Treatment of Hirschsprung's Disease with Faecal Incontinence and a Damaged Anal Canal After Pull-Through

Patients who have undergone a pull-through procedure for Hirschsprung's disease may be left with a damaged anal canal and persistent faecal incontinence. This subset requires a specific management approach distinct from uncomplicated post-operative care.

Clinical Scenario

Faecal incontinence with a damaged anal canal following pull-through. Because the anal sphincter mechanism may be compromised after surgery, conventional continence strategies are insufficient and active bowel management is indicated.

Approach (partial overview)

Management centres on a structured bowel management programme targeting regular and complete colonic emptying. The programme involves colonic irrigation — delivered either retrogradely or anterogradely — along with adjunctive dietary measures.

Full regimen details, sequencing, and individualised options are in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1186/s13023-020-01362-3

Patients with fecal incontinence and damaged anal canal should receive bowel management.
Options include regular retrograde enemas or antegrade colonic irrigation via an antegrade continence enema appendicostomy (ACE) or cecostomy +/− dietary modifications +/− laxatives.

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