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.

In August 2007, during a four day stay at my beach house in Mexico, I developed watery diarrhea up to 12 times a day. Four days after returning home I saw my physician and he said I must have picked up a bug in Mexico. I have been going there fore 35 years and have NEVER gotten anything before, but thought there is always a first. He prescribed Cipro for seven days with no results so I was given another seven day round. When that failed to help, I was given Flagyl and had blood work and stool samples taken twice. Everything was negative. He then switched me to another medication but I was still having the watery diarrhea up to eight times a day, mostly during the morning and evening. I started losing weight.

I was then referred to a specialist who continued my last medication and ordered a colonoscopy, despite my having had a normal test two years ago. I went along with it because I was told this physician was the “best”. For various reasons I did not go back to him and never will so I took the results to another physician. He diagnosed me with collagenous colitis but was unsure how I got it. I was told there was no known cure and that I would have to take medication for the rest of my life. Fortunately, I was also told it was not life-threatening. I have lost more than 20 pounds and continue to have watery diarrhea up to six times a day.

I have tried to do my own research on this condition but haven’t come up with anything useful. How do people live with this? When I get up in the morning, it takes at least two or three hours of trips back and forth to the bathroom before it is relatively safe for me to leave. Then after dinner, it is the same thing. Occasionally I have an “attack” in the middle of the day and unless I am immediately near a bathroom, it can be devastating because there is no warning. I want to have a normal life again.

DEAR READER:
Collagenous colitis is an inflammatory condition of the colon that causes chronic watery diarrhea. It is similar to lymphocytic colitis and some researchers believe that they are simply different stages of one disorder. They are often both referred to as microscopic colitis.

Some individuals develop patches of swelling in the colon lining (collagen) while others have swelling along the entire length of the bowel. It is more prevalent in people ages 60-80.

The most common symptom is chronic watery diarrhea that often starts suddenly. This can be consistent or cyclic (occurring in cycles of improvement and worsening) and can cause from three to 20 bowel movements a day. Other symptoms can include abdominal pain/cramps, dehydration, nausea, abdominal bloating, fecal incontinence and modest weight loss.

There is no known cause for either collagenous or lymphocytic colitis. Some researchers believe that toxins released by bacteria or viruses may trigger the inflammation but others have theorized them as autoimmune. Many individuals with the conditions also have one or more of the following conditions: celiac disease, diabetes mellitus, Sjorgen’s syndrome, thyroid problems, CREST syndrome, rheumatoid arthritis, scleroderma and pernicious anemia.

Diagnosis is often made by a gastroenterologist with the aid of blood and stool samples, colonoscopy or flexible sigmoidoscopy and biopsy.

The good news is that most cases resolve on their own in a matter of weeks and do not need treatment. Unfortunately you do not appear to be in the vast majority. Treatment usually includes lifestyle changes such as a low fat diet, cessation of caffeine, lactose, spicy foods and alcohol, and limiting intake of raw fruits and vegetables (which can cause gas and resultant diarrhea). If this fails to help, medication may be necessary. These include over-the-counter Imodium or Pepto-Bismol and prescription Lomotil, Colazal, Azulfidine and others. If medications and lifestyle changes fail to produce improvement, surgery to remove the inflamed areas may be necessary. It is important that the dietary changes are continued to ensure the symptoms do not recur.

I suggest you speak with your gastroenterologist about this. You may also wish to go online and get a copy of the collagenous colitis/lymphocytic colitis information from the Mayo Clinic. It is available at http://www.MayoClinic.com/health/collagenous-colitis/DS00824.

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.

DEAR READER: Colonic irrigation is unnecessary and should be avoided.

If you have chronic constipation, you should be examined by your primary care physician or a gastroenterologist. He or she can examine you to ensure there is no physical cause, such as blockage or polyps. You should then be checked for irritable bowel syndrome which can manifest itself as chronic diarrhea or constipation or a combination of both. Depending on the cause, you can then discuss treatment options such as bulking up with fiber, the use of stool softeners or perhaps you need medication.

You should stop using the enema bag. It is most likely worsening the situation and can lead to nutritional deficiency if used frequently.

To give you related information, I am sending you copies of my Health Reports “Constipation and Diarrhea” and “Irritable Bowel Syndrome”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 FOR EACH report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.