Hirschsprung’s Disease – Diagnosis and Treatment
Diagnosis
Doctors start by doing a physical exam and asking about the child’s bowel habits. They may use different tests to check for Hirschsprung’s disease.
- Doctors take a small piece of tissue from the colon using a suction tool and examine it under a microscope to check if nerve cells are missing, which signals the disease.
- Doctors insert a special dye, like barium, into the rectum with a tube for an X-ray. The dye highlights the shape and size of the colon. A narrow area without nerves and a swollen normal section can help confirm the problem.
- In anal manometry, mostly used for older children or adults, a doctor places a small balloon inside the rectum and inflates it. If the muscles do not relax as they should, this can indicate Hirschsprung’s disease.
Treatment
Connecting Healthy Bowel to the End
Doctors carefully remove the inner layer of the part of the colon that does not contain nerve cells. They then move the healthy part of the intestine down and connect it to the anus.
Surgeons often use special instruments through small cuts or directly through the anus. The minimally invasive method can help with recovery and lower the chance of large scars.
Temporary Opening in the Belly
When a child is very sick, doctors may use a two-step treatment. First, they remove the abnormal section of the colon. They then attach the healthy part of the colon to an opening in the belly.
This opening, called a stoma, allows stool to pass into a special bag outside the body. The lower intestine then has a chance to heal. Later, the surgeon attaches the healthy bowel to the rectum or anus and closes the opening.
What Happens After the Operation
Most children pass stool normally through the anus after the procedure. Some children may still have:
- Loose stools
- Trouble passing stool (constipation)
- Stool leaking (incontinence)
- Slower progress with toilet training
These issues often improve as the child grows. However, bowel infection risk remains, especially soon after surgery. Warning signs include:
| Possible Sign of Infection |
|---|
| Rectal bleeding |
| Ongoing diarrhea |
| High temperature (fever) |
| Swollen belly |
| Vomiting |
If you notice any of these symptoms, seek medical care quickly.
Ways to Help at Home
Caregivers can help children manage their health after surgery for Hirschsprung’s disease. One important step is choosing high-fiber foods if the child can eat solids.
Whole grains, fruits, and vegetables are good choices. Add new high-fiber foods slowly because adding too much too quickly might make constipation worse.
If the child is not on solid foods, caregivers should check with the doctor about special formulas that may help. Sometimes, doctors may recommend a feeding tube.
Drinking enough water is also important. Some kids who have had part of their colon removed may need extra fluids since their bodies might not absorb water as well.
Offer water throughout the day to keep them hydrated and support comfortable bowel movements. Physical activity is helpful, too. Light exercise, such as walking or playing, can help keep the digestive system working well.
For some children, medicines like laxatives may be needed. Caregivers should give these only if the doctor recommends them. Make sure to get clear instructions about how and when to use them, as well as any possible side effects.
Getting Ready for the Appointment
Steps You Can Take Before the Visit
Preparing for a medical appointment is important, especially when dealing with concerns like digestive issues in a child. Recommended steps include:
Check for Instructions: When making the appointment, ask if your child needs to follow any special instructions before coming in, such as not eating or drinking before certain tests.
Write Down Symptoms: Keep a record of all your child’s symptoms. Note how often bowel movements occur, their consistency, color, and if there is any pain.
Medical Background: Gather key medical details, such as your child’s past or current health problems and any family history related to bowel conditions.
List Medications and Supplements: Make a list of all medicines, vitamins, or supplements your child takes. Include details about your child’s usual fluid intake.
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Prepare Questions: Make a list of questions for the health care provider. Sample questions might include:
- What could be causing my child’s symptoms?
- Are there other possible causes?
- What tests are needed?
- What treatment options are available?
- If surgery is suggested, what can we expect during recovery?
- What are the risks of surgery?
- What is the outlook after treatment?
- Will my child need a special diet?
- Bring Support: If possible, bring another adult with you to help listen and remember what the doctor says.
Bring Documentation: Carry any previous medical records that may be helpful to the specialist.
Tip: Being prepared can help you feel more confident during the appointment, and you are less likely to forget important details or questions.
Questions the Doctor May Ask
The doctor will want to gather as much information as possible to understand your child’s condition. Being ready to answer detailed questions helps to speed up the process and guide decisions. You may be asked questions such as:
- When did the symptoms start?
- Have things gotten worse since they began?
- How often does your child have a bowel movement?
- Are bowel movements painful for your child?
- Has there been any diarrhea or blood in the stool?
- Has your child been vomiting?
- Does your child seem tired more than usual?
- What helps your child feel better, if anything?
- Is there anything that makes symptoms worse?
- Are there family members with similar problems?
The doctor might ask about specific details and patterns related to your child’s health. Sharing thorough and accurate information lets the healthcare team make the best choices for care.
Tip: If you do not know the answer to a question, it is okay to say so. Share what you have noticed and any concerns you have.
Below is a simple checklist to help you get ready:
| Checklist for Appointment Preparation | |
|---|---|
| Ask about pre-appointment requirements. | ☐ |
| Note all symptoms and their patterns. | ☐ |
| Gather all medication and supplement information. | ☐ |
| Prepare a list of questions. | ☐ |
| Bring someone for support, if possible. | ☐ |
| Collect relevant medical records. | ☐ |
Being ready with this information ensures that the appointment runs as smoothly as possible. It helps the doctor make an informed diagnosis and discuss the right treatment options for your child.
More Details
People with Hirschsprung’s disease face problems because part of their large intestine does not work the right way.
This section of the bowel does not have the nerve cells needed to move stool along. As a result, stool can get stuck, causing swelling, pain, and constipation.
Signs of Hirschsprung’s disease often show up in babies. These symptoms can include trouble passing stool, swollen belly, and vomiting. In some cases, older children might have ongoing constipation or problems gaining weight.
Common Symptoms:
- No bowel movement within the first two days of life
- Swollen abdomen
- Green or brown vomiting
- Trouble feeding
A doctor can use tests like X-rays, a rectal biopsy, or a manometry to check for this condition. Surgery, which removes the non-working section of the intestine, is the main treatment for Hirschsprung’s disease.
There are two main types of procedures:
| Type | Short Description |
|---|---|
| Pull-through | The bad part is taken out and healthy ends joined |
| Ostomy | Stool leaves the body through an opening in the belly while healing |
Most children do well after surgery. Aftercare may include a special diet and regular checkups.
