This digestive disorder that's present at birth affects the nerves in the colon. It causes severe constipation but can be treated.
Hirschsprung's (HIRSH-sproongz) disease is a condition that affects the large intestine (colon) and causes problems with passing stool. The condition is present at birth (congenital) as a result of missing nerve cells in the muscles of the baby's colon. Without these nerve cells stimulating gut muscles to help move contents through the colon, the contents can back up and cause blockages in the bowel.
A newborn who has Hirschsprung's disease usually can't have a bowel movement in the days after birth. In mild cases, the condition might not be detected until later in childhood. Uncommonly, Hirschsprung's disease is first diagnosed in adults.
Surgery to bypass or remove the diseased part of the colon is the treatment.
In children with Hirschsprung's disease, nerves fail to form in all or part of the large intestine (colon). Waste from digestion cannot pass through the part of the colon lacking nerve tissue. The normal colon swells with blocked stool.
Signs and symptoms of Hirschsprung's disease vary with the severity of the condition. Usually signs and symptoms appear shortly after birth, but sometimes they're not apparent until later in life.
Typically, the most obvious sign is a newborn's failure to have a bowel movement within 48 hours after birth.
Other signs and symptoms in newborns may include:
In older children, signs and symptoms can include:
It's not clear what causes Hirschsprung's disease. It sometimes occurs in families and might, in some cases, be associated with a genetic mutation.
Hirschsprung's disease occurs when nerve cells in the colon don't form completely. Nerves in the colon control the muscle contractions that move food through the bowels. Without the contractions, stool stays in the large intestine.
Factors that may increase the risk of Hirschsprung's disease include:
Children who have Hirschsprung's disease are prone to a serious intestinal infection called enterocolitis. Enterocolitis can be life-threatening and requires immediate treatment.
Your child's doctor will perform an exam and ask questions about your child's bowel movements. He or she might recommend one or more of the following tests to diagnose or rule out Hirschsprung's disease:
Abdominal X-ray using a contrast dye. Barium or another contrast dye is placed into the bowel through a special tube inserted in the rectum. The barium fills and coats the lining of the bowel, creating a clear silhouette of the colon and rectum.
The X-ray will often show a clear contrast between the narrow section of bowel without nerves and the normal but often swollen section of bowel behind it.
For most people, Hirschsprung's disease is treated with surgery to bypass or remove the part of the colon that's lacking nerve cells. There are two ways this can be done: a pull-through surgery or an ostomy surgery.
In this procedure, the lining of the diseased part of the colon is stripped away. Then, the normal section is pulled through the colon from the inside and attached to the anus. This is usually done using minimally invasive (laparoscopic) methods, operating through the anus.
In children who are very ill, surgery might be done in two steps.
First, the abnormal portion of the colon is removed and the top, healthy portion of the colon is connected to an opening the surgeon creates in the child's abdomen. Stool then leaves the body through the opening into a bag that attaches to the end of the intestine that protrudes through the hole in the abdomen (stoma). This allows time for the lower part of the colon to heal.
Once the colon has had time to heal, a second procedure is done to close the stoma and connect the healthy portion of the intestine to the rectum or anus.
After surgery, most children are able to pass stool through the anus.
Possible complications that may improve with time include:
Children also continue to be at risk of developing a bowel infection (enterocolitis) after surgery, especially in the first year. Call the doctor immediately if any of the signs and symptoms of enterocolitis occur, such as:
If your child has constipation after surgery for Hirschsprung's disease, discuss with your doctor whether to try any of the following:
Serve high-fiber foods. If your child eats solid foods, include high-fiber foods. Offer whole grains, fruits and vegetables and limit white bread and other low-fiber foods. Because a sudden increase in high-fiber foods can worsen constipation at first, add high-fiber foods to your child's diet slowly.
If your child isn't eating solid foods yet, ask the doctor about formulas that might help relieve constipation. Some infants might need a feeding tube for a while.
Hirschsprung's disease is often diagnosed in the hospital shortly after birth, or signs of the disease show up later. If your child has signs or symptoms that worry you, particularly constipation and a swollen abdomen, talk to your doctor.
You might be referred to a digestive disorders specialist (gastroenterologist) or to the emergency department if your child's symptoms are severe.
Here's some information to help you get ready for your appointment.
When you make the appointment, ask if there's anything your child needs to do in advance, such as fasting for a specific test. Make a list of:
Take a family member or friend along, if possible, to help you remember the information you're given.
For Hirschsprung's disease, basic questions to ask your doctor include:
Don't hesitate to ask other questions.
Your child's doctor is likely to ask you questions, including: