Quality of life for children with fecal incontinence after surgically corrected anorectal malformation

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Abstract

Purpose: The aim of this study was to investigate influences of fecal incontinence on children's quality of life after surgically corrected anorectal malformation. Methods: Seventy-one children with anorectal malformation underwent follow-up for 8 to 16 years postoperatively. They were divided into good, fair, and poor groups by assessment of anal function. The quality of life was investigated by self-structured disease impact questionnaires and Achenbach's Child Behavior Check List (CBCL). A quality-of-life scoring criteria was established to assess quality of life of the 71 children with operated anorectal malformation and controls. Results: Owing to fecal incontinence, 12 (16.9%) children reported that there were problems in peer relationships; school absences happened in 13 (18.3%) children; 17 (23.9%) children had to restrict themselves to certain food. Based on CBCL, 13 (18.3%) children had behavior problems. The behavior problems in children with poor fecal continence (66.7%) were significantly higher than those of children with good fecal continence (8.6%). According to the quality-of-life scoring criteria, the scores of children with operated anorectal malformation (9.4 ± 3.7) were significantly lower than those of the controls (11.2 ± 0.9). The scores of children with poor fecal continence (4.8 ± 1.4) were significantly lower than those of children with good fecal continence (10.9 ± 1.2). Conclusions: The children with poor fecal continence have poor quality of life caused by fecal dysfunction. Attention should be paid to the rehabilitation of fecal continence after surgery, such as bowel training and biofeedback therapy. The somatic and psychological care and long-term follow-up are necessary to improve the quality of life. J Pediatr Surg 35:462-464. Copyright © 2000 by W.B. Saunders Company.

Section snippets

Materials and methods

Seventy-one children who underwent surgical treatment for anorectal malformation at the second hospital of China Medical University underwent follow-up from 8 to 16 years postoperatively. Excluded were children who were mentally retarded. There were 48 boys and 23 girls, aged 8 to 16 years. The anomalies were classified according to the Wingspread International Classification of Anorectal Malformations.1 Thirty-seven children suffered from low anorectal malformations, 15 children had

Somatic assessment

Fecal continence was classified as good group (scores of 5 to 6), fair group (scores of 3 to 4), poor group (scores of 0 to 2; Table 2).

. Assessment of Fecal Continence

TypeLowIntermediateHighTotal
Good group306137
Fair group781025
Poor group0189
Fifteen children suffered from associated malformations. Nine children had genitourinary tract defects, such as rectourethra fistula, undescended testis, hypospadias, and hydronephrosis. One child had tethered cord syndrome, 2 children had limb anomalies, and

Discussion

Quality of life in children is multidimensional. It includes, but is not limited to, the social, physical, and psychological functioning of the child. Fecal incontinence influences the quality of life. Severe fecal incontinence is a problem that may substantially diminish a person's quality of life. Probably no aberration of bodily function is as socially unacceptable as the inability to control one's stools. In adults, unsatisfactory fecal continence commonly carries with it social and sexual

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Address reprint requests to Weilin Wang, MD, the Second College of China Medical University, No. 36 Sanhao St, Heping District, Shenyang Liaoning, 110003, P.R. China.

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