Babies who have trouble emptying their bowels sometimes have a problem called Hirschsprung disease. Treatment for this condition almost always requires surgery. Fortunately, most children who have surgery are fully cured and able to pass bowel movements normally.
Hirschsprung disease affects the large intestine (colon) of newborns, babies, and toddlers. The condition — which prevents bowel movements to pass through the intestines due to missing nerve cells in the lower part of the colon — is caused by a birth defect. Most of the time, the problems with pooping start at birth, although in milder cases symptoms may appear months or years later.
Hirschsprung disease can cause constipation, diarrhea, and vomiting and sometimes lead to serious colon complications, like enterocolitis and toxic megacolon, which can be life-threatening. So it's important that Hirschsprung disease be diagnosed and treated as early as possible.
Doctors aren't entirely sure why some children get Hirschsprung disease, but they do know it can run in families and affects boys more often than girls. In fact, Hirschsprung disease is about five times more common in males than females. Children with Down syndrome and genetic heart conditions also have an increased risk of Hirschsprung disease.
Newborns with Hirschsprung disease may show these signs:
- inability to pass stool within the first or second day of life
- swollen belly, bloating, or gas
- vomiting, which may include vomiting a green or brown substance
Inability to poop within the first 48 hours of life is often the key to detecting Hirschsprung disease in a newborn. This red flag can be very valuable in diagnosing the condition.
Less severe cases of Hirschsprung disease may go unnoticed until later childhood, or sometimes even adolescence or adulthood. The symptoms in these cases are usually milder but can be long-lasting, chronic conditions. Symptoms may include:
- abdominal swelling
- difficulty gaining weight
Surgery is thought to be the most effective treatment for Hirschsprung disease.The most common surgery to correct Hirschsprung disease involves removing the section of the colon without nerves and reattaching the remaining portion of the colon to the rectum. Often, this can be done through minimally invasive (laparoscopic) surgery immediately after the condition is diagnosed.
In some cases, the doctor may do the surgery in two steps. In the first step, the doctor will remove the unhealthy portion of the colon and then perform a procedure called an ostomy. In an ostomy, the doctor creates a small hole, or stoma, in the child's abdomen and attaches the upper, healthy portion of the colon to the hole. The child's stool passes through the stoma into a bag that is connected to it and needs to be emptied several times a day. This allows the lower part of the colon to heal prior to the second surgery. In the second surgery, the doctor closes up the hole and attaches the normal portion of the colon to the rectum.
The general outlook for children who have been treated surgically for Hirschsprung disease is excellent. After surgery, most can pass stool normally and have no lasting complications. However, a few kids might continue to have symptoms, including constipation and bowel control problems.
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