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Cloaca is a malformation that affects the rectum and urogenital tract in females. Females are normally born with three perineal openings: urethra, vagina and anus. Children born with a cloaca only have one opening because the urethra, vagina and rectum are joined together as a common channel instead of three separate ones. They may also may have more than one uterus and vagina.
The length of the common channel may vary between 1 cm and 10 cm. The length of the common channel affects prognosis (health outlook) and determines the type of surgery that a child will need. The shorter the common channel, the better the prognosis for bowel and urinary control will be.
Your baby will have only one opening in the perineum, instead of three. She may also have abdominal swelling if she has hydrocolpos. Your child may have other signs and symptoms if she has other health problems.
A healthcare provider may diagnose cloaca on an ultrasound before a baby is born. Our providers at the Colorado Fetal Care Center can perform this diagnosis.
Some infants will be diagnosed during a physical exam after birth. Tests will be done to evaluate for associated anomalies during the first 24 hours or life:
Treatment for cloaca requires surgery called posterior sagittal anorecto-vagino-urethroplasty (PSARVUP). During PSARVUP, the surgeon separates the urethra, vagina and rectum so there are three perineal openings in the perineum, instead of a single one. The main reconstructive surgery will be done when your child is about 2 to 6 months of age.
Usually on the second day of life, babies with cloaca will have surgery to create a colostomy, a surgical procedure to allow your baby's stools to pass. They will also have a hydrocolpos drainage to decompress the vagina, if needed.
Once we see that your baby is growing well, we can plan for PSARVUP surgery. The type of surgery your child will have depends on the length of the common channel. Treatment of any other health problems will also be needed.
Our colorectal team is led by internationally renowned pediatric colorectal surgeon Alberto Peña, MD. Dr. Peña developed the surgical technique used to treat cloaca and other anorectal malformations that is now widely used by top surgeons all over the world and has since been adapted to treat multiple conditions. Dr. Peña and Andrea Bischoff, MD have worked together for more than 10 years diagnosing and treating anorectal malformations such as cloaca.
We apply a multidisciplinary approach to diagnosing and treating children with anorectal malformations. Our team is made up of pediatric specialists such as urologists, gynecologists, nephrologist, psychologists, neurosurgeons and orthopedists. This multidisciplinary approach ensures that your child gets the comprehensive care they need to ensure the best possible outcomes.