Dilatation is required after surgery for correction of Anorectal Malformations in children. The surgeon will advise you when to start it and what size to use.

Buy a set of Hegar dilators. You can search online to find them. Enter “Hegar dilators” in the search field.   

Bring the dilators with you when you come to hospital two to four Weeks after Surgery. The surgeon will examine the child to determine the size of the anus and teach you to how to dilate the anus.

Procedure of dilatation ( will be explained to you)

• Start by dilating your child’s new anus two times each day – one time in the morning and one time in the evening.

• Put your child on their back with the knees pulled up towards the chest.

• Lubricate the dilator ( Xylocaine Jelly-2%). Put the dilator in the anus and keep in place for 30 seconds.

• Remove it and put it in again for 30 seconds.

• It is best to not dilate your child right after they eat a meal.

Changing the Size of the Dilator

• Every week, you will increase the size of the dilator, using the next larger size. Continue to dilate your child’s anus two times a day until you get to the goal size set by the doctor.

Important points about Dilatations

• The dilatations may cause some discomfort for your child as you get closer to the last 2-3 sizes, but it is very important to keep dilating two times a day.

• For best comfort, be sure to lubricate the dilator well.

• Lubricate and insert a smaller dilator, just before you insert the right size dilator.

• Position your child without movement.

• If the dilation plan is not followed right, there is risk of scarring during the healing process causing narrowing of anus and needing further surgery to correct it.

Finding the Desired Dilator Size

• As sizes are not standard, surgeon will guide you regarding size to use. These are rough guidelines. Be wary of poor standardization . Size 16 of one company may be equal to size 10 of another.

• Normal size for age:

  • 1-4 months            Hegar 12

  • 4-8 months            Hegar 13

  • 8-12months           Hegar 14

  • 1-3 years                Hegar 15

  • >3 Years                 Hegar 16

Frequency of Dilatations

• Start with Twice a day and increase size of dilator to next number till desired size told by surgeon is reached.

• When the desired size dilator goes easily, start dilating once daily according to the following protocol

  • Once a day for one month

  • Every 3 day for one month

  • Twice a week for one month

  • Once a week for one month

  • Every month for 3 months

If the dilatation gets harder, causes discomfort, or is bloody at any time during the above schedule, go back to dilating two times a day. When you can easily put in the dilator without discomfort, start the taper schedule again from the beginning (one time a day for a month).

Colostomy closure after dilatations

• If your child had a colostomy before definitive surgery to repair anorectal Malformation (ASARP or PSARP), the colostomy may be closed when the goal size of the anus is reached. After the colostomy is closed, you will still need to dilate your child’s anus until the dilator goes in easily with no discomfort. This will likely be about 3-4 weeks after you get to the last size dilator.