In the Brothers Grimm fairy tale, the trapped Rapunzel lets down her long hair through a tower window so a prince can climb up and rescue her.
Named after this tale, Rapunzel syndrome is an extremely rare medical condition where hairs the person has eaten become tangled and trapped in their stomach. This causes a trichobezoar (hair ball) to form, which has a long tail extending into the small intestine.
Recently, a 38-year-old woman had a 15 x 10 cm hair ball surgically removed from her stomach and a 4 x 3 cm hair ball removed from the top of her small intestine. This case, published in the journal BMJ Case Reports, marks the 89th published instance of Rapunzel syndrome in medical literature.
Like 85 to 95% of patients with Rapunzel syndrome, the woman presented to doctors with abdominal pain, nausea and vomiting. Other symptoms of Rapunzel syndrome include a bloated stomach, reduced appetite, weight loss and constipation or diarrhoea. In some cases the bowel is punctured, which can lead to sepsis (blood infection). Death has occurred in 4% of cases.
Fortunately, this woman made a successful recovery. But it’s unknown why she had been eating her own (or possibly other people’s) hair in the first place, or for how long. It can take six months for a hair ball to develop and there are reports of people coping with the dangerous symptoms of Rapunzel syndrome for 12 months before seeking treatment.
The authors of the BMJ Case Reports review found nearly 70% of patients with Rapunzel syndrome were females aged younger than 20. The youngest reported patients have been toddlers while the oldest patient was a 55-year-old man.
It’s thought more females than males develop Rapunzel syndrome because their hair strands are typically longer, and long hairs are more likely to get stuck in the stomach’s layers of mucous membranes. As more hair is consumed and is unable to be digested, the hair ball grows bigger.
Why do people eat hair?
Some people with intellectual disabilities and certain psychiatric disorders eat their own hair – a behaviour called trichophagia. These groups are thought to be at heightened risk for developing Rapunzel syndrome.
There are two particular psychiatric disorders that people who eat their hair are likely to have: trichotillomania and pica.
People with trichotillomania feel compelled to pull out their hair, often to the point of visible hair loss. It’s very common for people to then play with the removed hair strands. For example, nibbling the root of the hair or mouthing the hair along the lips can feel relaxing.