Bowel management in Low ARM

quote from "Pediatric Colorectal Conundrums: Case Studies: From Fundamental to Advanced (Pediatric Colorectal Surgery)" by Marc Levitt, Thomas Xu, Hussein Wissanji -

"Low ARMs, like recto-vestibular and perineal fistula, tend to be associated with congenital rectal dilation above the fistula. The dilated rectum is prone to constipation, and early bowel management is recommended. Bowel management in this population utilizes laxatives and fiber to keep the rectum empty and avoid distention of the dilated rectum. The pelvic floor and sphincter muscle may be more robust in these distal malformations; however, incontinence is still possible, especially in the setting of an associated spinal or sacral anomaly. Pelvic floor physiotherapy can assist with developing the ability to fully evacuate stool and hold onto the stool, both needed to improve continence. Rectal or ante-grade enemas can be helpful in achieving social continence when laxatives are ineffective and can be used as a bridge until the child achieves the capacity for voluntary bowel movements."