Disorders of Anus and Rectum

  • Mikko P. PakarinenEmail author
  • Risto J. Rintala
  • Antti Koivusalo
Living reference work entry


Pediatric anorectal disorders include a variety of relatively common functional and anatomical defects. Around 10% of children are brought to medical attention because of an anorectal disorder. Besides constipation, other typical complaints include blood in the stool, pain, and specific local anal findings. It is essential that pediatric surgeons are familiar with the pathophysiology and management of these diverse and usually relatively benign conditions, as these problems are not uncommon and are regularly seen in emergency room and outpatient clinics.


Disorder Anus Rectum 


  1. Bongers ME, van Wijk MP, Reitsma JB, Benninga MA. Long-term prognosis for childhood constipation: clinical outcomes in adulthood. Pediatrics. 2010;126:e156–62.CrossRefGoogle Scholar
  2. Chang JW, Wu TC, Wang KS, Huang IF, Huang B, Yu IT. Colon mucosal pathology in infants under three months of age with diarrhea disorders. J Pediatr Gastroenterol Nutr. 2002;35:387–90.CrossRefGoogle Scholar
  3. Clarke MC, Catto-Smith AG, King SK, Dinning PG, Cook IJ, Chase JW, Gibb SM, Robertson VJ, Simpson D, Hutson JM, Southwell BR. Transabdominal electrical stimulation increases colonic propagating pressure waves in paediatric slow transit constipation. J Pediatr Surg. 2012;47:2279–84.CrossRefGoogle Scholar
  4. Clayden G, Agnarsson U. Constipation in childhood. Oxford: Oxford Medical Publications; 1991.Google Scholar
  5. Dehghani SM, Malekpour A, Haghighat M. Solitary rectal ulcer syndrome in Felt B, Wise CG, Olson A et al: Guideline for the management of pediatric idiopathic constipation and soiling. Multidisciplinary team from the University of Michigan Medical Center in Ann Arbor. Arch Pediatr Adolesc Med. 1999;153:380–5.Google Scholar
  6. de la Torre L, Carrasco D, Mora MA, et al. Vascular malformations of the colon in children. J Pediatr Surg. 2002;37:1754–7.CrossRefGoogle Scholar
  7. Fishman SJ, Shamberger RC, Fox VL, et al. Endorectal pull-through abates gastrointestinal hemorrhage from colorectal venous malformations. J Pediatr Surg. 2000;35:982–4.CrossRefGoogle Scholar
  8. Flemming G. Chronic functional constipation in infants and children. Handb Exp Pharmacol. 2019; Scholar
  9. Gladman MA, Scott SM, Lunniss PJ, Williams NS. Systematic review of surgical options for idiopathic megarectum and megacolon. Ann Surg. 2005;241:562–74.CrossRefGoogle Scholar
  10. Heaton ND, Davenport M, Howard ER. Incidence of haemorrhoids and anorectal varices in children with portal hypertension. Br J Surg. 1993;80:616–8.CrossRefGoogle Scholar
  11. Hutson JM, Chase JW, Clarke MC, King SK, Sutcliffe J, Gibb S, Catto-Smith AG, Robertson VJ, Southwell BR. Slow-transit constipation in children: our experience. Pediatr Surg Int. 2009;25:403–6.CrossRefGoogle Scholar
  12. Hyman PE, Milla PJ, Benninga MA, Davidson GP, Fleisher DF, Taminiau J. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2006;130:1519–26.CrossRefGoogle Scholar
  13. Ismail M, Gabr K, Shalaby R. Laparoscopic management of persistent complete rectal prolapse in children. J Pediatr Surg. 2010;45:533–9.CrossRefGoogle Scholar
  14. Jamshidi R. Anorectal complaints: hemorrhoids, fissures, abscesses, fistulae. Clin Colon Rectal Surg. 2018;31(2):117–20.CrossRefGoogle Scholar
  15. Kellogg N, The Committee on Child Abuse and Neglect. The evaluation of sexual abuse in children. Pediatrics. 2005;116:506–12.CrossRefGoogle Scholar
  16. Koga H, Okazaki T, Kato Y, Lane GJ, Yamataka A. Anal canal duplication: experience at a single institution and literature review. Pediatr Surg Int. 2010;26:985–8.CrossRefGoogle Scholar
  17. Koivusalo A, Pakarinen M, Rintala R. Laparoscopic suture rectopexy in the treatment of persisting rectal prolapse in children: a preliminary report. Surg Endosc. 2006;20:960–3.CrossRefGoogle Scholar
  18. Koivusalo AI, Pakarinen MP, Rintala RI, Seuri R. Dynamic defecography in the diagnosis of paediatric rectal prolapse and related disorders. Pediatr Surg Int. 2012;28:815–20.CrossRefGoogle Scholar
  19. Kyrklund K, Koivusalo A, Rintala RJ, Pakarinen MP. Evaluation of bowel function and fecal continence in 594 Finnish individuals aged 4 to 26 years. Dis Colon Rectum. 2012;55:671–6.CrossRefGoogle Scholar
  20. Laituri CA, Garey CL, Fraser JD, Aguayo P, Ostlie DJ, St Peter SD, Snyder CL. 15-Year experience in the treatment of rectal prolapse in children. J Pediatr Surg. 2010;45:1607–9.CrossRefGoogle Scholar
  21. Lee-Robichaud H, Thomas K, Morgan J, Nelson RL. Lactulose versus polyethylene glycol for chronic constipation. Cochrane Database Syst Rev. 2010;(7):CD007570.Google Scholar
  22. Levine MD. The school child with encopresis. Pediatr Rev. 1981;2:285.CrossRefGoogle Scholar
  23. Levitt MA, Martin CA, Falcone RA Jr, Peña A. Transanal rectosigmoid resection for severe intractable idiopathic constipation. J Pediatr Surg. 2009;44:1285–90.CrossRefGoogle Scholar
  24. Macdonald A, Wilson-Storey D, Munro F. Treatment of perianal abscess and fistula-in-ano in children. Br J Surg. 2003;90:220–1.CrossRefGoogle Scholar
  25. Morrison ZD, LaPlant M, Hess D, et al. A systematic review of management options in pediatric rectal prolapse. J Pediatr Surg. 2019;54(9):1782–7.CrossRefGoogle Scholar
  26. Murthi GV, Okoye BO, Spicer RD, et al. Perianal abscess in childhood. Pediatr Surg Int. 2002;18:689–91.CrossRefGoogle Scholar
  27. Nelson RL, Chattopadhyay A, Brooks W, Platt I, Paavana T, Earl S. Operative procedures for fissure in ano. Cochrane database Syst Rev. 2011;9(11).Google Scholar
  28. Nelson RL, Thomas K, Morgan J, Jones A. Non surgical therapy for anal fissure. Cochrane Database Syst Rev. 2012;15(2):CD003431.Google Scholar
  29. Oh JT, Han A, Han SJ, et al. Fistula-in-ano in infants: is nonoperative management effective? J Pediatr Surg. 2001;36:1367–9.CrossRefGoogle Scholar
  30. Pakarinen MP, Koivusalo A, Rintala RJ. Functional fecal soiling without constipation, organic cause or neuropsychiatric disorders? J Pediatr Gastroenterol Nutr. 2006;43:206–8.CrossRefGoogle Scholar
  31. Peña A, Grasshoff S, Levitt M. Reoperations in anorectal malformations. J Pediatr Surg. 2007;42:318–25.CrossRefGoogle Scholar
  32. Pierce AM. Anal fissures and anal scars in anal abuse – are they significant? Pediatr Surg Int. 2004;20:334–8.CrossRefGoogle Scholar
  33. Pijpers MA, Bongers ME, Benninga MA, Berger MY. Functional constipation in children: a systematic review on prognosis and predictive factors. J Pediatr Gastroenterol Nutr. 2010;50:256–68.CrossRefGoogle Scholar
  34. Rajindrajith S, Devanarayana NM, Benninga MA. Review article: faecal incontinence in children: epidemiology, pathophysiology, clinical evaluation and management. Aliment Pharmacol Ther. 2013;37:37–48.CrossRefGoogle Scholar
  35. Rentea RM, St Peter SD. Pediatric rectal prolapse. Clin Colon Rectal Surg. 2018;31(2):108–16.CrossRefGoogle Scholar
  36. Rosen NG, Gibbs DL, Soffer SZ, et al. The nonoperative management of fistula-in-ano. J Pediatr Surg. 2000;35:938–9.CrossRefGoogle Scholar
  37. Trecartin AC, Peña A, Lovell M, et al. Anal duplication: is surgery indicated? A report of three cases and review of the literature. Pediatr Surg Int. 2019;35(9):971–8.CrossRefGoogle Scholar
  38. Woodward MN, Foley P, Cusick EL. Colostomy for treatment of functional constipation in children: a preliminary report. J Pediatr Gastroenterol Nutr. 2004;38:75–8.CrossRefGoogle Scholar
  39. Yamana T. Japanese practice guidelines for anal disorders II. Anal fistula. J Anus Rectum Colon. 2018;2(3):103–9.CrossRefGoogle Scholar
  40. Youssef NN, Barksdale E Jr, Griffiths JM, et al. Management of intractable constipation with antegrade enemas in neurologically intact children. J Pediatr Gastroenterol Nutr. 2002;34:402–5.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  • Mikko P. Pakarinen
    • 1
    Email author
  • Risto J. Rintala
    • 1
  • Antti Koivusalo
    • 1
  1. 1.Section of Pediatric Surgery, Children’s HospitalHelsinki University Central Hospital and University of HelsinkiHelsinkiFinland

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