Introduction
Anorectal malformations (ARMs) are congenital defects where the anus and rectum are abnormally developed. These conditions can vary in severity and often require surgical correction shortly after birth.

What Are Anorectal Malformations?
ARMs include a spectrum of abnormalities where the opening to the anus may be missing, misplaced, or connected abnormally to the urinary or reproductive systems. The condition is present at birth and can range from mild to complex forms.

Types of ARM

• Imperforate anus (no visible anal opening)
• Fistula (abnormal connection to urinary tract or vagina)
• Anal stenosis (narrow anal opening)
• High or low ARM, based on how far the rectum is from the surface

Common Signs

• No anal opening or an opening in an abnormal location
• Abdominal swelling
• Inability to pass stool normally
• Stool passing through the urinary tract or vagina in severe cases

Diagnosis

• Physical exam at birth
• Abdominal X-rays or ultrasound
• MRI or contrast studies in complex cases
• Evaluation for associated anomalies (spine, kidneys, heart)

Treatment
Treatment usually involves staged surgery:

• Initial colostomy may be needed for high or complex malformations
• Definitive repair (PSARP – posterior sagittal anorectoplasty) is done to create a functional anus
• Later, colostomy is closed if previously performed

Follow-Up and Prognosis

• Bowel control outcomes depend on the type of ARM and associated conditions
• Some children may require bowel management programs
• Regular follow-up with a pediatric surgeon and colorectal team is essential