Anoplasty

What is an anoplasty?

An anoplasty is a surgical procedure to repair or reconstruct your anus. Your anus is the end of your large intestine. It’s a short length of tube (about 3 to 4 cm) surrounded by circular muscles called sphincters that push poop out of your body. Anoplasty surgery repairs defects in your anus that prevent it from working correctly. Some defects are present at birth and some are caused by injury or disease.

What are anorectal procedures?

Anoplasty is one type of anorectal procedure. Anorectal procedures treat defects affecting your rectum and/or anus. Your rectum is the part of your large intestine that comes just before your anus. Common conditions that affect your anus can also affect your rectum, including polyps and tumors, fissures and fistulas, hemorrhoids, inflammation and stenosis. Some anoplasty procedures may involve your rectum as well.

Why is anoplasty surgery done?

The most common causes of anoplasty are:

• Anal stenosis: Anal stenosis is a narrowing of your anal canal caused in most cases by scar tissue. It usually affects adults, either as a side effect of anorectal surgery or of long-term (chronic) disease. Scar tissue adds bulk to your anal walls and prevents them from stretching to let poop pass through. This is also called "stricture." When stenosis is severe and other treatments have failed, you need anoplasty.
• Anorectal malformations: These are birth defects that affect how your baby’s anus and/or rectum develop. Imperforate anus is a condition in which the opening to your baby’s anus is missing or blocked. A perineal fistula is a misplaced anal opening that bypasses the anal muscles and opens in the area underneath the anus (the perineum). The opening is usually narrow and lacks muscle control.

When should anoplasty be done on an infant?

Some malformations can be corrected with a simple anoplasty shortly after birth. Babies with more complicated malformations may need several surgeries. These babies will typically have a colostomy first. The colostomy will allow them to pass poop safely through a temporary opening in their abdomen (stoma). Their healthcare providers will determine when to schedule the next surgery. After the anoplasty has healed, the colostomy will be reversed and they can begin using their anus to poop.

How should I prepare for anoplasty?

If you’re an adult, your surgeon may ask you to prepare for your procedure by clearing out your bowels. They’ll prescribe or recommend a bowel prep kit to help you do this. A bowel prep is an oral laxative formula that you’ll take the day before your procedure. It will clear your bowels by making you poop everything out. For most bowel preps, you’ll need to follow a special diet for several days before taking the formula. A typical diet is low fiber for two days, then only clear liquids for the last day.

What happens during the anoplasty procedure?

The purpose of anoplasty is to restore or create a functional anal canal. Your surgeon may take different steps depending on the nature of your condition. In most cases, you’ll be under general anesthesia for the operation and lie on your stomach. Surgeons often begin by using an electric stimulator machine to stimulate contractions in the anus muscles. This helps them map the location of the two sphincter muscles that mark the two ends of your anus or where it should be.

• Anal stenosis: When your anus is present but restricted by scar tissue, your surgeon will remove the scar tissue to allow your anus to relax and expand. This will restore your anus to its proper dimensions, but it leaves a gap in the inner lining. Your surgeon will take a flap of skin from the area just outside of your anus on the inside of your buttocks (the perianal region). Leaving it connected on one side, they’ll use the flap to cover the gap and close the perianal wound with stitches.
• Anorectal malformations: When your baby’s anus is missing or misplaced, their surgeon will have to construct a new one. The new anal canal must follow continuously from their rectum and pass through their anal sphincter muscles to open at the end. Surgeons may have to move or close inappropriate openings (fistulas) that branch away from this path. If your baby has a temporary colostomy, they’ll keep it for now. Their rectum will remain closed at the entrance to their new anus while it heals.

What happens after the anoplasty procedure?

Depending on how extensive the procedure was, you may go home the same day or stay in the hospital for a few days. You’ll have frequent follow-up visits in the weeks ahead to ensure everything is healing. You may need to perform periodic anal dilations while your anus heals. That means inserting a special dilator into your anus each day to stretch it. Dilating your new anus trains the tissues to settle at the right diameter and prevents narrowing and scarring (stenosis) during the healing process.

What are the possible risks or complications of anoplasty?

Short-term complications can include:

• Infection: Infection of the wounds while they’re healing can extend the healing process, sometimes beyond eight weeks. Your healthcare team will coach you on how to prevent this.
• Hematoma: This is a collection of pooled blood that can form within the healing tissues. A hematoma can also delay healing. You can treat it with ice and compression. Occasionally, you might need a small procedure to drain this collection.
• Urinary retention: Some people have difficulties getting pee to come out after the operation. Your healthcare team can help you with medications or a catheter until this resolves.
• Constipation: Some people also have constipation after the operation, especially if they’ve been constipated before. Long-term previous constipation may have trained your body to slow down its motility — the movement of food through your bowels. You may need medication to get it going again.

Long-term complications can include:

• Fecal incontinence: Surgery can disrupt the muscles or nerves that control bowel movements, making it hard to control your poop. Some children with anorectal malformations may also lack the necessary nerves and muscles from the start. Some will learn to control their bowels over time, and some won’t. Your healthcare team will discuss your prognosis and your options with you. It may involve bowel training and/or bowel management with daily cleansing.
• Stenosis: Stenosis is a risk after anoplasty if your anus isn’t dilated regularly during healing.
• Fistulas: Rarely, an internal infection following surgery can wear a hole in your anus, leading to a new fistula. Your surgeon would have to close it in another surgery.
• Diaper rash: It’s common for babies to develop a severe rash when they first begin pooping out of their anus. This is just because that skin hasn’t been exposed to poop before. You can help prevent it and treat it with ointments.

What is the recovery like from anoplasty surgery?

The healing process, including daily dilations, normally takes four to eight weeks. Daily dilations will make your anus bleed a little. This is normal and usually not very painful. Most anorectal procedures have a low pain threshold, and you’ll have medication to help manage it. You may have some constipation, and your provider may prescribe a special diet to follow during your recovery. Once the anus has completely healed, babies with colostomies will be ready for their final surgery to reverse it.

A note from Cleveland Clinic

Anal stenosis and anal malformations are rare, but it’s good to know that surgery is an option if they happen. Anoplasty is a very effective treatment when needed. Milder cases of anal stenosis may have other treatment options. If these fail, anoplasty can help. Children with more severe anorectal malformations may never have completely normal bowel function, but anoplasty can make it as near to normal as possible.