Cloaca: A cloaca is a type of anorectal malformation in which the rectum, vagina, and urethra open into a common area or single common channel. Cloacas occur in 1 in 20,000-25,000 live births. It is thought that this number may be higher. (Cloacas are commonly misdiagnosed as rectovaginal fistulas. This is concerning because this means that problems that are urological may go undiagnosed and untreated.) When diagnosing a cloaca there is the presence of a single perineal orfice. Only one opening is visible.
Initial treatment of the infant born with a cloaca is to divert the GI tract usually by colostomy, divert the urinary tract if necessary, and decompress the vagina if distended. After the infant recovers from the colostomy, the main repair of the cloaca is planned. This repair is called an anorectovaginourethroplasty. During this surgery the rectum, vagina, and urethra will be simultaneosly repaired and will be located as seperate structures. The colon will be pulled through to the place where the anal opening should be by creating an anus, the vaginal wall will be repaired if needed, and if located too high the urethra will be brought to the surface and repaired.
There are 3 main conscerns in regard to the child with a cloaca: urinary control, bowel control, and sexual function. If present, urinary incontinence can be well managed with medication and/or intermittent catheterization. Children with bowel incontienece can be socially continent using a bowel management program. Sexual function issues refer to menstration, intercourse, and obstetric issues.
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