Colorectal Clinic

Learn more about specific conditions we diagnose, treat and manage at Phoenix Children’s Colorectal Clinic:

Any abnormality of the perineum – the anal, rectal and pelvic area – is called an Anorectal Malformation (ARM). These birth defects include not having a digestive tract opening (imperforate anus or anal atresia), abnormally complex connections of the rectum to the bladder, and exposure of the organs on the lower half of the abdomen (exstrophy). Our colorectal specialists work with other specialists to repair defective organs and tissues. We treat a wide range of conditions, including rare and complex defects requiring intricate plastic and reconstructive surgery.

Some babies are born without an anus, a condition sometimes called Imperforate Anus or Anal Atresia. This condition isn’t always identified on a prenatal ultrasound and is sometimes diagnosed after birth. Examples of imperforate anus defects include:

  • The rectum is not connected to the anus.
  • The rectum is attached to the urinary tract or genitals.
  • There is only one opening for the rectum, bladder and vagina (cloaca).

After the baby is born, surgeons will schedule a procedure to create an opening or ostomy on the abdomen. Stool is collected in a medical bag attached to the newborn’s abdomen. After this surgery, the baby can begin to eat and grow.

Surgeons may perform additional procedures at the same time or in a later surgery to create an anus or make other repairs. Our surgeons have expertise in all types of operations to treat this and other conditions.

Some newborns have an opening in the lower half of their abdominal wall, leaving the bladder and intestines exposed. Cloaca exstrophy is a rare problem that is usually identified during a prenatal ultrasound.

To treat this condition, our team of physicians plan a procedure to close the open area and create an opening called an ostomy on the abdomen to allow stool to pass.

At a later date, doctors can perform reconstructive surgery to create normally positioned openings for stool and urine. This condition presents additional challenges as a child grows. Our team provides follow-up evaluation and care throughout our patients’ lives. Doctors will recommend when and whether additional corrective surgeries are needed during later childhood, adolescent and young adulthood years.

In a baby who has bladder exstrophy, the lower part of the abdomen is open and the bladder is exposed. The baby will need a closure and reconstruction of the urethra, the tube and opening where urine comes out of the body. Some children need a channel created on the abdomen to drain the bladder. Surgeons will discuss the ideal timing and may recommend doing this procedure years later. We follow children with bladder exstrophy throughout their lives to make sure they stay healthy. We also consider ways to optimize reproductive health later in life.

Hirschsprung disease is a condition in which babies are missing certain nerves in the lining of the rectum. As a result, they are not able to pass stool very well. If babies have symptoms of Hirschsprung disease, doctors may perform a small biopsy of the lining to look for normal nerves, called ganglion cells. If no ganglion cells are present, surgeons can remove the diseased portion of the rectum. The intestines that have normal nerves are then reconnected to the anus. We use minimally invasive surgery whenever possible to allow babies to heal quickly after this procedure.

Cloaca is a rare and complex type of anorectal malformation. In babies born with this condition, the intestines, bladder and reproductive organs remain connected instead of being separated during normal fetal development. Baby girls may not have a vaginal opening and newborns can have just one opening for urine, bowel and other functions.

To treat cloacal disorders, the surgeon will create an opening (ostomy) on the abdominal wall. This lets stool come out so the baby can be fed. After the ostomy procedure, stool will pass through the opening and into a bag attached to the abdomen.

Surgeons will plan follow-up procedures to separate the connections and reconstruct more normally positioned and functioning openings. We use a minimally invasive approach whenever possible. We are national leaders in the surgical treatment of complex cloaca conditions.

Steps of Treatment Process for a Cloaca

If your child has a cloaca, your child’s care team will guide you through the steps, treatments and schedules involved in caring for your child’s unique condition. Steps typically involved in cloaca care include:

  1. Prenatal diagnosis and birth plan
  2. Baby’s birth
  3. Time in neonatal intensive care unit (NICU) after birth
  4. Discharge and follow-up care as the infant grows and develops
  5. Evaluation of the spine, bladder, intestines and reproductive tract connections
  6. Neurosurgical care if a spine procedure is needed
  7. Other procedures, if needed, such as intestinal pull-through to help pass stool or surgical creation of urinary and other openings
  8. Bladder and kidney function evaluation and care, if needed, for conditions such as incontinence, infection, blockages or kidney reflux (backward urine flow)
  9. Vaginal surgery, if needed, to create a connection and opening or to create a vagina
  10. Guidance about dating or sexual function concerns before and throughout the reproductive years
Colorectal Clinic Cloaca Journey Video

What to Expect at Your Appointment

If your child has been seen by Phoenix Children’s colorectal specialists before birth or as a newborn, we will automatically schedule follow-up appointments with the colorectal clinic.

You will have an appointment for your baby and a number to call in case something comes up that needs more immediate attention. We will give you the contact information for our colorectal nursing team. Our specialized nurses know all about anorectal malformations and other bladder, bowel and pelvic conditions.

We take time to get to know you and your child. We’ll ensure that your child or teen feels completely at home and comfortable. Your care team will provide details about what to expect during early clinical exams and other steps of diagnosis, treatment and follow-up care. We’ll keep you fully informed, answer questions, and address any sensitive issues or concerns that you or your child may have. 

New Patients

If you are calling our clinic for the first time, we will ask you some basic questions. Then, one of our colorectal nursing staff will call to get additional details and start the process of obtaining records and X-rays or other images from other facilities.

We will arrange to see you soon, and the provider can review your information ahead of time. You may get a call from a Phoenix Children’s patient representative to discuss any out-of-pocket costs you may have associated with your insurance provider.

Questions to Expect

Whether your child is an existing or new patient of Phoenix Children’s colorectal clinic, we will ask a lot of questions about the basics. For example:

  • Is your child eating normally and gaining weight?
  • How is the stool?
  • If there is an ostomy, how is it working?
  • If your child has had anorectal surgery, are they constipated? Do they have any pain? Are they able to play and go to school?

Sometimes, we need to get new X-rays or schedule procedures. We will discuss these and other details during your first visit.

Ongoing Care

Our team continues to guide your family or other care providers as your child grows up. Over the years, children and teens may develop complications. For example, connections can become too narrow or an ostomy may no longer be needed after other surgical repairs are completed. We will check in often and discuss any new or corrective procedures, if needed.

We have many tips and tricks for different stages of development. These include transitions through different stages of life, such as potty training, entering school, participating in sports, and dealing with the challenges that come with the teen years. We’re always here to answer your questions and guide you at every turn.