Introduction
Constipation is a common issue in infants and children, but not all cases are the same. While functional constipation is usually benign and related to diet or behavior, Hirschsprung disease is a serious congenital condition requiring medical intervention. Understanding the differences is crucial for early diagnosis and appropriate treatment.
What is Hirschsprung Disease?
Hirschsprung disease (HD) is a congenital disorder caused by the absence of ganglion cells in the distal bowel, leading to a lack of peristalsis and difficulty in passing stool. This occurs due to a failure of neural crest cell migration during fetal development.
Key Features of Hirschsprung Disease:
- Delayed meconium passage (>48 hours after birth).
- Severe, persistent constipation starting in the neonatal period.
- Abdominal distension and bilious vomiting.
- Failure to thrive due to poor feeding and malabsorption.
- Enterocolitis risk, presenting with fever, explosive diarrhea, and sepsis.
- Empty rectum on digital examination with an explosive stool release upon finger withdrawal.
- Requires surgical intervention (pull-through procedure).
What is Functional Constipation?
Functional constipation is a common condition caused by dietary factors, inadequate fiber intake, withholding behavior, or psychological stress. It does not involve structural abnormalities of the intestine.
Key Features of Functional Constipation:
- Usually starts after infancy, often during toilet training.
- No history of delayed meconium passage at birth.
- Normal abdominal growth without significant distension.
- Stool withholding behavior common in toddlers.
- Fecal soiling (encopresis) due to overflow incontinence.
- Full rectum on digital examination.
- Improves with dietary changes, laxatives, and behavior therapy.
