Learning About Anal Dilation in Children

Anal dilation is a treatment that your child may need after anal or rectal surgery. It also may be done because of a condition your child has. Dilation involves inserting a small, sterilized, and lubricated stainless steel device into the anus. It's done to stretch the anus and help it stay open.

Depending on your doctor's instructions, you may be asked to dilate your child's anus once or twice a day. The devices that are used may be called Hegar devices. They have tapered ends.

These devices usually come in sets of eight. Each device has one end that is slightly larger than the other end. Each device is a bit wider than the previous one. The smallest one is 3/16 inch wide. The largest one is about 3/4 inch wide.

Anal dilation may be needed after your child has had anal or rectal surgery. Dilation is done to prevent scarring that can cause anal strictures (narrowing of the anal canal). Or your child may have been born with a small anal opening. For example, your child may need dilation if they have Hirschsprung disease. This is a birth defect that affects nerve cells in the large intestine.

If your child develops narrowing or tightness, it can make it hard and painful for your child to have a bowel movement. Your child could become constipated.

Your doctor will tell you when to begin dilating your child’s anus. If your child has had surgery, your doctor will tell you how long to wait before starting dilation so the surgery site can heal.

Most of the time, doctors recommend buying a Hegar dilator set. If this isn't possible, talk with your doctor about other options.

Your doctor will tell you to do it once a day or twice a day. If you do it twice a day, try to do it once in the morning and once in the evening. Try not to do it after meals. Doing it before meals reduces the chance of pain or vomiting.

Your doctor will decide what size dilator to start with, depending on your child's size and needs. After a week, you may be instructed to use the next larger size in the set.

If possible, two adults will work together. Before and after the procedure, both adults should wash their hands with soap and clean, running water for 20 seconds, which is as long as it takes to sing "Happy Birthday" twice.

Follow these steps to do the anal dilation.

1. Sterilize the dilator by rubbing an alcohol wipe around it for at least 20 seconds before use.
2. Have the other adult hold the child still while reassuring and encouraging the child.
3. Lay your child on their back.
4. Put a diaper or clean pad under your child.
5. Apply water-soluble lubricant to the dilator and hold it like a pencil.
6. Gently insert the dilator into your child's rectum. Insert it about 1 to 1 ½ inches deep, depending on your doctor's advice.
7. Hold it in place for 20 to 30 seconds, following your doctor's instructions.

Your child may release gas or stool. This is common. After dilation, clean up your child and comfort them. Clean the dilator with soap and warm water. Wash your hands with soap and clean, running water for 20 seconds.

Even though it's needed, anal dilation can be upsetting for the child and their caregivers. Ask for support from your doctor and care team. They are there to answer questions and provide help.

Your child may feel discomfort or pain during the dilation. Your child may cry. A small amount of blood (less than the size of a quarter) during the dilation or later in the diaper is normal.

The most common risks are pain and bleeding. Your doctor can talk with you about strategies for comforting your child and managing your child's pain.

Contact your doctor now or seek immediate medical care if:

• You can't insert the dilator.
• Your child continues to cry, shows signs of being in pain, and can't be soothed after the dilation session is done.
• After the dilation, you see blood in more than one or two of your child's stools.
• You see blood in your child's diaper that’s larger than the size of a quarter.