What is a perineal Anoplasty? 

 

          What is food to you? Food can have many definitions and many foods have many significances or symbol. To the poor, food does mean life whereas to the rich, food is pleasure. No matter what definition of food to you, either you eat to live or live for food, one thing in similar is food is eaten, it is digest and processed before eliminated through bowel movement. The bowel movement involves the rectum and the anus after the processed food is processed through the digestive system including the intestine. Here is a question, what happen if there is problem with bowel movement? Constipation and diarrhoea ay be the first thing that popped in your head but in this DoctorOnCall’s article, there are few medical problems leading to bowel movement issues and needs perineal anoplasty.

          What exactly is perineal anoplasty? We need to breakdown the two words to get better understanding of this. Perineal are region below the pelvic which includes between the anus and the genitals. Anoplasty is surgical procedure to repair or reconstruct the anus. Hence, perineal anoplasty is a surgery to repair anal defects in both male and female. In most cases, perineal anoplasty is done to help improve anal stenosis. An anal stenosis is a narrowing of the anal canal which is typically caused by scar tissue from a surgery such as haemorrhoidectomy or chronic disease. The aim of perineal anoplasty is to restore the normal function of the anus by dividing the narrowed part and widening the anal canal.

          This procedure may also be done in babies with birth defects of the anus and rectum known as anorectal malformations. Anorectal malformations include wide spectrum of defects in the development of the intestinal and urogenital tracts in babies. Many children with such malformation have an imperforate anus meaning there is no opening of the anus where it should be or a blocked anus. Without proper treatment, it can make the babies have difficulty to pass stool or even impossible. In most cases of anorectal malformations, posterior sagittal anorectoplasty (PSARP) is used by surgeon to fix the issue. PSARP is usually followed with colostomy which is a procedure to allow stool to pass through an opening known as the stoma. Colostomy acts a temporary measure before it is closed and the child is able to perform bowel movement just like any other normal children could.

          Before a surgery such as perineal anoplasty, doctors and surgeons will do certain tests to ensure the person do need the surgery. This could be from physical examination and imaging test such as x-ray and ultrasound. Before a surgery can be performed, there are specific instructions that needs to be adhered to avoid problems during surgery. For adult, they may need to clear the bowels by taking laxative which is usually given a day before surgery. They may also need to follow special diet several days before the surgery. This would be further explained by dietician or surgeon. For children, mother need to follow specific instructions by healthcare provider to ensure surgery can go smoothly.

          Most patients undergoing perineal anoplasty will be under general anaesthesia meaning they are not awake and not alert. In anal stenosis case, surgeons often use electric stimulator machine to stimulate anal contractions. This help to guide them on where the anus should be. They will also remove the scar tissue to enable anus to relax and expands. This will leave a gap in the inner lining and is then covered with skin flap from the inside of the buttocks. The wound is then stitched. In anorectal malformations, surgeons not only construct a new anus but also move or close inappropriate openings (fistula) along the bowel movement path. A child may be leave with temporary colostomy before it is closed after the child is able to make use of the new anus.

          Hospitalisation duration depends on the severity of the defect. This could from one day to several days staying in the hospital. Healthcare provider will use instrument known as a dilator into the anus to help stretch it. Dilating the new anus is important as training for the tissues of the anal to be on the designated size and to prevent scarring. Such procedure should be continued by adult patients or mother of the child for several months to improve muscle tone and for the anus to work properly.

          Any medical procedure does have potential risk, side effects or complications. This includes infections, hematoma or bruising of the anal area, constipation and urinary retention leading to difficulty urination. In rare cases, it may lead to fecal incontinence marked by inability to control bowel movement, anal stenosis and new fistula resulted from infections.

          In essence, perineal anoplasty help to restore the function of the anus. It is performed in adults and children. It is important to follow all doctors’ instructions before and after surgery to ensure good outcome. Since dilation plays vital role in the anus function, it should be done daily to prevent stenosis and to ensure functionality. Should there is any side effects or discomfort from the surgery, do address this to your healthcare provider as they may give medicines to ease the pain or prescribe special diet to speed up recovery process.

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