Irritable Bowel Syndrome in Children

What is irritable bowel syndrome?

Irritable bowel syndrome (IBS) is a chronic disorder causing annoying and often painful abdominal and bowel symptoms. IBS is considered a functional bowel disorder, meaning that, although symptoms are clearly present, when the bowel is examined visually and under the microscope, there is no evidence of damage to the tissues. Symptoms include:

• Bloating

• Cramping

• Chronic or intermittent diarrhea

• Chronic or intermittent constipation

• Urgency with defecation

• Incomplete sensation of defecation

• Passage of mucus in the stool

What causes irritable bowel syndrome?

The digestion and propulsion of nutrients and fluids through the gastrointestinal system (GI) is a very complicated and very well organized process. The GI tract has its own intrinsic muscles and nerves that connect, like an electrical circuit, to the spinal cord and brain. Neuromuscular events occurring in the GI tract are relayed to the brain through neural connections, and the response of the brain is also relayed back to the gastrointestinal tract. As a result of this activity, motility and sensation in the bowel is generated. An abnormality in this process results in a disordered propulsion of the intestinal contents and generates the sensation of pain.

The exact cause of IBS is unknown. One theory is a person with IBS may have a colon that is more sensitive and reactive than usual, so it responds strongly to stimuli that would not affect others. The nerves that control the digestive tract may also be more sensitive to the activity associated to the process of digestion. Children with irritable bowel syndrome may be more aware of gas and motion and rumbles of the intestines. They are more aware of these discomforts and hence more irritated when they occur. Children may experience the symptoms of IBS due to:

• Motility abnormalities

• Hypersensitivity of the inside of the bowel to stretching and motion

• Stress

• Overgrowth of bacteria in the bowel

All of the above factors can trigger the occurrence of symptoms. It is important to stress to the child with a functional bowel disorder that his or her abdominal pain is real and not imaginary.

Who is affected by irritable bowel syndrome?

• IBS occurs in both children and adults. Almost 14 percent of high school students and 6 percent of middle school students complain of IBS-like symptoms.

• Girls and boys are equally affected by the disorder.

• There is no known gene that causes IBS, but the disorder does seem to occur more often in families where either a child or a parent has the disorder.

Why is irritable bowel syndrome a concern?

Children with IBS often do not feel well. Those who have diarrhea may have little warning of their need to go to the bathroom, and, therefore, may be embarrassed and avoid going to school or socializing with their schoolmates. Children can become depressed or anxious because of the disorder.

Most children with IBS continue to grow and develop normally. However, some children may eat less to avoid the pain that can accompany digestion, and therefore, lose weight.

What are the symptoms of irritable bowel syndrome?

According to the National Institute of Diabetes and Digestive and Kidney Diseases, IBS in children tends to produce two types of symptoms: diarrhea or pain, depending on the age of the child. Symptoms may include:

• Recurrent abdominal pain. The pain becomes chronic when it has been present for a period greater than three months.

• An altered bowel pattern with diarrhea and constipation, all of which suggests intestinal motility problems.

• Nausea

• Dizziness

• Loss of appetite

In children, symptoms of functional bowel disorders are variable and are age dependent. For example:

• Infantile colic (younger than 4 months of age)

• Gastroesophageal reflux (younger than 2 years of age and then reappears in adolescence and adulthood)

• Chronic nonspecific diarrhea (younger than 4 years of age)

• Constipation (any age)

• Irritable bowel syndrome (adolescents and adults)

The symptoms of IBS are not unique for the condition. Altered bowel pattern and abdominal pain could be symptoms of organic disease--one reason why you should always consult your child's health care provider for a diagnostic work-up.

How is irritable bowel syndrome diagnosed?

Your child's health care provider will obtain a thorough medical history, perform a full physical examination, and obtain screening laboratories to assess for infection and inflammation. The laboratory tests, imaging studies, and procedures to be performed will be dictated by the history and physical examination. Tests and procedures that your child's health care provider may order include the following:

• Blood tests. These tests are done to evaluate whether your child is anemic, has an infection, or has an illness caused by inflammation or irritation.

• Urine analysis and culture. These are done to help assess for urinary tract infections.

• Stool sample. This sample is taken to culture to check for bacteria and parasites that may cause diarrhea.

• Stool samples for occult blood. Occult blood cannot be seen and is only detected by a special solution that turns blue when coming into contact with blood. It suggests an inflammatory source in the gastrointestinal tract.

• Lactose breath hydrogen test. This test is done to determine if your child is intolerant to lactose, a sugar present in milk and milk products.

• Abdominal X-ray. A simple study that will give the health care provider an idea of how the internal organs look.

• Abdominal ultrasound. A diagnostic imaging technique which creates images from the rebound of high frequency sound waves in the internal organs.

• Endoscopy. A test that uses a small, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of part of the digestive tract. Tissue samples from inside the digestive tract may also be taken for examination and testing.

   

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• Colonoscopy. A test that uses a long, flexible tube with a light and camera lens at the end (colonoscope) to examine inside the large intestine.

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What is the treatment for irritable bowel syndrome?

Specific treatment of IBS will be determined by your child's health care provider based on:

• Your child's age, overall health, and medical history

• Extent of the problem

• Your child's tolerance for specific medications, procedures, or therapies

• Expectations for the course of the condition

• Your opinion and preference

The main objective of treatment for IBS is to restore normal daily function. Management begins with the positive diagnosis of IBS. This will give your child reassurance that he or she does not have any life-threatening condition. Treatment may include dietary changes, medication, and stress management. 

Try to help the child focus on something fun or pleasant during a painful episode.

In lactose intolerant patients, restriction of lactose or supplementing the enzyme that digests the sugar (lactase/Lactaid) is recommended since this sugar can be a trigger for symptoms of IBS.

A controversial issue is the use of high fiber in children since it could promote flatulence and abdominal distension. It is recommended in the adult population, and it may be beneficial in children in which the symptom of constipation predominates.

Depending on the severity of the symptom, medication may be indicated. In rare cases, pain control needs to be administered by specialists in the field of pain management. Biofeedback has become part of the treatment strategy, as well as acupuncture.