Constipation and Hirschprung’s Disease

Constipation

Defined as infrequent passage of stool associated with pain and difficulty, or delay in defaecation.

•  95% of infants pass 1 stool/day.

•  95% of school children pass 3 stools/wk.

•  Constipation is common in childhood.

•  Approximately 5% of school children suffer significant constipation, usually functional.

•  Organic cause more likely if: delayed passage of meconium beyond 24hr of age; onset in infancy; severe; associated with faltering growth or abnormal physical signs (include per anal examination).

Prognosis

The vast majority of children can be ‘cured’ by an enthusiastic and sympathetic paediatrician with complete evacuation of any stool masses, maintaining soft stools, and defaecation training. Many children need long term therapy.

Hirschprung’s disease

Hirschsprung’s disease (HD) is a disorder of distal intestinal motility that is the result of a congenital absence of ganglion cells in the myenteric plexuses of the rectum and distal colon. This causes constipation that is often severe and a clinical picture consistent with a distal pseudo-obstruction characterized by enlargement of the normally ganglionated proximal colon (megacolon). Surgical resection of the aganglionic segment of bowel and reconstruction with normal proximal bowel is the treatment of choice and is associated with overall excellent results in the majority of patients.