title: High and intermediate imperforate anus: psychosocial consequences among school-aged children.
abstract: OBJECTIVE
  Imperforate anus is an unusual malformation, which, even after surgical intervention, usually entails constipation and fecal incontinence. This study aimed to evaluate ongoing psychosocial effects of this birth defect in school-aged children.
  
  
  METHODS
  Twenty-five children born with high and intermediate imperforate anus participated in the study, along with their parents and classroom teachers. One group of healthy children and 1 group of children with juvenile chronic arthritis, along with their parents, served as controls. Children and parents individually answered a questionnaire devised for this study. Parents filled out the Child Behavior Checklist and the children's teacher filled out the Teacher's Report Form.
  
  
  RESULTS
  According to test results, children with imperforate anus were happy and optimistic. They liked school better and reported better relationships with schoolmates than the other children. The index group reported statistically significantly more frequent constipation. According to parental responses, the imperforate-anus children suffered from fecal incontinence and odor, as well as constipation (P < .001). Index-group parents reported on the Child Behavior Checklist that their children had more emotional and behavioral problems. On the Teacher's Report Form, teachers reported few problems for the same children.
  
  
  CONCLUSIONS
  Patients with imperforate anus did not experience psychosocial impairment despite significant functional problems.
authors.affiliation: Division of Pediatric Surgery, Q2:03, Astrid Lindgren Children's Hospital, Karolinska University Hospital, SE-171 76 Stockholm, Sweden. maria.ojmyr-joelsson@karolinska.se
authors.forename: Maria
authors.initials: M
authors.lastname: Ojmyr-Joelsson
authors.forename: Margret
authors.initials: M
authors.lastname: Nisell
authors.forename: Björn
authors.initials: B
authors.lastname: Frenckner
authors.forename: Per-Anders
authors.initials: PA
authors.lastname: Rydelius
authors.forename: Kyllike
authors.initials: K
authors.lastname: Christensson
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000367:Age Factors; D001006:Anus, Imperforate / Q000145:classification / Q000523:psychology* / Q000601:surgery; D002648:Child; D003248:Constipation / Q000209:etiology / Q000523:psychology*; D005178:Faculty; D005242:Fecal Incontinence / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents; D012647:Self-Assessment; D011795:Surveys and Questionnaires