Treatment of Hirschsprung's Disease with Faecal Incontinence After Pull-Through (Intact Anal Canal, Colonic Hypermotility)
After a technically successful pull-through procedure, some patients develop faecal incontinence despite an anatomically intact anal canal. When this occurs alongside a tendency to loose stools and colonic hypermotility — without colonic dilatation — a defined medical management approach is indicated as first-line treatment.
Clinical scenario
Faecal incontinence with an intact anal canal, no colonic dilatation, and loose stools due to colonic hypermotility following pull-through surgery. In this setting, patients should receive medical management as the initial therapeutic step before any further intervention is considered.
Treatment approach
Management focuses on dietary modification to slow colonic transit, with additional agents considered when dietary measures alone are insufficient. The complete structured regimen — including agent selection, sequencing, and individualisation — is set out in the full protocol.
References
DOI: 10.1186/s13023-020-01362-3
- Patients with an intact anal canal and appropriate pull-through but fecal incontinence should receive medical management as the first-line treatment.
- For patients without colonic dilatation and a tendency to loose stools (hypermotility), a constipating diet +/− loperamide +/− bulking agents (pectin, psyllium).
- These include a constipating diet, loperamide and bulking agents (e.g. pectin, psyllium).
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