What is the Dilatation Schedule after Imperforate Anus Repair?
Before You Arrive at Cincinnati Children’s
Bring the dilators with you when you come to Cincinnati Children’s for your child's surgery. You will need them at your follow-up clinic appointment after surgery to keep the repaired imperforate anus from narrowing. If you are traveling from out of town, pack them in your checked luggage since you may not be allowed to have them in carry-on luggage.
Two to Four Weeks after Surgery
You will have a clinic appointment with the doctor and nurse, and they will:
- Determine the size of the anus
- Teach you to how to dilate the anus
Dilating Your Child’s New Anus
You will start by dilating your child’s new anus two times each day – one time in the morning and one time in the evening. With each dilation, you will insert the dilator twice.
- Put your child on their back with the knees pulled up towards the chest.
- Lubricate the dilator. 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 size up in number. Continue to dilate your child’s anus two times a day until you get to the goal size set by the doctor. Please do not go higher in size above the goal set.
Tips about Dilatations
The dilatations may cause some discomfort for your child as you get closer to the last two-three sizes. You may feel that you want to stop dilating your child’s anus every day because of the slight discomfort, 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. This can narrow the anus. If this happens, your child may need to have more surgery to correct the problem.
Finding the Goal Size of Dilator
To find the final size of the Hegar dilator your child will use, see chart below.
| When Starting Dilatations, Your Child Is: | Final Desired Dilator Size |
| 1-4 months | #12 |
| 4-8 months | #13 |
| 8-12 months | #14 |
| 1-3 years | #15 |
| 3-12 years | #16 |
| More than 12 years | #17 |
Schedule for Tapering Use of Dilators
Once you find that the dilator goes in easy two times a day and does not cause discomfort, you may start to taper (reduce) how often you dilate your child’s anus. While you taper, you will still use the goal size dilator.
Month 1: One time a day for a month.
Month 2: One time every other day for a month.
Month 3: One time every third day for a month.
Month 4: Two times a week for a month.
Month 5: One time a week for a month.
Month 6-8: One time a month for three 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).
For Children with a Colostomy
If your child had a colostomy before this surgery, 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 three-four weeks after you get to the last size dilator.
Contact Us
If you have any questions or concerns during this process, contact the Colorectal Center for Children at 513-636-3240.
