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American Family Children's Hospital

New Pediatric CHARM Clinic

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Pediatric CHARM Clinic

American Family Children's Hospital now offers comprehensive, individualized care for children with cloaca, Hirschsprung's disease and anorectal malformations (CHARM), congenital problems that affect the anus, rectum, and part or all of the colon.


Ankush Gosain, MD, assistant professor at University of Wisconsin School of Medicine and Public Health, and his team typically diagnose patients when they are newborns and continue to treat them through their teenage years. They often collaborate with UW Health nutritionists, urologists and gastroenterologists to form the best treatment plan for each patient.


Video: The Multidisciplinary CHARM Clinic



Patients with these conditions experience problems with constipation, along with continence, sexual function and urinary tract issues. The providers in the CHARM Clinic help children manage those challenging symptoms and live socially acceptable lives through their school-age years. In addition to surgery, patients with these conditions are treated with oral medications, including stool softeners and laxatives. Enemas are commonly part of the treatment plan.




An extreme case of an anorectal malformation, cloaca occurs in girls and results in the urinary tract, vagina and gastrointestinal tract fusing together into just one opening. A complex reconstructive surgery is needed to separate the three items and create distinct openings for each.


The most extreme case is called cloacal exstrophy, in which the urinary tract, vagina and GI tract not only are fused together but also are exposed rather than being inside the abdomen. This rare condition occurs in approximately one in every 40,000 to 200,000 births and usually requires multiple surgeries.


Hirschsprung's Disease


For patients with this disease, the nerves to the colon haven't formed correctly, leading to a bowel obstruction. To treat this, that part of the bowel is removed and the remaining parts of the bowel are connected. Patients with Hirschsprung's disease typically have lifelong constipation problems and some also deal with recurrent intestinal infection, called enterocolitis.


Dr. Gosain is a member of the Hirschsprung's Disease Research Collaborative, a national group of geneticists, pediatric surgeons, pediatricians and gastroenterologists studying the genetic background of the disease. He performs surgeries for Hirschsprung's disease laparoscopically.


Anorectal Malformations


In about one of every 4,000 births, either the child's anus or rectum isn't properly formed and requires surgery. If the anus doesn't line up in the correct spot, meaning it is either in front of or behind the sphincter muscles, patients will experience constipation.


On the other end of the spectrum, children can have a blind ending of the rectum in the pelvis, which results in a flat bottom. In this case, complex reconstructive surgery is needed to essentially create a new anus.