Irritable Bowel Syndrome in Children

Irritable bowel syndrome (IBS) is a chronic disorder that causes annoying and often painful abdominal and bowel symptoms. Although symptoms are clearly present, when the bowel is examined visually and under the microscope, there is no evidence of tissue damage. Symptoms may include:

• Bloating

• Cramping

• Chronic or intermittent diarrhea

• Chronic or intermittent constipation

• Urgency with defecation

• Incomplete sensation of defecation

• Passage of mucus in the stool

The exact cause of IBS in children is unknown. One theory is that a person with IBS may have a colon that is more sensitive and reactive than normal. This causes the bowel to respond strongly to stimuli that would not affect others. The nerves that control the digestive tract may also be more sensitive to digestion. Children with irritable bowel syndrome may be more aware of gas and motion and rumbles of the intestines. They are more aware of and bothered by these discomforts. Children may experience symptoms of IBS due to:

• Problems with how food moves through their digestive system
• Hypersensitivity of the inside of their bowel to stretching and motion
• Stress
• Overgrowth of bacteria in their bowel

All of the above factors can trigger symptoms. It is important to stress to the child that their abdominal pain is real and not imaginary.

• IBS occurs in both children and adults. Almost 14% of high school students and 6% 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.

A child with IBS often does not feel well. A child with diarrhea may have little warning of the need to go to the bathroom. Therefore, the child may be embarrassed and try to avoid going to school or socializing with schoolmates. This can cause depression and anxiety.

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

IBS in children tends to produce two types of symptoms: discomfort or pain, depending on the age of the child. IBS symptoms in kids may include:

• Recurrent abdominal pain. The pain becomes chronic when it has been present for more than three months.
• An altered bowel pattern with diarrhea and constipation, all of which suggests intestinal motility problems.
• Nausea
• Dizziness
• Loss of appetite

Symptoms of IBS in children are variable and may be age-dependent. For example:

• Infantile colic in babies younger than 4 months of age
• Gastroesophageal reflux (GERD) or heart burn in children younger than 2 years of age that reappears in adolescence and/or 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 to the condition. Altered bowel patterns and abdominal pain can be symptoms of many other conditions. Always consult your child's healthcare provider for diagnosis.

Your child's healthcare provider will perform a thorough medical history and physical exam. Lab tests will be done to check for infection and inflammation. Tests and procedures that your child's healthcare provider may order include:

• 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 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 healthcare 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 upper part of the digestive tract. Tissue samples from inside the digestive tract may also be taken for examination and testing.

   

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

Treatment of IBS will be determined by your child's healthcare 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 they do not have a life-threatening condition. Treatment may include dietary changes, medication, probiotics and stress management.

Parents can help children with IBS but encouraging them to focus on something fun, pleasant or distracting during a painful episode.

If your child is lactose intolerant, it is recommended that you restrict lactose or supplement the enzyme that digests the sugar (lactase/Lactaid). Lactose sugar can be a trigger for symptoms of IBS.

The use of high fiber in children with IBS is somewhat controversial since it can promote gas and bloating. However, a high-fiber diet is recommended for adults and may help children with IBS-related constipation.

Depending on the severity of your child’s symptom, medication may be needed. In rare cases, specialists may be consulted for pain control. Biofeedback and acupuncture may be used to relieve painful symptoms of irritable bowel syndrome.