Home care for children's anal dilation

This is the 4370th article of Da Yi Xiao Hu

Anal dilation is very important for children who have undergone anorectal surgery. Do you know what anal dilation is? How to dilate the anus? What are the effects? Let's learn about it together.

1. What is anal dilation?

Anal dilation refers to the use of an anal dilator (Hegar rod) inserted into the baby's anus to achieve the purpose of expanding the anus, which can not only reduce postoperative complications, but also improve the mid- and long-term quality of life of children after surgery.

Figure 1 Different types of anal dilators

2. What diseases require anal dilation?

1. Babies with anorectal malformation (anusless) who have undergone anal shaping

2. Babies who underwent pull-out surgery for Hirschsprung's disease

3. Babies with anal stenosis (without surgery)

3. The purpose of anal dilation

1. Preventing postoperative anorectal scarring and stenosis

2. Stimulate intestinal peristalsis, promote gas discharge and defecation, and relieve abdominal distension

3. Develop good bowel habits: Anal dilation can train the sensation, reflex and contraction function of the anal sphincter and levator ani muscles.

4. Principles of anal dilation

1. Follow the doctor's advice to dilate the anus

Parents must take their baby to the outpatient clinic for a follow-up visit 2 weeks after the operation to determine the size of the anus after the operation and check the recovery of the anal wound. At the same time, a specialist nurse will guide the correct way to dilate the anus.

It is recommended that parents prepare a record book to record in detail the time, model, and any special circumstances of each anal dilation.

2. Timing principle

In order for the baby to develop a habit of regular bowel movements in the future, parents can decide the timing of each anal dilation according to their own family situation and the baby's daily routine. At the beginning, the anal dilation should be performed twice a day, once in the morning and once in the evening. It is recommended that once the time for anal dilation is determined (such as 8:00 in the morning), it should not be changed at will. There should be a certain interval between two anal dilations, and they should not be performed too close together.

It is recommended to perform anal dilation before feeding (before meals) to avoid stimulating the anus and causing the baby to defecate and affect anal dilation.

It is not recommended to perform anal dilation after a meal. If you want to do it after a meal, it is recommended to do it one hour after the meal.

3. Principle of non-stop

Anal dilation may be a painful operation for some new parents, because the baby may cry and make noise during the process, and various things may interrupt the dilation.

If there are elderly people at home taking care of the baby, it is recommended to explain to them the importance of anal dilation and let them join in the operation. In this way, when the parents are out for something, the elderly can also perform anal dilation for the baby regularly.

Generally speaking, if the baby has mild discomfort symptoms such as cold and cough, there is no need to stop anal dilation. If there is a small amount of mucosal bleeding during anal dilation, you can reduce the number of anal dilations per day depending on the situation.

4. A certain degree of tension

When dilating the anus, the dilator or finger should not be too tight when entering and exiting the anus to avoid damaging the rectal mucosa, nor should it be too loose to achieve the effect of dilating the anus. As for the meaning of tension, it means that when the dilator or finger enters the anus, you can feel the feeling of being wrapped by the anal muscles.

5. Stop anal dilation principle

During the first outpatient follow-up after surgery, the doctor or specialist nurse will assess the anal condition after surgery and inform the parents of the target size of the anal dilator. When the anal dilator reaches the required size, the patient needs to come to the outpatient clinic for a follow-up and stop the anal dilator. The target sizes for different ages are shown in the following table.

5. Anal dilation operation process

1. Preparation of materials

Anal dilator, paraffin oil, gloves, diaper pad

Figure 2 Preparation of materials

2. Choose the right anal dilator model

Generally, anal dilation begins 2 weeks after surgery. Depending on the healing of the baby's anal wound and the degree of stenosis, the specialist nurse will inform the starting model of the anal dilator.

Generally speaking, increase one size per week until you reach your target size.

Pay attention to keeping warm during the operation. You can cover the baby's belly with a small blanket and adjust the room temperature to 22℃~26℃.

3. Anal dilation position

Anal dilation requires the cooperation of two people, with the baby lying flat on his back and his legs raised (see the picture above). This can expose the anus to the maximum extent and help you insert the anal dilator smoothly. Therefore, it is recommended that the baby's father fix the baby's position while the mother performs the anal dilation operation.

4. Anal dilation operation process

(1) Lubricate the anal dilator (using paraffin oil). There is a horizontal line on each anal dilator to indicate the depth of dilation. Parents are advised not to be stingy with the paraffin oil. Apply the paraffin oil evenly on the anal dilator stick each time the anus is dilated. It is recommended that the application position be higher than the marked line. This way, even if the baby does not cooperate and causes the anal dilator to move forward and backward, it will not damage the rectal mucosa.

(2) Insert the anal dilator with the concave side facing upwards, close to the posterior wall of the rectum, and insert along the physiological curvature of the rectum. Before insertion, use paraffin oil to lubricate the anal opening to protect the skin around the anus.

(3) Selection of anal dilator model: Start with the starting number anal dilator and dilate the anus one by one until the anal dilator is inserted with a certain degree of tension. The duration of each anal dilator session will be informed by the doctor or specialist nurse.

6. Stop the anal dilation plan

Once the anal dilator reaches the designated size, dilating twice a day is very convenient and does not cause discomfort, parents need to go to the specialist clinic for a follow-up visit to evaluate the degree of dilating and gradually reduce the frequency of dilating. From the initial twice a day to once a day, once every other day, once every two days until dilating is no longer needed. From then on, the entire home dilating operation is completed.

Author: Wu Anqi, head nurse, pediatric intestinal management specialist nurse, Department of General Surgery, Shanghai Children's Medical Center