DEAR DR. GOTT:
My 10-year-old grandson had corrective surgery for Hirschsprung’s disease when he was an infant. He has been experiencing fecal leakage since then. He gets quite embarrassed but he can’t keep from having “accidents”. I was wondering if Kegel exercises would be of benefit to him. Any help you can offer would be appreciated.
DEAR READER:
Hirschsprung’s disease is a condition of the large intestine. It causes problems with passing stool because of missing nerve cells in the intestinal muscles. It is present from birth (congenital) and has no known cause.
Hirschsprung’s occurs in one out of every 5,000 births and ranges from mild to severe. In mild cases, babies often have minimal symptoms and may not be diagnosed until early childhood. Severe cases may lead to bowel obstruction, necessitating emergency surgery. Most cases fall into the moderate category which usually causes constipation or difficulty absorbing nutrients. The condition is five times more common in boys and sometimes is associated with other congenital disorders such as Down syndrome.
Symptoms can occur immediately after birth or may taken several months or years to appear. In infants, symptoms include diarrhea, constipation, gas, failure to have a bowel movement after the first or second day of life or vomiting (especially vomiting green bile). Older children may experience infections of the colon such as entercolitis, inability to gain weight, abdominal swelling and problems absorbing nutrients which leads to weight loss, delayed/slowed growth and diarrhea.
Hirschsprung’s disease develops while the baby is still in the womb. At some point during development of the colon, the nerve bundles that line it, fail to form. This can occur throughout the entire large intestine or just a few centimeters up from the rectum. The longer the affected area, the worse symptoms tend to be. It is not caused by anything the expectant mother has done or not done.
The only known risk factor is if you have one child with the disorder there is a greater risk of another child being born with Hirschsprung’s (because it is inherited, even if the parents do not have the disorder), and especially if that child has Down syndrome or is male.
The only treatment for Hirschsprung’s disease is surgical removal of the affected area of colon. You stated your grandson has already had this surgery. I suspect his fecal leakage is due to the surgery which carries the risk of muscle, rectal and nerve damage. I urge your grandson’s parents to talk to his gastroenterologist about his problem and see if there is anything that can be done. Older individuals can be helped by medication, surgery or surgical implants and since your grandson is only 10, I cannot see him having to spend the rest of his life with this embarrassing side effect. At the appointment to discuss the leakage, Kegel exercises can be brought up as a possible aid. I am not sure they will be effective but they cannot do any harm.
To give you related information, I am sending you a copy of my Health Report “Constipation and Diarrhea”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.
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