Bowel Movement Case Study

During a normal bowel movement, stool passes from the large intestine to the rectum, and then to the anus. Nerves and muscles help control when the bowel movement occurs and help the child to sense the need for a bowel movement. Anorectal malformations cause abnormalities in the normal bowel movement process. A child may have a difficult, painful time passing a stool within day or two after birth and is characterized by a swollen belly. Also in some cases there is stool passing in another opening, for example, urethra in boys and vagina in girls. In most cases, the child is not being able to have a bowel movement at all. Or stool can enter the urinary tract instead of the anus, causing urinary tract infections and sepsis in the 4th day

the presence of a presacral mass.
At birth, a history of excess oral secretions and central cyanosis implies the potential presence of VACTERL (Vertebral, Anorectal, Cardiac, Tracheoesophageal, Renal and Limbs particularly radial) anomalies. So full examination of the spine, the pelvis, the esophagus, and the cardiovascular system to ensure a life-threatening abnormality has not been overlooked because of an absent rectum.
Check for the normal position and size of the anus:
In a girl the size should be 1/3 of the distance from the coccyx to the fourchette. In case the anus is present and in the correct position then the passage of a soft catheter greater than 2 cm into the rectum and the presence of meconium passage rules out atresia. The normal size of the anus is described as 1.3 + (3 × birth weight in kg) in millimeters.

Check for the buttock groove:
The parasagittal muscle fibers are located on both sides at the midline in normal anal position. These fibers give rise for the midline buttock groove. The higher the fistula in the urethra then fewer the parasagittal fibers are found and so the perineum appears more flat. In the presence of an anal membrane the anus will be in the normal position but a thin epithelial lining is present overlying the opening. Meconium can be seen bulging behind the