaluated clinically by using the scoring system proposed by the Japnaese Society of Pediatric Surgeons. Manometric studies and radiological examinations were also done upon 25 of them to analyse their local function and structure. Children with the malformation tend to have low scores on fecal sensation in their first decade of life and most of them (87%) are under the enema program. More than half of those under the program (58%) are free from the incontinent state regardless of their sense of defecation. Involuntary fecal excretions are avoided unless the stool is loose, which indicates that the habitual enema is effective for them to live without being frustrated by soilings. The patients for which the program is effective tend to have better objective scores than those whose everyday enemas are less effective. After the long-term habitual enema, most adolescent patients can sense the defecation and are in controllable states even if the objective findings indicate poor local functional state.
