Hirschsprung disease: Dietary guidelines to ease stooling

Hirschsprung disease is a condition of the gastrointestinal (GI) tract in which nerve cells, called ganglion cells, have not formed on the inner wall of the bowel. When these cells are missing, stool (poo) does not move properly through the bowel, which can make a child very sick.

Hirschsprung disease is normally treated with surgery. However, even after surgery, a child may continue to have issues with stooling.

The guidelines below are designed to help you adapt your child's diet and help manage their stool output. They also promote general bowel health. We encourage the entire family to follow a similar diet so that your child with Hirschsprung disease is not singled out.

What is the goal of a special diet for Hirschsprung disease?

A diet for children with Hirschsprung disease can help improve the texture of your child's stool and reduce any gas or bloating. The goal for children with Hirschsprung disease is to have at least one or two soft (peanut butter-like texture) stools every day with as little discomfort as possible.

Dietary guidelines to make stooling easier

Important: Please tell your child's healthcare team if your child is already on a special diet before you follow any of the guidelines below.

Limit concentrated sugars and sugar alternatives

Sugars and sugar alternatives can increase gas and bloating and cause diarrhea.

• Avoid sweets and sugary foods such as candies, cookies, soda, juice, sports drinks and syrup.
• Avoid sugar alternatives such as sucrose (Splenda), sorbitol and manitol.
• Read the labels of processed food and choose foods and drinks with less than 10 g of sugar per serving.

Eat a high-fibre diet

Fibre helps to make the stool soft and bulky, which prevents constipation. It also helps to control blood sugar levels.

• Introduce fibre slowly, as it may cause gas and bloating at first.
• Make sure your child is drinking enough fluids. Water is best.
• Consider adding natural wheat bran or psyllium to your child's food. Some psyllium products can cause choking, however, so make sure your child has no difficulties with swallowing and takes enough fluids.

Monitor your child's response to dairy products

Milk and milk products contain a sugar called lactose. The body uses an enzyme called lactase to break down this sugar in the intestine. If your child does not produce enough lactase, they may find it difficult to absorb lactose and develop symptoms such as bloating, gas and diarrhea.

• Consider reducing your child's intake of lactose to see if it helps to ease their symptoms.
• Try lactose-free dairy milk or soy drinks.
• Offer your child yogurt and firmer cheese such as Swiss or cheddar - they might find these easier to tolerate than a glass of plain milk.
• Limit milk to 500 mL a day once your child is aged over 12 months.

You can find more guidelines in the table below.

Eat regularly

• Have three meals and one or two snacks each day.
• Aim to eat every three hours. Eating throughout the day will make your child's bowel work throughout the day.

Record any changes in your child's symptoms

Not all people react the same way to foods. Your child's ability to tolerate foods depends on:

• how much of their bowel is affected by Hirschsprung disease and
• whether they have had part of their bowel removed or have an ostomy.

There may be a period of trial and error while you learn what works best for your child. Some parents find it useful to keep a record of the food their child eats and how this affects their symptoms, for example the frequency and texture of their stool and whether they feel less bloated or gassy.