Pathophysiology Of Fecal Continence : The Significant Morbidity Following Surgical Correction Of Anorectal Malformations

Incontinence can affect individuals mentally as well as physically, it can have a negative effect

There did not to appear to be a pelvic disassociation. Due to the shape of the

Discuss potential postoperative laparoscopic abdominal surgery complications. Include assessment findings, diagnostic evaluation, and nursing measures designed to prevent these complications from occurring.

Fig (32): Flash artifact (arrow) visualized due to motion of bowel gas anterior to IVC (inferior vena Cava) (Robbin ML. et al., 2009).

As a congenital malformation commonly affecting children born with Spina Bifida, the Arnold-Chiari malformation, or Chiari Malformation Type II, involves the irregular extension of both the cerebellar tonsils and the brain stem tissue into the opening to the spinal canal – the foramen magnum (NINDS, 2013). Typically, the brain stem and the cerebellum sit above the opening to the spinal canal, where the brain stem houses most of the cranial nerves that supply the body. Providing the control centres for vital bodily functions such as breathing, regulation of the body’s internal environment through maintenance of heart rate and blood pressure, as well as providing sensory and motor control to a significant portion of the body (Joynt, 2014), the Arnold-Chiari malformation causes substantial problems for patients. Likewise, the congestion of these structures in the spinal canal limits the flow of the cerebrospinal fluid (CSF) from the brain to the spinal cord (Medway, 2006), causing other medical issues that become regularly associated with Spina Bifida as a result, such as hydrocephalus (Columbia Neurosurgery, n.d.). Issues associated with the Arnold-Chiari malformation can only be relieved, rather than treated, through surgical processes that aim to eliminate or reduce these symptoms (WebMD, 2014).

Spina bifida is a skeletal system disease and birth defect in which the neural tube fails to close properly during the first five weeks of pregnancy. Since the neural tube failed to close, the child will have damage to the nerves, spinal cord, and brain that varies in severity. Although the disease has declined since 1982, there has not been a significant decline and the disease has relatively stayed at the same percentile over the last several years. When I was born, I had a hole above my anus, where the end of my spinal cord is, that was no larger than the tip of a pen, but was still noticeable. After tests were conducted, it appeared to the doctors that I was almost a spina bifida newborn and that my neural tube barely closed in time for the developmental process, which is why this disease is so appealing to me.

Exomphalos can be linked to genetic abnormalities and it may occur with any age of the mother (“Contact a Family,” 2012). Gastroschisis is characterised by a defect in the abdominal wall and it is positioned to one side of the umbilical cord, typically the right side. In most cases the bowel will develop out of the abdomen. The bowel will remain out of the abdomen for the remaining time of the pregnancy. In some cases, the amniotic “ fluid irritates the bowel and makes it inflamed and thick, so that it does not work properly. Sometimes the bowel becomes twisted as it floats in the fluid and the blood supply is restricted.” (“Contact a Family,” 2012). At birth, the bowel can become further irritated when it is exposed to the air. Gastroschisis is associated with younger mothers; if the mother is under 20 years old, the risk of her child having gastroschisis is twelve times more likely (“Contact a Family,” 2012). Gastroschisis is typically not linked with any other abnormality, which means that is almost always an isolated abnormality (“Contact a Family,” 2012).

The three neural tube defects detailed in the textbook are spina bifida occulta, meningocele, and myelomeningocele. Of the three defects, myelomeningocele causes the most neurological deficit. It results when the external sac contains meninges, cerebrospinal fluid, and a portion of the spinal cord or its nerve roots. A myelomeningocele frequently results in permanent neurological difficulties, including paralysis, bladder and bowel dysfunction, twisted or abnormal legs and feet, and Chiari malformation. Spina bifida occulta, on the other hand, is the most common neural tube defect but the least severe. It generally will not cause neurological dysfunction, but sometimes associates with foot weakness or bowel and bladder disturbances. Spina bifida

IA abnormalities may present as an absence of the anal opening or the opening may be in the wrong location. Further abnormalities include abnormal connections between the urinary system and intestines or the vagina and the intestines. In girls, a cloaca may form, which is a single

The external sphincter is a cylindrical striated muscle under voluntary control and comprises predominantly slow-twitch muscle fibres, capable of prolonged contraction. With age there is a shift towards more type II (rapid) fibres (Cni, 1993). The external sphincter has a nerve supply by the inferior rectal branch of the pudendal nerve (S2, S3) and the perineal branch of the fourth sacral nerve (S4). Primary function is closure of the anal canal to postpone evacuation, regulation is partly reflex (e.g., sudden increase in abdominal pressure) and partly voluntary through the visceral and somatic afferent and somatic efferent nerves. The external sphincter also contributes to some extent to the anal resting tone. The external sphincter constitutes the inferior outer aspect of the anal sphincter and envelops the inter-sphincteric space . The external sphincter is approximately 2.7 cm high, but is anteriorly shorter in women (approximately 1.5 cm) (Rociu et al., 2000). The lateral part of the external sphincter is

Urinary incontinence is a real and disruptive condition that may affect all age groups but, in particular, post-menopausal women. The urinary system is composed of the kidney, ureters, bladder, and urethra. At the end of the urethra is the urethral sphincter which is a band of muscle in the wall of the urethra that controls the release of urine from the body. Typically, the urethral sphincter remains closed except during urination. The

Occurring once in approximately 5000 live births, Hirschsprung disease is a congenital abnormality characterized by the absence of autonomic parasympathetic ganglion cells in the colon preventing peristalsis and resulting in intestinal obstruction and abdominal distension. Also known as congenital aganglionic megacolon, this medical malady is an unfortunate anomaly of a very vulnerable population – infants and children. Hirschsprung disease can occur in otherwise healthy babies, but is commonly diagnosed in combination with Down’s syndrome and congenital heart defects. Functional outcomes, thanks to contemporary medical advances, are generally successful. As medical professionals, nurses play a significant role in helping patients achieve therapeutic goals. Therapeutic goals also include a level of psychological wellness in living with persistent bowel dysfunction after Hirschsprung surgery but few, if any, studies have addressed this likelihood.

Considering the long-term benefit of C-section for women, the protection of pelvic floor which contains the muscles that support the uterus, bladder, and other abdominal organs would be the most relevant. The article "C-section by choice" in Parenting, states that the damage to the nerves or muscles can result to postpartum incontinence, uncontrollable urination that often occurs when you run, cough, or even laugh. Vaginal delivery contributes to a gradual, age-related weakening of the pelvic floor, which increases the chances of incontinence

Incidence estimated to be as high as 1 in 100 births.(2) Deformity usually present at birth but may not present until the first year of life, hip dysplasia and other associated anomalies should be excluded.(3) Pathogeneis is unknown but is believed to result from intrauterine crowding or positioning.(2)

All surgeries can be stressful. However, constipation after surgery is often an distressing side effect that complicates the healing process, and make you feel even more uncomfortable. What’s even worse is chronic constipation that can persist for several weeks after surgery.