This protocol addresses patients who have undergone pull-through surgery for Hirschsprung's disease and subsequently present with faecal incontinence despite an intact anal canal. The specific sub-population is characterised by the absence of colonic dilatation together with a tendency to loose stools reflecting colonic hypermotility.
Patients with an intact anal canal and appropriate pull-through but faecal incontinence should receive medical management as the first-line treatment. For those without colonic dilatation and a tendency to loose stools (hypermotility), initial management focuses on dietary and pharmacological strategies to address bowel consistency and frequency before escalating further.
When symptoms prove intractable despite first-line measures, a surgical intestinal intervention may be required in isolated cases. The full structured regimen — including sequencing, specific indications, and all management steps — is available via the link below.
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).
An enterostomy may be required in isolated cases for intractable symptoms.
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