Faecal Incontinence After Pull-Through in Hirschsprung's Disease — Intact Anal Canal with Colonic Hypermotility
Following pull-through surgery for Hirschsprung's disease, some patients develop persistent faecal incontinence despite an anatomically intact anal canal. When this occurs alongside loose stools and an absence of colonic dilatation, a structured bowel management approach becomes the appropriate first-line strategy.
Clinical Scenario
This protocol applies to patients with faecal incontinence after pull-through in whom the anal canal is intact, there is no colonic dilatation, and the predominant functional pattern is colonic hypermotility with a tendency to loose stools. Medical management is the indicated first-line treatment in this setting.
Management Overview
The approach centres on a structured bowel management programme designed to achieve regular and complete colonic emptying. This may involve either retrograde or antegrade colonic irrigation techniques, combined where appropriate with dietary measures.
The complete protocol — including technique selection, sequencing, and adjunct measures — is available via the link below.
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)
- Proceed to bowel management if there is failure to respond, despite adequate dosing and compliance
- 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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