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Programs & Services

Colorectal Clinic

Phoenix Children’s colorectal clinic is a nationally known leader in treating colorectal conditions and malformations. Our team members are active in research and quality improvement efforts. We share a dedication to providing the best possible care, quality of life and future for your child. Our goal is to give children an independent future that is not held back by medical or surgical challenges.

Our colorectal clinic’s teams of medical and surgical specialists are able to offer the latest treatment options for children and teens with colorectal conditions. We use minimally invasive techniques to shorten recovery time and improve outcomes.

Colorectal Programs & Services

Prenatal Support: If your baby has a prenatal diagnosis of an anorectal malformation, cloaca or exstrophy, we find it helpful for you talk to other families with similar first-hand experiences. We have many parents and patients who would be happy to meet you. They can answer your questions and help reduce any anxiety or stress you may feel.

Workshops & Parties: Our colorectal clinic offers workshops for patients and their families who are interested in education, personal connections, and giving and receiving support for those affected by an anorectal malformation. Many families are going through the same thing or have similar experiences. These workshops feature brief informational sessions and age-appropriate breakout sessions. Clinic physicians are available to offer support, encouragement and answers to your individual questions.

We also plan parties and events that give patients and families a chance to get to know each other, and to relax and have fun outside of the hospital.

School Intervention: Families often describe some of the unique challenges their children face in school. We are here to help with these concerns. We will provide special plans to help educate teachers about the needs that children with bowel or bladder reconstructions may have. We are happy to call school administrators, nurses or educators as often as needed to assist. We also can connect you with other parents who can coach you through this important time.

Coaching During Developmental Milestones: Every child is different in terms of how and when they poop! We can help during every stage of development. Sometimes knowing that someone else achieved success gives us hope. We regularly get patients and families together to discuss these issues and learn something every time. Patients who need help in the early years often become the coaches in later years.

Bowel Management: What to Expect

When you come to us for help with your child’s bowel management, we will:

  • Start with a thorough history of your child’s bowel function.
  • Perform an exam with your child’s permission. This may include a genital and rectal exam.
  • Identify goals for your child, with you leading the conversation.
  • Set up any tests or laboratory work that your child needs, which may include:
  • Work closely with our gastroenterologist in the motility clinic
  • Review different options for improving bowel function, and discuss which would be most helpful for your child:
    • Dietary fiber and hydration
    • Oral medications
      • Laxatives
      • Fiber supplements
      • Medications to slow down transit for diarrhea
    • Rectal large-volume enemas
      • Navina
      • Peristeen
      • Foley catheter system
    • Antegrade enemas through a cecostomy – learn more about a cecostomy tube for children
      • Chait cecostomy tube
      • MiniACE cecostomy tube
      • Appendicostomy
      • Malone antegrade continence enema (MACE)
  • At the beginning of your bowel management journey, we will be following your child closely. This will be on your schedule. It can be daily, weekly or monthly depending on the type of intervention and your goals.
  • Continue to offer long-term support and follow your child through their milestones.
    • Follow up every six to 12 months
    • Visits as needed for any questions or concerns that come up
    • Evaluation as needed to change to a different treatment option or update your plan of care

Social services: Common challenges of daily life and unexpected events can affect your ability to care for a family member with a medical condition. We will ask you questions about your unique situation in order to provide help or connect you to available services and resources. In addition to surgical procedures, the right services and support contribute to achieving good outcomes and quality of life.

Procedures

Ostomy: This procedure is typically done during the first few days of life to treat babies born without an anus that can pass stool. The surgeon creates an opening (ostomy) and connects the intestines to the abdominal wall. In most instances, surgeons connect parts of the colon in two locations, one for stool to pass and one that goes downstream. The baby can be fed very soon after the operation. Stool passes into a bag called an ostomy appliance. Our nurses help with training and follow-up care as long as the ostomy is needed. Surgeons may recommend reconstructive surgery later on to create a typical anus and channel for bowel movements. 

Cecostomy: A cecostomy can help children who have constipation or fecal incontinence if laxatives or enemas are not effective. During a cecostomy, surgeons create a surgical opening so doctors can place a tube (catheter) that is used to flush the large intestine. The flush is done while sitting on the toilet so stool is flushed into the toilet. Learn more about cecostomy for children.

Anoplasty: In some cases, an ostomy to relieve obstruction is not necessary because stool can come out of an anus that is too small and not in the proper position within the anal sphincter muscles. We evaluate each case individually and many times we recommend moving the anus to a spot within the muscles. This is done all on the bottom with no incisions on the abdomen. Babies can sometimes go home the same day or have a short hospital stay depending on their age.

Anorectal Pull-through Procedure: The first step for a baby who is born without an anus is an operation to make an ostomy to allow stool to pass so the newborn can eat, digest food and have bowel movements. After the baby gets bigger, doctors will conduct a specialized imaging test called a colostogram. This type of X-ray provides a highly detailed image of the baby’s organs and tissues, including any defects. Surgeons can see if and how the intestines are connected to the bladder. They then make plans to disconnect the rectum and make a new connection on the baby’s bottom. This is done during open surgery or a minimally invasive laparoscopic procedure.

During laparoscopy, surgeons operate using small incisions, specialized surgical instruments and a camera-guided viewing tube. Minimally invasive techniques can ease recovery and speed healing time. Your child’s doctor will discuss the best approach for your child’s condition and type of connection defects.

Most babies can be fed within a day or two of the surgery and can go home when feeding well. Doctors will implant special dilators to keep the new connection open as it heals.

Laparoscopic-assisted Cloaca Repair: This multispecialty procedure is an effective treatment for cloaca – a condition in which there is just one opening for the rectum, bladder and vagina. It typically involves teamwork among doctors from multiple specialties, such as urology, gynecology and surgery.

Doctors use a camera and small instruments to view and separate abnormal tissue connections. They can then connect the rectum to its normal position on the baby’s bottom and correct any other defects.

Our team has advanced expertise in complex care for children with cloaca. We help families understand their child’s different organs systems, and we schedule the appropriate repairs as soon as the baby is ready.

Doctors approach treatment by dividing specific goals, such as passing stool and urinating, into separate categories and steps. This allows doctors to plan reconstructive surgery when it is most appropriate and less likely to have complications.

Doctors may combine procedures depending on the condition of the child’s internal organs, tissues and connections. For example, surgeons may create a channel and opening for normal urination through the baby’s bottom and open up the vaginal opening at the same time that they make an anus. This type of procedure is called a laparoscopic anorectoplasty with a urogenital sinus repair. Urology, surgery and gynecology all work together during these operations. Babies stay in the hospital for a few days.

Revision Surgery: Older children and teenagers may develop a narrowing called a stricture at one of their new connections. Surgeries to open up those strictures can be simple or complex depending on how much needs to be done. We involve the patient, at any age, in the decision making and answer all their questions.

Ostomy Takedown or Reversal: When the new connections on the bottom are healed, we can reverse the ostomy that was created in the first few days of life. Now stool will be able to pass from the bottom for the first time. We pay special attention to the skin to help protect it from a rash. This operation requires a few days in the hospital to get back on food and to watch for any problems.

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