Vomiting, including vomiting a green or brown substance
Constipation or gas, which might make a newborn fussy
The most accepted theory of the cause of Hirschsprung disease (HSCR) is that there is a defect in the craniocaudal migration of neuroblasts originating from the neural crest, a process that begins at four weeks of gestation and ends at week 7 with the arrival of neural crest-derived cells at the distal end of the colon [Fu M., et al. 2004]. Failure of the cells to reach the distal colon leaves that segment aganglionic and therefore nonfunctional, resulting in Hirschsprung disease. Defects in the differentiation of neuroblasts into ganglion cells and ganglion cell destruction within the intestine may also contribute to the disorder [McKeown., et al. 2013].
Children who have Hirschsprung's disease are prone to a serious intestinal infection called enterocolitis. Enterocolitis can be life-threatening. It's treated in the hospital with colon cleaning and antibiotics [Goldstein.,
Abdominal X-ray using a contrast dye
Barium or another contrast dye is placed into the bowel through a special tube inserted in the rectum. The barium fills and coats the lining of the bowel, creating a clear silhouette of the colon and rectum. The X-ray will often show a clear contrast between the narrow section of bowel without nerves and the normal but often swollen section of bowel behind it [Amiel J and Sproat-Emison., et al. 2008].
A manometry test is typically done on older children and adults. The doctor inflates a balloon inside the rectum. The surrounding muscle should relax as a result due to Hirschsprung's disease [Moore., et al. 2009].
This is the surest way to identify Hirschsprung's disease. A biopsy sample can be collected using a suction device, then examined under a microscope to determine whether nerve cells are missing. After confirmation of nerve cell damage it will go for treatment (Fitze., et al. 2002).
Surgery to bypass the part of the colon that has no nerve cells treats Hirschsprung's disease. The lining of the diseased part of the colon is stripped away, and normal colon is pulled through the colon from the inside and attached to the anus. This is usually done using minimally invasive (laparoscopic) methods, operating through the anus [Kim., et al. 2006].
- Ileostomy: The doctor removes the entire colon and connects the small intestine to the stoma. Stool leaves the body through the stoma into a bag.
- Colostomy: The doctor leaves part of the colon intact and connects it to the stoma. Stool leaves the body through the end of the large intestine. Later, the doctor closes the stoma and connects the healthy portion of the intestine to the rectum or anus [Burzynski., et al. 2004].
After surgery, most children pass stool normally — although some may have diarrhea at first. Toilet training may take longer because children have to learn how to coordinate the muscles seed to pass stool. Long term, it's possible to have continued constipation, a swollen belly and leaking of stool (soiling) (Uesaka., et al. 2007).
- Swollen abdomen
- Bleeding from the rectum. (Uesaka and Nagashimada., 2008)
Dietary fiber refers to the edible parts of plants or carbohydrates that cannot be digested. Fiber is in all plant foods, including fruits, vegetables, grains, nuts, seeds, and legumes. If the child has constipation after surgery, following fibers are can be preferred for relief-
- Add high-fiber food in diet: If the child eats solid foods, include high-fiber foods. Offer whole grains, fruits and vegetables and limit white bread and other low-fiber foods. Because a sudden increase in high-fiber foods can worsen constipation at first, add high-fiber foods to your child's diet slowly [annot., et al. 2013].
- Increase fluids: Encourage the child to drink more water. If a portion or the child’s entire colon was removed, your child may have trouble absorbing enough water. Drinking more water can help the child stay hydrated, which helps to easy pass the stool [Martucciello., et al. 2000].
- Encourage physical activity: Daily aerobic activity helps promote regular bowel movements.
- Laxatives: If the child does not respond to or cannot tolerate increased fiber, water or physical activity, certain laxatives [ex- Lectulose, Besacodyl etc.] medications to encourage bowel movements — might help relieve constipation [Bajaj., et al. 2005].
Psyllium is a type of soluble fiber that comes from a shrub like herb called Planto ovata. Psyllium may be the most used fiber supplement on the market. Psyllium can be used in the conditions including hemorrhoids, irritable bowel syndrome, constipation and diarrhea. Psyllium husks can be consumed in their whole form either by mixing in fruit juice or milk. One glass of liquid can be mixed with dried psyllium seed to produce it effect. However, psyllium supplements are commonly ground into a more easily ingested powdered form [Garcia-Barcelo., et al. 2009].
Glucomannan is a precursor of sugar that present in several plants including dietary fiber. It is derived from the root of the konjac plant. Glucomannan swells to about 17 times its original volume when immersed in water and used in the treatment of constipation. For this reason, glucomannan can be an effective bulking fiber in small doses [Pini Prato., et al. 2013].
Methylcellulose is a bulk-forming fiber that can increase the amount of water in stool, which can help relieve constipation. As with any bulk-forming fiber supplement, it is important to take methylcellulose with a full glass of water. Methylcellulose is the key ingredient in a popular brand of fiber supplement [Menezes., et al. 2005].
In addition to being high in fiber, flaxseed also possesses other beneficial properties including rich concentrations of omega-3 fatty acids, phytochemicals and lignans. Flaxseeds can be purchased in their whole form or in a ground supplement, which may be easier for the body to digest. The use of constipation in these seeds is also used to treat Hirschsprung disease by several doctors [Bull., et al. 2011].
- Wheat dextrin is a natural fiber used in one popular brand of fiber supplement.
- Calcium polycarbophil is a bulk-forming fiber laxative used in another popular brand of fiber supplement [Raveenthiran., et al. 2011].
- Inulin is a starch like substance found in a variety of fruits, vegetables and herbs. Inulin supports the growth of a particular type of bacteria that may help improve bowel function [Parisi., et al. 2000].
|Fruits||Serving size||Total fiber (grams)*|
|Pear, with skin||1 medium||5.5|
|Apple, with skin||1 medium||4.4|
|Strawberries (halves)||1 cup||3.0|
|Figs, dried||2 medium||1.6|
|Raisins||1 ounce (60 raisins)||1.0|
|Grains, cereal and pasta||Serving size||Total fiber (grams)|
|Spaghetti, whole-wheat, cooked||1 cup||6.3|
|Barley, pearled, cooked||1 cup||6.0|
|Bran flakes||3/4 cup||5.5|
|Oat bran muffin||1 medium||5.2|
|Oatmeal, instant, cooked||1 cup||4.0|
|Popcorn, air-popped||3 cups||3.6|
|Brown rice, cooked||1 cup||3.5|
|Bread, rye||1 slice||1.9|
|Bread, whole-wheat||1 slice||1.9|
|Legumes, nuts and seeds||Serving size||Total fiber (grams)*|
|Split peas, boiled||1 cup||16.3|
|Lentils, boiled||1 cup||15.6|
|Black beans, boiled||1 cup||15.0|
|Lima beans, boiled||1 cup||13.2|
|Baked beans, vegetarian, canned, cooked||1 cup||10.4|
|Almonds||1 ounce (23 nuts)||3.5|
|Pistachio nuts||1 ounce (49 nuts)||2.9|
|Pecans||1 ounce (19 halves)||2.7|
|Vegetables||Serving size||Total fiber (grams)*|
|Artichoke, boiled||1 medium||10.3|
|Green peas, boiled||1 cup||8.8|
|Broccoli, boiled||1 cup||5.1|
|Turnip greens, boiled||1 cup||5.0|
|Brussels sprouts, boiled||1 cup||4.1|
|Sweet corn, boiled||1 cup||3.6|
|Potato, with skin, baked||1 small||2.9|
|Tomato paste, canned||1/4 cup||2.7|
|Carrot, raw||1 medium||1.7|
The mechanism of action of fiber on constipation includes:
- Fiber increases stool bulk and accelerates colon transit.
- Fermenting fiber produces short-chain fatty acids (butyrate, propionate, acetate, etc.), which increase osmotic load and accelerate colon transit [Stewart., et al. 2003].
- Short-chain fatty acids change the intraluminal microbiome (mass) directly or indirectly by decreasing luminal pH, which accelerates colon transit [Holschneider., et al. 2003].
- Fiber contains more water compare to other food [Coran., et al. 2000].
I would like to thanks Dr. APJ Abdul kalam Techniccal University, Uttar Pradesh, Lucknow to do this review article with encouragement and push up my adrenaline level to believe myself for submitting this article.
The author declares no conflict of interest
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