Effectiveness of the bowel management program in children with constipation secondary to anorectal malformation

  • Karla A. Santos Jasso Instituto Nacional de Pediatría
  • Mario Andrés De Giorgis Stuven Instituto Nacional de Pediatría
  • Alejandro Ruíz Montanez Instituto Nacional de Pediatría
  • Claudia J. Banuelos Castaneda Instituto Nacional de Pediatría
  • Luis de la Torre Mondragón Universidad Nacional Autónoma de México


Introduction: in Mexico, approximately 1 000 children each year are born with anorectal malformation (ARM). Despite surgical correction, those children present fecal function problems (60-70% have difficult to manage constipation). A Bowel Management Program (BMP) was implemented, which consists of initial rectal disimpaction, followed by administration of a stimulant laxative (sennosides), with favorable results. The objective of this study was to describe the effectiveness of
the BMP in children with constipation secondary to ARM.

Material and methods: A descriptive, retrospective, transverse study to answer the question: how effective is the BMP in children with constipation secondary to ARM? Efficacy was evaluated by means of a construct with three variables (daily fecal evacuations, absence of fecal staining, and simple abdominal x-ray without fecal residue in rectum and left colon after evacuation). All children with surgically corrected ARM and constipation from two national referral centers for children
with the condition were included.

Results: of 151 children with ARM monitored in outpatient service, only 67.33% had constipation. Of this group, 88.1% showed good response to the BMP. The average dose of sennoside was 8.45 mg/kg, 95% CI: 5.94-11.12 mg/kg (199.5 mg total dose; 95% CI: 139.50-259.50 mg). Abdominal cramp was the primary adverse effect reported (5.8%).

Discussion: use of sennosides had a positive impact on our patients’ quality of life by achieving colonic and rectal emptying and preventing daily fecal staining.

Biografía del autor/a

Karla A. Santos Jasso, Instituto Nacional de Pediatría
Pediatric Colorectar Surgeon
Mario Andrés De Giorgis Stuven, Instituto Nacional de Pediatría
Resident in Pediatric Colorectal Surgery
Alejandro Ruíz Montanez, Instituto Nacional de Pediatría
Pediatric Colorectal Surgeon. Colon and Rectum
Claudia J. Banuelos Castaneda, Instituto Nacional de Pediatría
Resident in Pediatric Surgery.
Luis de la Torre Mondragón, Universidad Nacional Autónoma de México
Professor of the Specialized University Course in
Pediatric Colorectal Surgery.


Levitt Ma, Pena A. Anorectal Malformations. Orphanet J Rare Dis 2007;2:33.

De Vries P, Pena A. Posterior Sagittal Anorectoplasty. J Pediatr Surg 1982;17:638-643.

Hartman E, Oort F, Aronson D, Sprangers M. Quality of life and disease-specific functioning of patients with anorectal malformations or Hirschsprung’s disease: a review. Arch Dis Child 2011;96:398–406.

Pena A, Guardino K, Tovilla JM, et al. Bowel management for fecal incontinence in patients with anorectal malformations. J Pediatr Surg 1998;33:133–137.

Bischoff A, Levitt M, Pena A. Bowel management for the treatment of pediatric fecal incontinence. Pediatr Surg Int 2009;25:1027-1042.

Pena A. Anorectal Malformtions. Semin Pediatr Surg 1995;4:35-47.

Holschneider AM, Koebke J, Meier-Ruge WA, Schafer S. Postoperative Pathophysiology of Chronic Constipation and Stool Incontinence. En: Anorectal Malformations in Children. Berlín: Springer pp. 222-230.

Brunton. Fármacos que afectan el flujo de agua y la motilidad gastrointestinales: emesis y antieméticos; ácidos biliares y enzimas pancreáticas. In: Goodman and Gilman. Las Bases Farmacológicas de la Terapéutica. 9th Edition. Mexico City: McGraw-Hill Interamericana; 2006 pp. 981-993.

Gordon M, Naidoo K, Akobeng AK, Thomas AG. Osmotic and stimulant laxatives for the management of childhood constipation. Cochrane Database Syst Rev 2012;7:CD009118.

Cómo citar
Santos Jasso, K., De Giorgis Stuven, M., Ruíz Montanez, A., Banuelos Castaneda, C., & de la Torre Mondragón, L. (2014). Effectiveness of the bowel management program in children with constipation secondary to anorectal malformation. Acta Pediátrica De México, 35(2), 100-105. https://doi.org/10.18233/APM35No2pp100-105
Artículo original