Cloacal Abnormalities
Access exceptional care for cloacal abnormalities at Montefiore Einstein Urology at the Children’s Hospital at Montefiore Einstein (CHAM). As a leader in urology, we are an academic-based referral site for the most complex and high-risk cases. For more than a century, we have been at the forefront of innovation, research and clinical care for genitourinary (GU) conditions.
Montefiore Einstein continues to make advances in the diagnosis and treatment of GU conditions. Our multidisciplinary team of specialists is passionate about uncovering diagnostic approaches and treatments that can improve outcomes.
At Montefiore Einstein Urology, you can expect compassionate research-based treatment plans that meet the highest standards for quality and safety. We are committed to ensuring your child will receive the best patient- and family-centered care in a supportive and nurturing environment.
When you want only the best for your child, turn to our dedicated providers who will develop a highly personalized treatment plan.
What Are Cloacal Abnormalities?
The cloaca is a common chamber for the urinary, intestinal and genital tracts that typically divides into separate organs. Cloacal abnormalities are a type of anorectal malformation that develops while a female fetus is growing in the mother’s womb. A baby with a cloacal abnormality is born with one opening in the perineum (versus three) because the vagina, urinary tract and anus don’t separate properly during fetal development. This rare birth defect is estimated to affect about one in 50,000 newborns.
Causes of Cloacal Abnormalities
Cloacal anomalies are thought to occur randomly with no known cause.
Signs & Symptoms of Cloacal Abnormalities
Symptoms of cloacal malformation are often discovered at birth. The appearance of a cloacal malformation varies depending on where the vagina, anus and urinary tract merge into a single channel. Malformations merging at a low point in the common channel typically allow waste to leave freely, but a malformation at a high point may create difficulties in waste elimination.
Cloacal malformations are sometimes associated with other anomalies, including:
- Anal abnormalities
- Cardiac or spinal cord problems
- Clitoris resembling a penis
- Gastrointestinal issues
- Kidney, ureter or other urological abnormalities
- More than one vagina, uterus or cervix
Diagnosing Cloacal Abnormalities
In some cases, cloacal abnormalities can be diagnosed with prenatal testing, including ultrasound and magnetic resonance imaging (MRI). When the malformation is detected at birth, additional tests are recommended to thoroughly identify the nature of the abnormality and any other associated conditions. These tests include:
- Echocardiogram
- Endoscopy
- X-rays
Treating Cloacal Abnormalities
Cloacal abnormalities can be treated with surgery to create three separate openings in the perineum. The surgical approach and technique depend on the type and severity of the condition. A colostomy is typically performed soon after birth to restore the ability to pass stool. For children with bladder conditions, a catheter may be inserted to facilitate urination.
When the patient is in stable health and between the ages of 6 to 12 months, reconstructive surgery can be performed to separate the rectum from the single channel and reconstruct the vagina and urethra using the remaining surrounding tissue. After recovery from surgery, the colostomy can be reversed.
The ability of a child to recover full control of eliminating feces and urine after surgery depends on many factors, particularly the severity of the original malformation. Patients with milder cases are not likely to experience further symptoms as they mature. In more severe cases, urine leakage may require intervention later in life. After successful surgical correction, children born with cloacal abnormalities are likely to experience healthy sexual activity as they mature.