Functional Abdominal Pain
What is functional abdominal pain?
Functional abdominal pain is classified as a functional gastrointestinal disorder (FGIDs). Functional abdominal pain is the most common condition seen by pediatric gastroenterologists. Diagnosis may be made in children who have abdominal pain for two months or greater, a normal physical exam performed by their health care provider, and absence of infection, inflammation or anatomic irregularities of the gastrointestinal tract. Your child’s gastroenterologist will carefully exam and evaluate your child for these other disorders.
Causes of functional abdominal pain
Functional abdominal pain is thought to be caused by the input from overly sensitive nerves of the GI tract muscles and nerves that are processing these signals in the brain. We call this our “brain-gut axis.” In functional abdominal pain and other functional gastrointestinal disorders, there is a heightened sensitivity to the normal function of the gastrointestinal tract.
Daily functions of the GI tract, like stretching and pushing food down after we eat, may feel more painful due to these sensitive nerves. Any periods of stress, anxiety and depression worsen the symptoms because of the close interaction between the brain and the GI tract.
Functional abdominal pain is not caused by an anatomic, biochemical, inflammatory or infectious abnormalities.
Signs and symptoms of functional abdominal pain
The pain associated with functional abdominal pain is real. The pain can be chronic or recurrent. The pain is usually felt between the chest and the pelvis, most commonly concentrating in the middle, near the belly button. The pain can come and go or it can be continuous. It can also be made worse by esophageal reflux, constipation, food intolerance, medication side effects, viral or bacterial infections or stress and anxiety.
Overlap diagnoses of functional abdominal pain
Other disorders that may be associated with functional abdominal pain include:
- Functional dyspepsia
- Irritable bowel syndrome (IBS)
- Abdominal migraine
- Functional constipation
- Anxiety disorders
- Depressive disorders
Testing and Diagnosis of functional abdominal pain
Your healthcare provider will obtain a detailed history of the pain and perform a physical exam. In functional abdominal pain, physical exam is normal and the child is growing well. Screening tests may be performed to screen for other conditions causing pain. Extensive testing, including endoscopy is usually performed only if basic screening lab results do not fit the diagnosis of functional abdominal pain. If physical exam and screening tests are unremarkable, then a diagnosis of functional abdominal pain may be made.
Testing may include:
- Blood tests. These tests are done to evaluate whether your child is anemic, has an infection, or has an illness caused by inflammation, irritation or autoimmune factors.
- 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.
- Abdominal ultrasound. A diagnostic imaging technique which creates images from the rebound of high-frequency sound waves in the internal organs. Used to evaluate for potential disorders of the kidneys, liver, pancreas and gallbladder.
Treatment for functional abdominal pain
The main objective of treatment for functional abdominal pain is to restore normal daily function. Medical intervention is combined with cognitive behavioral therapy (CBT) to help manage symptoms. Dietary changes can also help. Fortunately, functional abdominal pain causes no serious long-term health problems. It is important to continue with life as normal, attending school and regular activities, despite pain.
Medications are determined by your provider based on severity of symptoms and may include:
- Antispasmodics and other medications to target visceral hypersensitivity.
- Probiotics to alter the intestinal flora of the bowel.
- Peppermint to aid with abdominal pain in conjunction with other therapies.
- Diet: A dietician can help determine if a trial free of gluten or lactose would benefit your child. The addition of fiber may also be useful.
- Psychological interventions.
- Cognitive Behavioral Therapy for functional abdominal pain, including education, relaxation training, coping skills for pain and associated distress, and goal setting for improved functioning (school attendance, engagement in social activities). Caregivers are an important part of the care team and are often asked to coach their children in using therapy strategies between visits.
Outlook for diagnoses for functional abdominal pain
Most children diagnosed with functional abdominal pain will see improvement or resolution of their symptoms with proper treatment. However, some children may continue to have pain into adulthood. Our team emphasizes improved quality of life as our primary treatment goal for children and families affected by functional abdominal pain.
Why choose the Division of Gastroenterology, Hepatology and Nutrition at CHOP?
We provide a multidisciplinary team approach involving gastroenterologists, psychologists, nursing, dieticians and social workers who provide collaborative care for your child.