Hirschsprung’s Disease

What is Hirschsprung’s disease?

Hirschsprung’s disease is a rare birth defect that affects the large intestine (bowel). It is caused by missing some or all of the nerve cells in your intestine. Nerve cells are important because they tell your intestine to push stools through your bowel. This condition occurs while a baby is in the womb. Cells may be missing from a small part of the intestine near the bottom (anus). Or cells may be missing from a large part of the intestine. This causes stools to back up in the intestine. It causes severe constipation, blockage, and colon infections.

Symptoms of Hirschsprung’s disease

The earliest sign of Hirschsprung’s disease is when your newborn baby does not have a bowel movement. This should occur in the first 24 to 48 hours after birth. Other symptoms include:

  • Constipation or gas, which may make your baby fussy.
  • Poor appetite.
  • Swelling of the stomach.
  • Vomiting bile (a green liquid) after eating.
  • Bloody diarrhea.
  • Inability to pass a stool.
  • Infrequent or explosive stools.

Sometimes, symptoms are not present at birth. This may mean your child has a milder case. Symptoms in older children may include:

  • Chronic constipation.
  • Lack of weight gain or growth.
  • Swollen abdomen.
  • Diarrhea.
  • Frequent bowel movements.
  • Anemia (a low number of red blood cells).

What causes Hirschsprung’s disease?

As a baby grows in the womb, his or her nerve cells may not grow from the top of the intestine to the anus. Doctors do not know what causes the nerve cells to stop growing.

Hirschsprung’s disease can be genetic. This means a parent could pass it on to his or her child. The rare disease is 5 times more frequent in males than in females. Children who have inherited or congenital conditions are at a higher risk as well. This includes Down syndrome.

How is Hirschsprung’s disease diagnosed?

Talk to your doctor if your child has any of the symptoms listed above. Most cases are found shortly after birth. Your doctor will do a physical exam and ask about your family history. If your doctor suspects Hirschsprung’s disease, he or she will order imaging tests, such as an X-Ray of your child’s abdomen. Your doctor may take a sample of tissue (biopsy) from inside your child’s bottom. A baby cannot be tested for the condition while in the womb.

Can Hirschsprung’s disease be prevented or avoided?

Since the cause of Hirschsprung’s disease is unknown, you cannot prevent or avoid it. However, parents who have the disease can unknowingly pass it on to their children.

Hirschsprung’s disease treatment

Surgery is the only way to treat Hirschsprung’s disease. It should be done as soon as the doctor diagnoses the disease. The type of surgery your child has depends on the severity of the disease.

The most common type is a pull-through surgery. The surgeon will remove the part of the intestine that is missing nerve cells. They reattach the healthy part of the intestine to the anus. During surgery, the surgeon may need to remove all or part of the colon as well. Once your child heals, he or she will have a functioning intestine.

Children who have more severe cases of Hirschsprung’s disease may need an ostomy surgery. The surgeon brings the end of the intestine through an opening in the stomach, called a stoma. They attach it to a pouch, called an ostomy, outside the body to collect stool. This creates an alternate way to remove stool from your child’s body. The pouch should be emptied regularly to dispose of the stool. When the surgeon attaches part of the large intestine to the stoma it is called a colostomy. When the surgeon attaches part of the small intestine to the stoma it is called an ileostomy.

Your child may have this surgery prior to the pull-through procedure. It allows their intestine to heal. In this case, the ostomy is a temporary solution. If nerve cells are missing from too much of the intestine, the ostomy may be permanent.

During either surgery, your child may need a feeding tube. This helps them receive the nutrients they need. Feeding tubes can be inserted through the nose or the stomach.

Living with Hirschsprung’s disease

Hirschsprung’s disease cannot be cured on its own. It can be fatal for children who do not have surgery.

After surgery, most children lead normal lives. They may have minor health problems as a result of the disease. These include diarrhea, constipation, or other problems passing stool. Some children develop an infection called enterocolitis (digestive tract inflammation). This can be serious, so call your doctor right away if your child has the following symptoms:

  • Vomiting.
  • Fever.
  • Swollen stomach.
  • Abnormal fatigue
  • Blood in the stool.

Some problems can occur after pull-through, including:

  • Narrowing of the anus.
  • Constipation.
  • Diarrhea.
  • Leaking stool from the anus.
  • Delayed toilet training.
  • Enterocolitis (digestive tract inflammation).

Children may need to make some lifestyle changes to help manage their condition. For instance, eating foods that are high in fiber can help reduce constipation. The large intestine absorbs water and salt that the body needs. If your child has to have a large portion of the intestine removed, it will absorb less. Make sure your child gets plenty of fluids and salt to make up for this.

Your baby and older children will feel better after ostomy surgery because they will be able to pass stool easily. Adjusting to life with an ostomy pouch will take time and may make your child feel different. Your child will need to learn how to care for the stoma and how to change the ostomy pouch. With a few lifestyle changes, children with ostomies can lead normal lives. An ostomy nurse can answer questions and show your child how to care for an ostomy.

Questions to ask your doctor

  • My child seems to be constipated a lot. Does this mean they have Hirschsprung’s disease?
  • Which type of surgery does my child need?
  • How long does surgery last and what are the risks?
  • How long will it take my child to recover from surgery?
  • Is there anything special I should give my child to eat or drink before surgery?
  • What lifestyle changes does my child need to make after surgery?
  • Will my child be able to lead a normal life?
  • What will happen if my child does not have surgery?
  • If I have a child who has Hirschsprung’s disease, what is the chance my future children could have it as well?