Why incontinence? Postoperative incontinence, fecal leakage and constipation are the most common postoperative complications; the underlying cause is sphincter dysplasia, especially in middle and high malformations, where both internal and external anal sphincters are underdeveloped, so basically there will be abnormal defecation manifestations after surgery to a greater or lesser extent. Generally speaking, several structures related to the control of defecation include: 1, puborectalis muscle: this is the most important muscle for the control of defecation, the location is deeper, and if the injury will lead to severe incontinence, this muscle also controls urination, and in females control labor, so it is also called urogenital muscle; in patients with high-grade clavicular anus, the alignment of this muscle will be abnormal, and the specific manifestation is that the barium enema examination shows that the angle of rectal anus is open, and that the rectal anus angle is wide. This is one of the main reasons for abnormal defecation after high anal locking surgery. 2, the external anal sphincter: location is relatively shallow, close to the skin, transcutaneous stimulation can be seen after the contraction, this muscle is random muscle, by the brain’s direct control, is an important part of the anal sphincter ring, with the puborectalis muscle together to constitute the control of defecation of the most important on the enough, sphincter three-ringed structure, if the injury will also cause incontinence, in the patients with high-grade locking of the anus, the development of this muscle is also abnormal, and serious patients even missing, therefore, there will be anomalies in bowel movements. Patients even missing, so there will be incontinence, dirty stool, the main manifestation is the external mouth of the anus is bared, no depression; 3, the internal sphincter: this muscle is mainly to control the feeling of defecation, produce the feeling of defecation, stimulate the defecation reflex, etc., in the anal atresia of the children are also underdeveloped; 4, the length of the anal canal high-pressure area: under normal circumstances, in the pubic rectus muscle and the part of the external sphincter between the part of the anal canal called the anal canal, the usual anal canal is closed Normally, the anal canal is closed, which forms a closed, tubular area of about 3-6cm in length, the pressure is higher than that in the rectum, so it plays a role in controlling the bowel movement. In children with anal atresia, this structure is significantly shortened or disappeared, which can be obtained by anorectal manometry. What are the signs of fecal incontinence? Since all the above mentioned structures are abnormal in children with anal atresia, these patients will have different degrees of fecal incontinence and fecal leakage, and the following situations are common in these patients: 1. The patient does not know that he/she has a bowel movement, and therefore when fecal matter arrives at the rectum, he/she cannot produce the intention to have a bowel movement, and the external sphincter does not have time to produce a contraction response, and therefore cannot achieve the function of controlling the bowel movement, and therefore leads to leakage of fecal matter; this is This is mainly due to the dysfunction of the internal sphincter, which is slow in sensation. 2, some patients can feel the presence of feces, can produce stool, but want to contract the external sphincter, feces has been discharged, this part of the patient compared to the first category of patients is relatively light, the main reason is that the nerve reflex is not sensitive enough, may be the nerve afferent or efferent pathway retardation caused by the 3, the last category is to be able to produce fecal desire, also able to contract the external sphincter, but due to the sphincter strength is not enough, or anal canal hypertension. The last group is those who can produce the urge to defecate and can contract the external sphincter, but due to insufficient strength of the external sphincter or shortening of the length of the high-pressure zone of the anal canal, they are unable to control defecation, resulting in defecation. Principle and method of treatment program The above three categories are the main causes of postoperative “fecal incontinence”, for the above causes, we have formulated targeted treatment means, the application of surface transcutaneous electrical stimulation technology and targeted biofeedback therapy for postoperative fecal incontinence after anal atresia surgery, and the results are very satisfactory, with an effective rate of 80% or more, after nearly 10 years of clinical practice, we have developed targeted treatment means. After nearly 10 years of clinical practice, we have figured out a complete set of evaluation and treatment system for these patients. Transcutaneous electrical stimulation refers to stimulate the reflex zones of the defecation control center on the body surface, and stimulate the perianal sphincter muscle group, to achieve the training of the internal sphincter sensitivity and pelvic floor plexus afferent and efferent sensitivity, and at the same time, the external sphincter is in a tense state, to maintain the tenseness of the external sphincter, to achieve the purpose of bowel control; this method is similar to the Chinese medicine of the electronic acupressure points, through the surface of the body to complete, safe, non-invasive, non-painful, and painless, this method is similar to the Chinese medicine of electronic acupoint massage, completed by the body surface. Strength can be adjusted, painless, without any adverse reactions; biofeedback is a new type of treatment means, mainly through the instrument so that the patient to achieve visual, auditory, anal sphincter, pelvic floor muscles and the brain to form a fixed pattern of thinking, to strengthen the control of defecation, safety, no side effects, painless; the specific method is: percutaneous electrical stimulation of the lumbar 1-2, sacral 2-4, the electrode in the anus (part of the case) The specific method is: transcutaneous electrical stimulation lumbar 1-2, sacral 2-4, intra-anal electrodes (some cases can be adjusted), each part of the 2,000 times, the current intensity can be adjusted; biofeedback half an hour, the cost of 264 yuan per day, the course of treatment 2-4 weeks. Precautions However, it should be noted that the application of the above treatment in anal atresia has strict indications, for patients with complete incontinence can not be biofeedback to achieve the therapeutic purpose, so first of all, we must assess the symptomatic patients, assess their sphincter function, if there is no sphincter group, it is “a clever woman can not cook without rice! If there is no sphincter muscle group at all, then it is a “tricky job” and such a patient must be surgically orthopedic, with a portion of the muscle grafted first, and then biofeedback training can be done.