Constipation … is a word that confuses both patients and clinicians: it is a word that defines the state of the bowel function as poorly as the word asthma defines respiratory disease. Constipation can be as simple as a slightly firm stool, but can be a patient who has bowel perforation from the retention of faeces; just as asthma can be someone with a wheeze on exercise, but may result in the death of another patient when severe.
Firm stool passed infrequently can be because of the need for a better diet, a better bowel habit and more fluid each day. But there are a range of other potential causes. There-in lies part of the problem for a patient with constipation – because most will resolve with more fluid, more fibre and a better bowel habit, clinicians do not necessarily consider that some have a condition that requires further investigation, and even surgery.
Hirschprung Disease causes bowel obstruction in 1 in 5000 live births … which means it is rare. If present, surgery is needed to remove the part of the bowel that is missing the relaxing nerves at the “bottom” end. And, there are other reasons for constipation that may need surgery, including a narrow anus, or after surgery for an imperforate anus, or where the lower part of the bowel is too big – a congenital megarectum.
Extreme examples of congenital megarectum do occur, this case above is of a boy from PNG; the image on the left is with the white barium around the HUGE rectum: the H.U.G.E rectum is shown at operation in the right image. Cases similar to this occur in Australia, although they rarely (and should never) reach this extreme.