Hirschsprung's Disease

Hirschsprung's disease is a condition in which nerve cells are missing from part of the bowel from birth, which affects bowel movements and the passing of stool. The main treatment is surgery; however, some children continue to have bowel problems after surgery, such as constipation, difficulty passing stool, fecal incontinence, or stool soiling in their underwear. In these cases, how the child uses their pelvic floor and abdominal muscles during bowel movements, whether they can relax these muscles enough, and their bowel control can be assessed together. In suitable children, pelvic floor physiotherapy can be used alongside surgical and medical treatment to support muscle coordination, the mechanics of passing stool, and bowel control.

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Common and Treatable

A study of children who had a Soave procedure for Hirschsprung's disease and continued to have fecal incontinence reported that pelvic floor muscle training and biofeedback significantly improved bowel control.

"My child had surgery for Hirschsprung's, but the constipation hasn't gone away."

"I'm looking for an additional treatment to support my child's bowel control after Hirschsprung's surgery."

"My child often has stool soiling in their underwear."

Sun X, Wang R, Zhang L, Li D, Li Y. Efficacy of pelvic floor muscle training for the treatment of fecal incontinence after Soave procedure for Hirschsprung disease.

Hirschsprung's Disease FAQ

How is Hirschsprung's disease related to the pelvic floor muscles?

The pelvic floor muscles and anal sphincters play an important role in holding in stool and releasing it at the right time. Even after Hirschsprung's disease has been treated surgically, some children may develop problems coordinating their pelvic floor muscles during bowel movements. This goes along with ongoing constipation, difficult bowel movements, or fecal incontinence.

Why does constipation continue after Hirschsprung's surgery?

Ongoing constipation after surgery can have different causes: anatomical, related to bowel motility, or functional. In some children, the pelvic floor muscles contract instead of relaxing during a bowel movement, meaning the coordination of defecation is impaired, and this can also cause constipation. That is why, when symptoms persist, a detailed assessment of how your child passes stool is important.

Can pelvic floor physiotherapy be used for Hirschsprung's disease?

Yes. Pelvic floor physiotherapy can be used especially in children who still have problems such as constipation, difficulty passing stool, or fecal incontinence after surgery and who have been found to have pelvic floor dysfunction. The program is tailored to the child's age, symptoms, and assessment results.

How is biofeedback therapy used for Hirschsprung's disease?

Biofeedback helps the child learn how their pelvic floor and anal sphincter muscles work through visual feedback. Depending on the child's needs, the work can focus on relaxing the muscles at the right time during bowel movements or on using the muscles needed for bowel control more effectively.

Can physiotherapy help with fecal incontinence after Hirschsprung's surgery?

Yes. In suitable children, pelvic floor muscle training and biofeedback can be used to support bowel control. Treatment is a personalized program that takes into account the child's muscle function, coordination, and the underlying causes of the fecal incontinence.

Can difficulty passing stool in Hirschsprung's disease come from the pelvic floor?

In some children, the pelvic floor muscles cannot relax enough during a bowel movement, which can make it harder to pass stool. This is called dyssynergic defecation, and it can be one of the contributing causes of severe constipation that persists after Hirschsprung's surgery.

What does physiotherapy for Hirschsprung's disease involve?

The child's bowel habits, toilet posture, coordination of the abdominal and pelvic floor muscles, and bowel control are assessed. Depending on needs, treatment includes pelvic floor training, EMG biofeedback, relaxation and coordination work for bowel movements, breathing exercises, correct toilet posture, and personalized exercises.

When can physiotherapy start for Hirschsprung's disease?

The timing of physiotherapy depends on the child's surgical course, age, ongoing bowel symptoms, and the doctor's assessment. Especially if constipation, difficulty passing stool, or fecal incontinence continue after surgery, a pelvic floor assessment should be considered.