Man born without anus almost killed himself over condition

His condition was so embarrassing that it nearly drove him to suicide.

And he endured merciless taunts growing up.

Warehouse operations supervisor M.B. Nesh, 29, was born with an imperforate anus, which means he did not have an anal opening.

Even now, after finally fixing the problem, the memory of what he went through is painful.

After his birth, surgeons made small openings or stoma in his belly and attached the ends of the intestines to the openings to fix his defect.

This allowed him to pass motion into a pouch attached outside the body.

It was not until he was three that doctors surgically created an anus for him. The problem seemed to be fixed.

Unfortunately, it left him with a terrible and embarrassing side effect - bowel leakage.

"I still wore diapers when I went to K1 (first year at kindergarten) and because of that, the children teased me. It got so bad I didn't want to go back. I dropped out of K1," he said.

The teasing continued when he went to primary school at age eight.

"I was relegated to the back of the class where I sat alone. No one wanted to sit with me or be my friend. They said I was stinky.

"I was also seated near the door in case I needed to go to the toilet fast," Mr Nesh recalled.

His only friend growing up was his dog Spotty.

"Spotty loved me unconditionally. He never judged me," Mr Nesh said.

The lonely boy soon grew up to become "an angry teenager".

"I picked fights and became violent. I hung out with the wrong crowd and was often hauled into the disciplinary master's office," he said.

At 16, in Secondary 2, Mr Nesh dropped out of school. That same year, his world crumbled.

"My mother, who was my rock and supporter, died suddenly from a heart attack. Eight months later, one of my brothers, seven years older than me, died in a road accident," he said, tears welling up.

As if that was not tragic enough, Mr Nesh lost both his father and his best friend, Spotty, to cancer six months after that.

"I was at my lowest then... My parents who provided me a safe harbour each time I got into trouble were no longer around. I asked why all the bad things happened to me. That was when I entertained thoughts of suicide," he said.

"Those were my darkest days."

He remembers being in his dark bedroom staring at his window but the fear of dying stopped him.

"I also remember telling myself if I did it, then I would disappoint my late mother who always encouraged me to make something out of my life despite my condition."

Mr Nesh, who now lives with his eldest brother and older sister in the west, picked himself up and started over.

ODD JOBS

He studied part-time and took up odd jobs, working as a cleaner, mover and security guard.

Then a motorcycle accident while doing his national service worsened his condition.

"My incontinence became bad. I wanted to improve my situation. So I did my own research and found that I could actually opt for a pacemaker to be implanted.

"But the pacemaker alone costs $45,000. Besides, I would need to change the battery after three to five years, and that would cost between $7,000 and $8,000. How could I afford it?" he said.

So Mr Nesh picked a cheaper, subsidised option - a colostomy and stoma bags - and had the surgery in 2013.

He said he paid only a small amount because the operation was subsidised and he used his Medisave.

Checks with hospitals show that the surgery and hospital stay for a private patient would cost $10,000. It is between $2,400 and $3,500 for a subsidised patient.

The operation meant Mr Nesh's stools were drained from the intestines through the stoma into a bag attached to his abdomen.

Not wanting to live with the smell, Mr Nesh changed his bag every day.

"Because of work, I used the better grade bags, which cost $250 a month," he said.

Post surgery, Mr Nesh completed his O levels as a private student. With four credits, he studied for a diploma in logistics and operations management and later got a job in a shipping firm.

But having to move heavy equipment around caused him to suffer a hernia at the stoma site repeatedly.

His surgeon, Dr Aileen Seah, felt Mr Nesh could not continue like this and brought his situation to the attention of the Parkway Pantai group in the hope that he would be given an artificial sphincter under its Life Renewed Project.

Mr Nesh then underwent a series of operations over four months this year.

The procedures, which included the cost of the implant and hospital expenses, came up to more than $100,000. They were fully sponsored by Parkway Pantai.

Mr Nesh, who recently married his girlfriend of four years, said he is happy with the result.

"I got a second chance to make something of myself. I will definitely make sure I will live up to my late parents' expectations."

Condition complex birth defect

Anorectal malformation or an imperforate anus is a complex birth defect where a baby's rectum does not form and connect properly to its anal canal.

The baby's anus looks abnormal in that there is no opening for excrement to come out.

Related muscles such as the anal sphincter may not even be developed or formed properly.

This birth defect occurs in one in every 5,000 live births and no one knows the exact cause.

It is usually detected at birth.

If there is no passage for excrement to come out, then a colostomy or a temporary opening is made in the colon. Otherwise, the baby will die.

Reconstructive surgery to connect the rectum out to the anal opening is done when the child is older.

NON-FUNCTIONAL

Dr Aileen Seah, a general surgeon with Parkway East Hospital, said Mr M.B. Nesh was born without a functioning anal sphincter.

"So the latest surgery provides a fluid filled band around his anal canal to act like an anal sphincter - to let out stool when it is socially convenient and to hold his stool when it is not," she said.

How this works is when the band is filled with fluid, it bulges and squeezes the anal canal, gripping it shut.

When the fluid is pumped out of the band, the band flattens out, releasing the grip and the anal canal will then be able to open and release the stool.

Dr Seah said that without surgery, the patient would have to live with incontinence.

"Living with faecal incontinence is a social stigma. Most become social recluses and are not able to leave their home," she said.

Mr Nesh's surgery took between two and three hours.

An artificial bowel sphincter was implanted around his anal canal so he is able to control his bowel movements.

Dr Seah said there are risks, which include infection of the implant (which means it would need to be removed), erosion or even malfunctioning of the implant.

This article was first published on June 25, 2015.
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