Belly Pain 101: What’s the Difference Between IBS and IBD?

All children have occasional brief bouts of abdominal pain or diarrhea. If it doesn’t last for long, there’s usually no need to interfere with your child’s daily activities. Avoid foods that seem to irritate your child’s stomach and make sure a child with diarrhea drinks plenty of fluids.

But if the problems persist for more than a couple of days and start to get in the way of your child’s school and social life, the first step is to contact your pediatrician. It could be a stomach bug, another type of infection or a food allergy. Or it could be something more serious that requires further medical attention.

Two possible suspects are irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). The names are similar, and the symptoms can be as well — but the two conditions require different approaches to treatment.

What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome (IBS) is characterized by stomach discomfort or pain and often a change in bowel habits. Symptoms can include:

• Bloating
• Cramping
• Chronic or intermittent diarrhea
• Constipation

These symptoms can make a child feel sick. Persistent diarrhea can be an embarrassment that causes a child to avoid social activities or resist going to school. If the stomach pain is bad enough, a child may start eating less and may lose weight. These are all serious consequences.

Treatment for IBS is tailored to each individual child, and may include:

• Medicines such as acid blockers or antispasmodics
• Dietary strategies to cut back on foods that trigger symptoms and identify foods that promote better health
• Behavioral health counseling to help a child cope with symptoms and manage worries that can contribute to the stomach problems

In most cases, these simple interventions help reduce the intensity of the symptoms so that they no longer trouble the child. Over time, children may outgrow their IBS.

What is inflammatory bowel disease (IBD)?

Inflammatory bowel disease (IBD) is a chronic condition that involves inflammation in the lining of the digestive system. It can be debilitating and even life-threatening. IBD may present with symptoms similar to IBS at first, but there are certain warning signs that may alert your doctor to order blood tests to check for the inflammation that characterizes IBD.

• Weight loss or no increase in weight
• Growth slowdown or no growth between doctor’s visits (children should grow throughout childhood and adolescence)
• Persistent diarrhea, especially bloody diarrhea and nighttime diarrhea
• Other signs of inflammation, such as fevers, mouth sores, joint swelling or certain rashes

If a blood test shows anemia, low albumin levels, or high levels of specific inflammation markers, your child should be referred to a pediatric gastroenterologist for additional tests to identify the source of the inflammation.

The two main forms of IBD are Crohn’s disease and ulcerative colitis. Both are diagnosed with an endoscopy and colonoscopy. The scopes look for visual signs of inflammation in the intestines. If found, tissue samples (biopsies) are taken and examined under a microscope. The location of the inflammation and the appearance of the inflamed cells determine the specific diagnosis.

The approach to treatment is similar for the different forms of IBD, and is always tailored to each child’s unique medical situation. Treatment may include:

• Medication to reduce inflammation or suppress the body’s immune response
• Nutritional therapy to identify and adopt a diet that does not trigger inflammation, sometimes using a liquid formula taken through a nasogastric (NG) or gastrointestinal (G) tube
• Surgery to repair or remove sections of the intestine that have become blocked or in which the tissue has irreversible inflammation

There is currently no cure for IBD, but the symptoms can generally be managed with treatment. Children and adults with IBD often have periods without symptoms (remission) followed by flare-ups with intense symptoms. Treatment that works for one stage of the disease may not work for the next, so the medical team must regularly watch for signs that a change in treatment may be needed.

What to do when your child complains of belly pain

When your child complains of a sore stomach or has diarrhea, it’s usually a minor problem that will resolve itself. But contact your pediatrician if the problem continues for more than a couple of days or is severe enough to keep your child from going to school or participating in the activities they enjoy. Early and accurate diagnosis can help your child get the treatment they need.