Neonate | Constipation | Hirschsprung disease | Patient well | Rectal biopsy and wash out, planned pull through |
| | | Patient unwell, other compromising factors | Rectal biopsy and diversion enterostomy followed by staged pull through |
| | ARM | Anal stenosis, perineal fistula, anal membrane | Primary anoplasty/reconstruction |
| | | No perineal opening | Colostomy and staged reconstruction |
| | Intra-pelvic mass/lesion | | Excision of the lesion as appropriate |
Childhood | Constipation | Previous operation for ARM, failure of medical treatment | | Anal calibration/dilatation, disimpaction of stool |
| | Previous surgery for Hirschsprung disease, failure of medical treatment | | Anal dilatation, botulinum toxin, excision of residual/recurrent aganglionic segment, lateral sphincterotomy/ myectomy (and histology), ACE stoma* |
| | Recurrent anal fissure failure of medical treatment | | Excision of chronic anal fissure and histology |
| | Severe faecal impaction | | Disimpaction of stool |
| | Intra-pelvic mass/lesion | | Excision of the lesion as appropriate |
| Constipation and soiling | Megarectum present | | ACE stoma±excision of megarectum |
| | No megarectum | | Consider ACE stoma |
| Faecal incontinence | Previous anorectal malformation | ? Megarectum | ACE stoma±excision of megarectum, anal plug |
| | Neuropathic bowel ± bladder | | ACE stoma ± Mitrofanoff |