{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T22:11:20Z","timestamp":1790892680286,"version":"4.1.0"},"reference-count":101,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T00:00:00Z","timestamp":1692489600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>After an initial pull-though, patients with Hirschsprung disease (HD) can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or fecal soiling. This current review focuses on algorithms for evaluation and treatment in children with HD as a part of a manuscript series on updates in bowel management. In constipated patients, anatomic causes of obstruction should be excluded. Once anatomy is confirmed to be normal, laxatives, fiber, osmotic laxatives, or mechanical management can be utilized. Botulinum toxin injections are performed in all patients with HD before age five because of the nonrelaxing sphincters that they learn to overcome with increased age. Children with a patulous anus due to iatrogenic damage of the anal sphincters are offered sphincter reconstruction. Hypermotility is managed with antidiarrheals and small-volume enemas. Family education is crucial for the early detection of HAEC and for performing at-home rectal irrigations.<\/jats:p>","DOI":"10.3390\/children10081418","type":"journal-article","created":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T01:33:11Z","timestamp":1692581591000},"page":"1418","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0712-3508","authenticated-orcid":false,"given":"Elizaveta","family":"Bokova","sequence":"first","affiliation":[{"name":"Comprehensive Colorectal Center, Department of Surgery, Children\u2019s Mercy Kansas City, Kansas City, MO 64108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ninad","family":"Prasade","sequence":"additional","affiliation":[{"name":"Comprehensive Colorectal Center, Department of Surgery, Children\u2019s Mercy Kansas City, Kansas City, MO 64108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjana","family":"Janumpally","sequence":"additional","affiliation":[{"name":"Comprehensive Colorectal Center, Department of Surgery, Children\u2019s Mercy Kansas City, Kansas City, MO 64108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4291-3214","authenticated-orcid":false,"given":"John M.","family":"Rosen","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children\u2019s Mercy Kansas City, Kansas City, MO 64108, USA"},{"name":"Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO 64108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1711-443X","authenticated-orcid":false,"given":"Irene Isabel P.","family":"Lim","sequence":"additional","affiliation":[{"name":"Comprehensive Colorectal Center, Department of Surgery, Children\u2019s Mercy Kansas City, Kansas City, MO 64108, USA"},{"name":"Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7711-7392","authenticated-orcid":false,"given":"Marc A.","family":"Levitt","sequence":"additional","affiliation":[{"name":"Division of Colorectal and Pelvic Reconstruction, Children\u2019s National Medical Center, Washington, DC 20001, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8689-5989","authenticated-orcid":false,"given":"Rebecca M.","family":"Rentea","sequence":"additional","affiliation":[{"name":"Comprehensive Colorectal Center, Department of Surgery, Children\u2019s Mercy Kansas City, Kansas City, MO 64108, USA"},{"name":"Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,20]]},"reference":[{"key":"ref_1","first-page":"568","article-title":"A Genetic Study of Hirschsprung Disease","volume":"46","author":"Badner","year":"1990","journal-title":"Am. 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