Has your newborn baby not pooped for two or three days after birth? Or is their belly just swollen and hard to the touch? It's normal for a new mother or father to feel a little scared when they see something like this. Most of the time, these are not serious things. However, in rare cases, these symptoms can be caused by a condition called Hirschsprung's Disease , which we are talking about today. So, let's talk about this in detail without being afraid.
Simply put, what is Hirschsprung's Disease?
Hirschsprung's Disease is a very rare, congenital condition in which a baby is born without the nerve cells in the last part of the colon that help push stool out.
Think of our intestines as a tube. The food we eat is digested, and waste products, called feces, travel down this tube. This journey is aided by nerve cells in the walls of the intestines. These cells send signals to the muscles in the intestines, causing them to contract and relax, pushing the feces forward.
A baby with Hirschsprung's disease doesn't have these nerve cells at the end of the large intestine. So, when the stool comes in, it can't move through and gets stuck. Like cars getting stuck in traffic. This causes the stool to build up and form a large blockage in the intestine. This can cause the baby to have severe constipation, intestinal obstruction, and sometimes dangerous infections .
Normally, a healthy baby has their first bowel movement within the first 24-48 hours of birth. This first stool is called 'meconium'. It is usually a black, thick substance. However, a baby with Hirschsprung's disease is unable to have this type of bowel movement.
What is the specific reason for this situation?
Doctors still don't know exactly why some babies develop this disease, but it is widely believed to be related to genes .
Simply put, during the first few weeks of a baby's development in the womb, nerve cells grow throughout the baby's entire digestive tract, from the mouth to the anus. But in a baby with Hirschsprung's disease, this nerve cell growth stops abruptly at the end of the large intestine.
This may be due to certain changes (mutations) in our body's DNA, which is like an instruction book. Sometimes these genetic changes can be inherited from parents to children. Also, children with other congenital conditions, such as Down syndrome, and certain heart diseases, are at slightly higher risk of developing Hirschsprung's disease.
How do we recognize these symptoms?
Most of the time, these symptoms appear within the first 6 weeks of life, especially within the first 48 hours. However, in some children, symptoms may take several years to appear.
You should be aware of the following characteristics.
| Characteristic | Description |
|---|---|
| Not defecating | One of the main symptoms of a newborn baby is that they do not have a bowel movement even after 48 hours of birth. If the baby is a little older, they may have chronic constipation that lasts for a long time and does not respond to medication. |
| Abdominal bloating | The baby's stomach may appear bloated and hard due to stool and air trapped in the intestines. |
| Vomiting | The baby may vomit. Sometimes this vomit may look green or brown. This may mean that bile is coming up due to a blockage in the intestines. |
| Bloody diarrhea | This is a very dangerous symptom . It indicates the development of a life-threatening intestinal infection called enterocolitis . It can also be accompanied by fever, severe diarrhea, and abdominal pain. |
| Stunted growth | If the child is a little older and has not been diagnosed with the disease, frequent constipation and poor nutrition may cause stunted growth and constant fatigue. |
The most important thing is that if your baby has any of these symptoms, especially if a newborn baby is not pooping, don't ignore it. It is essential to take your baby to a doctor immediately.
How does a doctor accurately diagnose this disease?
When you take your child to a doctor, he or she will examine your child, ask you about your symptoms, and then recommend several tests to confirm the diagnosis.
- Abdominal X-ray: This can be used to check for bowel obstruction or bloat.
- Contrast Enema: In this, a special white liquid (a dye called barium) is passed through the baby's rectum and a series of X-ray pictures are taken. This liquid allows the inside of the intestine to be seen clearly. The part without nerve cells usually looks thin, while the part filled with stool above it looks larger and more swollen. This can give a good idea of the disease.
- Rectal Biopsy: This is the test that confirms the disease 100%. In this, the doctor takes a very small piece of tissue (tissue sample) from the inner wall of the child's rectum and examines it under a microscope. By looking at whether or not there are nerve cells in that piece of tissue, the disease can be accurately determined.
- Anorectal Manometry: This test is usually done on older children. It involves inserting a small balloon-like device into the rectum and inflating it to check if the muscles in the rectum are working properly.
What are the treatments for this?
Hirschsprung's Disease is not a condition that can be cured with medication. The only and most permanent treatment for it is surgery . Don't worry, this surgery is now being performed very successfully.
During the surgery, the doctor removes the part of the colon that lacks nerve cells and connects the healthy, nerve-filled part of the colon directly to the rectum. This surgery is called a "pull-through procedure."
Sometimes, depending on the child's condition, a temporary "ostomy" surgery may be performed before this main surgery. This involves creating an opening (stoma) so that a part of the healthy intestine comes to the surface of the skin of the abdomen. Then, an ostomy bag is attached to this opening to collect stool. Once the child has recovered a little and is ready for the main surgery, this opening is closed and a pull-through surgery is performed.
What complications can occur after surgery?
Most children are able to have normal bowel movements after surgery and go on to live healthy lives. However, some children may still experience some problems after surgery. It is important to be aware of this.
Hirschsprung-associated enterocolitis
This is the most dangerous complication . It can occur before or after surgery. It is a severe infection of the intestines.
If your child has symptoms after surgery, such as fever, abdominal swelling, vomiting, severe diarrhea, or blood in the stool, it is an emergency. Take your child to the hospital's Emergency Department (ETU) immediately.
Fecal incontinence
Some children may have difficulty controlling their bowel movements after surgery. This means that they may pass stool without even realizing it. This may be due to the effects of the surgery on the muscles of the rectum. With time and some exercises (pelvic physical therapy), this condition can be controlled to a large extent.
Constipation and blockages
Some children may experience constipation after surgery. This may be due to a narrowing of the surgical site or other causes. In such cases, your doctor will prescribe the necessary treatment.
Even if this condition is treated with surgery, it is important to continue to monitor the child's condition. Talk to the doctor regularly about your child's bowel habits and diet.
Take-Home Message
- Hirschsprung's Disease is a rare birth defect that causes the inability to defecate due to the absence of nerve cells in the intestine.
- The main symptoms of a newborn baby not having a bowel movement within 48 hours, a swollen abdomen, and green/brown vomit are: If you see these, see a doctor immediately.
- This disease is confirmed by a biopsy.
- The treatment is surgery. After successful surgery, most children can lead normal lives.
- If you develop symptoms such as fever, abdominal swelling, or bloody diarrhea after surgery, you should immediately go to the hospital's Emergency Department (ETU), as this could be a sign of a dangerous infection called enterocolitis.
- This is a condition that requires lifelong monitoring. Therefore, it is very important to follow the doctor's instructions and have your child checked at regular intervals.
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