How will it be diagnosed?
In some cases it can be very hard to diagnosis Hirschsprung's, which is why some children can go many years without it being diagnosed.
The diagnosis will be dependant on how old your child is. In a young or newly born baby, the diagnosis will generally be on bowel movements or lack of them, the condition of the tummy and a full thickness or suction biopsy of the rectum.
This is where tiny snip-its of the bowel are taken and tested for the presence ganglion cells and if found, how many? In the affected part of the bowel there is an increase in the nerve trunk density and thickness. Ganglion cells can be found in Hirschsprung's children but they may be so few in numbers that the bowel will not function properly. Sometimes more than one biopsy to may be necessary to obtain a definitive diagnosis.
The older child may have a contrast x-ray to show the state of the bowel. Depending on the age of the child anorectal manometry may be performed. This will test the strength of the muscles around the rectum to see if they are working properly. It is painless but does feel a little uncomfortable or strange.
What is the treatment? Will laxatives cure it?
Hirschsprung’s is a very serious disease and the only current effective treatment is a surgical procedure called a pullthrough operation. This is where the affected or aganglionic part of the bowel must be removed as it will never function properly and the good bowel is pulled down and attached to the anus.
This may be performed in a one, two or three stage operation. In the two stage operation the pullthrough is performed but part of the bowel is attached to a bag. The reason for this is usually to allow the bowel to recover from all of its stretching and infections, such as enterocolitis, that may have occurred previously. The attaching of the bowel to a bag, through a hole in the tummy, is called a stoma. Depending on where in the bowel the stoma is taken from it is called either an ileostomy or a colostomy. At a later date, agreed with the surgeon, the stoma will be closed and your child will then start to pass motions normally.
In the one stage procedure there is no stoma and your child will pass motions soon after the operation.
The operation which was first performed by Dr. Swenson in 1948, has had subtle variations developed over time and are known as the Swenson, Duhamel and Soave procedures. The newest procedures are the Transanal & Laparoscopic pullthrough’s. The Transanal is where the pullthrough is performed via the anus and no abdominal incisions are necessary. The Laparoscopic method reduces the abdominal incisions and therefore the stay in hospital. Your doctor will perform the surgery that they feel most comfortable with and which they consider give the best results for your child. Remember that the doctor does want the best for your child.