At just over two months old, Dingding's bowel movements were his mother's biggest headache. Unlike other newborns who pass meconium within a day or two, he didn't have his first bowel movement until the fourth day—and even then, it was only a tiny bit. After that, he went several more days without passing stool, his little tummy swelling up like a small round ball. His mother had no choice but to use a suppository every few days to help him pass stool.This also affected Dingding's appetite, causing him to lag behind other babies his age in growth. With no other options, his mom took him to the hospital. It turned out Dingding's constipation was actually due to congenital megacolon.The doctor explained that a segment of Dingding's intestine lacked properly developed nerve cells. During bowel movements, this insensitive section failed to contract, causing stool to accumulate instead of moving forward. Surgery was needed to remove this affected portion and restore normal intestinal motility for regular bowel function.
Newborns typically pass their first stool, known as meconium, within ten hours of birth. While most babies clear their meconium within 2-3 days, some infants show no signs of their first bowel movement—or only pass a small amount—even after two or three days. They may then go several days, or even a week or two, between bowel movements.Parents may initially assume this is mere constipation and not pay much attention. Only when the child goes several days without passing stool and their abdomen becomes distended like a small round ball do they seek medical help. It is then discovered that the child does not have ordinary constipation, but rather congenital megacolon or another underlying condition.
Congenital megacolon, also known as congenital aganglionosis or Hirschsprung's disease, occurs when nerve cells are absent in the affected intestinal segments. This causes persistent intestinal spasms, preventing stool from moving forward and causing it to accumulate in the proximal colon. The affected intestinal tract becomes thickened and dilated. It is a relatively common congenital gastrointestinal malformation, frequently seen in newborns.with reported incidence rates ranging from 1 in 2,000 to 1 in 5,000 births.
Once diagnosed with megacolon, surgical resection of the affected intestinal segment is typically required to restore normal peristalsis and bowel function. Failure to do so allows the normal intestine above the affected area to continue dilating, ultimately necessitating resection of what could have been preserved due to delayed surgery. Additionally, prolonged severe abdominal distension significantly impacts the child's appetite, leading to poor eating habits.resulting in reduced nutrient absorption and subsequent developmental delays or emaciation.
This may alarm some parents, as constipation is common in children. How can one distinguish between constipation caused by Hirschsprung's disease and ordinary constipation when a child struggles to pass stool?
Generally, if an infant passes no or only minimal meconium within 48 hours of birth, or experiences persistent constipation after birth—defecating only every 3-7 days or even once every week or two—and in severe cases cannot pass stool without enemas,and physical examination reveals abdominal distension resembling a frog belly with palpable hard fecal masses, parents should be vigilant. Promptly take the child to the hospital for examinations such as digital rectal examination, barium enema, and rectal mucosal biopsy to rule out congenital megacolon.Of course, parents shouldn't panic if their child hasn't had a bowel movement in two or three days. Some children, especially those breastfed, may go this long without defecating. However, if the child is feeding well, the abdomen isn't distended, and stool consistency is normal, there's no need for excessive worry.
In summary, when facing issues with their child's bowel movements, parents should neither be careless nor overly alarmed.What parents should do: In addition to monitoring stool frequency, closely observe other symptoms such as the child's first stool after birth, stool consistency, and whether accompanied by abdominal distension, vomiting, or poor appetite. Provide these details as thoroughly as possible to the doctor for reference. Once a diagnosis is confirmed, follow the professional medical advice.
Guidance: Dr. Le Shenglin, Chief Physician, Pediatric Surgery Department, Guangdong Maternal and Child Health Hospital (Expert Appointment)