Vaginal Abnormalities: Cloacal Abnormalities

In some cases the 3 tracts come together at a low point. A newborn with this defect has no visible anus (the opening where feces leave the body). Everything else looks normal. There is often a wide common channel that drains freely. Urinary obstruction is not a problem.

In other cases the 3 tracts come together at a high point. For these newborns, the common channel is long, so draining waste is more difficult. Urinary tract infections are common.

Other issues:

• The clitoris may look like a penis (gender confusion)
• There may be more than one vagina and cervix
• The vagina can be obstructed leading to an abdominal swelling
• The anus may be malformed
• There may be other problems with the ureters and kidneys
• The spinal cord can be abnormal
• The heart can have structural defects
• Limbs can be deformed

They are most often found at birth. The doctor will see that the newborn has only one opening. Often it is hooded and elongated. The baby will also have abdominal swelling.

The tests to confirm the diagnosis include:

• Ultrasound
• X-rays (Retrograde Genitogram)
• MRI

Surgery is needed to treat these issues. The method depends on the type and extent of the problem. It is important to work with an experienced pediatric urologist.

Repair

The first goal is to stabilize the newborn. This may involve a loop colostomy. This would let the child pass stool and mucus from the colon out through a space in the abdominal wall. For this, the colon is split into two. The open ends are sewn to the abdomen to make a stoma or opening. The stoma can drain the upper colon to let stool pass, while mucus can drain from the lower part.

Because the bladder is most often swollen, the baby will need a catheter to drain urine. And because of fluid build-up from hormones, the vagina may also need decompression.

Reconstruction

This can start once the baby is stable and the anatomy is clearly defined. This occurs around age 6 months to 1 year.

If the common channel is less than 4 cm in length, the rectum is detached from the vagina. The common channel is brought down to the surface of the skin. The channel is then divided, and the openings of the vagina and urethra are put in the right places. If the channel is more than 4 cm, the surgical repair will be more complicated and can result in urinary incontinence.

At 2 to 3 weeks after surgery, the rectum is stretched to avoid narrowing. The colostomy is closed after 3 months.

Many parents have questions about their child’s ability to control urine or feces after surgery. The result depends on how serious the problem was at first.

In milder cases, 9 out of 10 babies have good control and a nearly normal pattern with stools. Urinary control is also better in the milder cases (where the common channel is less than 4 cm long).

Around 7 or 8 out of 10 patients with more severe cloacal anomalies will have good control. They will have very few episodes of leaking. The others may have long-term problems and will need further care.

There may also be neurological issues in leaking, which may affect up to 1/3 of patients. Learning to self-catheterize can help with bladder emptying. Some may benefit from enema-treatments for better bowel emptying and stool control.

Once the cloacal abnormality is fixed, a normal and enjoyable sex life is possible.