A baby who is struggling to pass stool, developing a swollen abdomen or becoming unwell may need to be checked by a doctor. One possible cause is Hirschsprung disease, a bowel disorder that can affect newborns and young children.
To understand Hirschsprung disease and the bowel problems it can cause in newborns, we spoke with Dr Gopal Agarwal, Director – Department of Paediatrics and Neonatology at Cloudnine Group of Hospitals, Gurgaon, who shares insights on its symptoms, diagnosis and treatment.
What Is Hirschsprung Disease?
Hirschsprung disease is a condition present from birth that affects the intestine. A baby with this condition is born without a group of nerve cells, called ganglion cells, in part of the bowel. These cells are normally responsible for helping the intestine move its contents towards the rectum.How Does Hirschsprung Disease Affect Bowel Movements?
When these nerve cells are missing, the affected part of the intestine cannot relax normally. It stays contracted, making it difficult for stool to pass through. As stool collects behind this area, the baby's abdomen may become swollen and uncomfortable.In newborns, this can lead to delayed passage of meconium, the baby's first stool. Some babies may also develop vomiting, feeding difficulties or problems passing stool. The severity depends on how much of the intestine is affected.
What Are the Signs of Hirschsprung Disease in Babies?
The symptoms can appear soon after birth or become noticeable during the first weeks or months of life.Common signs include:
- Delayed passage of meconium
- A swollen or enlarged abdomen
- Difficulty passing stool
- Constipation that continues or becomes severe
- Green or yellowish vomiting
- Poor feeding
- Reduced interest in feeds
- Poor weight gain
- Episodes of abdominal discomfort or irritability
- Explosive or sudden passage of stool after an examination
Is Delayed Meconium Always Hirschsprung Disease?
No. Delayed meconium can happen for several reasons, and Hirschsprung disease is only one of them. Other bowel problems can also cause delayed stool.If your newborn has not passed meconium, especially with abdominal swelling or vomiting, speak to a doctor promptly.
How Do Doctors Diagnose Hirschsprung Disease?
Doctors may follow a few steps to determine whether a baby has Hirschsprung disease.Diagnosis may include:
- Physical examination: The doctor checks the baby's tummy and asks about feeding, vomiting and bowel movements.
- Abdominal X-ray: This can show whether the bowel is swollen or whether stool and gas are building up.
- Contrast enema: A special liquid is used to make the intestine visible on an X-ray. It can help doctors identify the affected section.
- Rectal biopsy: A small tissue sample is taken from the rectum and examined for the presence of ganglion cells. This is usually the key test used to confirm the diagnosis.
How Is Hirschsprung Disease Treated?
Hirschsprung disease is mainly treated with surgery. The affected part of the bowel is removed, and the healthy bowel is connected to the rectum so stool can pass more easily. This is called a pull-through procedure.“Treatment generally involves surgery to remove the affected section of the intestine and connect the healthy intestine to the anus. Most children do well after appropriate treatment, although some may need continued monitoring for bowel-function problems.”
- Dr Gopal Agarwal, Director – Department of Paediatrics and Neonatology at Cloudnine Group of Hospitals, Gurgaon
When Should You Seek Medical Help?
Seek medical attention if your baby has:- Increasing abdominal swelling
- Repeated vomiting, especially green vomit
- Poor feeding
- Unusual sleepiness or weakness
- Fever
- Difficulty passing stool along with worsening discomfort
- Signs of dehydration
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FAQs on What Is Hirschsprung Disease and Why Does a Baby Fail to Pass Stool?
- Is Hirschsprung disease a serious condition?
It can become serious if untreated, especially when bowel blockage or infection develops. Early diagnosis and appropriate treatment can significantly reduce the risk of complications. - Can Hirschsprung disease come back after surgery?
The condition itself does not usually return after the affected bowel is removed. However, some children may continue experiencing constipation, diarrhoea or bowel-control difficulties. - Can Hirschsprung disease affect a child’s growth?
Severe or untreated bowel problems may affect feeding, nutrition and growth. Once the condition is treated and bowel function improves, many children can grow and develop normally.