​​DISCLAIMER: The following information has been gathered from various sources, including Medical Professionals and experts in the field. This is in no way a medical text, but can be used as a helpful set of information that will hopefully give you an understanding and basic knowledge of the subject.
Types of Anorectal Malformation Seen in Girls
​​In girls, the pelvis contains several important structures. The diagram below shows a typical female anatomy:
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Urinary System:
Ureters: These tubes carry urine from the kidneys to the bladder.
Bladder: Stores urine.
Urethra: Carries urine from the bladder to the outside of the body.
Digestive System:
Rectum: The final section of the large intestine, responsible for storing faeces (poo).
Anus: This is a muscle that controls the ability to hold faeces (poo).
Reproductive System:
The female reproductive system helps in reproduction by producing eggs, supporting pregnancy, and giving birth.
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It has internal and external parts:
The external parts include the labia, the clitoris and the vagina just inside.
The internal parts include the vagina, cervix, the uterus (womb), and the two fallopian tubes each with the ovaries.
Pelvic Floor Muscles:
These provide support to the bladder, intestines and reproductive organs. They play a role in passing urine, faeces (poo) and sexual function.
Ligaments and Nerves:
Ligaments stabilise the pelvis, keeping the organs in place.
Sensory nerves carry signals to the brain, including sensations like pain, pressure and temperature.
Motor nerves control muscle movements involved in passing urine, faeces (poo) and sexual activity.
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ARM in girls can broadly be classified into low and high types.
Anorectal Malformations can occur in different forms and in different degrees of severity.
Children with low malformations are often expected to have better outcomes than high malformations (i.e. less problems with soiling) but may have problems with constipation.
Children with high malformations tend to have more complex anatomy.
Low ARM:
The anal opening is usually visible to some degree on the skin of the bottom (the perineum).
It may be closed over by a thin layer of skin, be in a slightly different position (sometimes just inside the outermost part of the vagina) or narrower than usual.
There may also be a connecting passage to the skin called a fistula.
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High ARM:
The bowel ends blindly at a higher level in the pelvis.
This type of ARM is seen more often, but not always, in babies with Down syndrome.
Alternatively, the bowel may form an abnormal connection to the vagina, higher up.
Instead of having three separate openings (urethra, vagina, and anus), some girls can be born with a single opening called a cloacal malformation, where both urine and faeces (poo) pass.
In these children, the urethra is also typically positioned higher than normal.
Cloaca is a particularly complex form of high ARM, requiring specialised management.
Perineal Fistula (also called Rectoperineal Fistula)
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In a perineal fistula the opening for faeces (poo), the anus, is not in its normal position.Instead, the bowel opens onto the perineum, the area of skin between the genitals and the anus.
This abnormal opening is located outside the ring of muscles (called sphincter muscles) that help control bowel movements.
The opening may be too small for faeces (poo) to pass.If the opening is large enough, soft faeces (poo) may pass, especially in breastfed babies.
In some babies this type of fistula is found immediately after birth, during the newborn check.
Fistula *
