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Pediatric Irritable Bowel Syndrome (IBS)
What is irritable bowel syndrome?
Irritable bowel syndrome (IBS) is a chronic disorder causing 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 include:
Chronic or intermittent diarrhea
Chronic or intermittent constipation
Urgency with defecation
Incomplete sensation of defecation
Passage of mucus in the stool
Prevention & Risk Assessment
Prevention & Risk Assessment
What causes irritable bowel syndrome?
The exact cause of IBS 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 the symptoms of IBS due to:
- Problems with how food moves through the digestive system
- Hypersensitivity of the inside of the bowel to stretching and motion
- Overgrowth of bacteria in the bowel
All of the above factors can trigger symptoms. It is important to stress to the child 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% 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.
Why is irritable bowel syndrome a concern?
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, a child may be embarrassed and 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.
What are the symptoms of irritable bowel syndrome?
IBS in children tends to produce two types of symptoms: discomfort 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 more than 3 months.
- An altered bowel pattern with diarrhea and constipation, all of which suggests intestinal motility problems.
- Loss of appetite
In children, symptoms are variable and are age dependent. For example:
- Infantile colic (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 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 other conditions. Always consult your child's health care provider for diagnosis.
How is irritable bowel syndrome diagnosed?
Your child's health care provider will take 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 health care 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 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.
- 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.
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, probiotics, and stress management.
Try to help the child focus on something fun or pleasant during a painful episode.
In a child who 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.
A controversial issue is the use of high fiber in children since it could promote gas and bloating. It is recommended for adults and may help children who have constipation.
Depending on the severity of the symptom, medication may be needed. In rare cases, specialists may be consulted for pain control. Biofeedback has become part of the treatment strategy, as well as acupuncture.
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