Irritable Bowel Syndrome In Children

Irritable bowel syndrome (IBS) is the failure of the large intestine to operate as it should. This condition affects people of all ages, including children. In children with IBS, the large intestine appears to be more sensitive and reactive than normal, resulting in an array of chronic symptoms that commonly occur after eating or when under stress.

Children with IBS may experience discomfort or pain – as well as embarrassment – as a result of the condition. The most common symptoms of IBS are abdominal pain and/or cramping accompanied by diarrhea, constipation or both. Most children with IBS alternate between periods of diarrhea and constipation, but some children mainly experience one of these symptoms. Other symptoms of IBS include gas, bloating and indigestion.

During normal digestion, wave-like muscle contractions (peristalsis) within the intestines occur a few times each day, helping to move contents through the digestive tract before they are expelled as waste through the anus. Muscles, nerves and hormones work together to create peristalsis, which maintains normal digestion.

For children with IBS, nerves and muscles in the large intestine may be hypersensitive and can suddenly and involuntarily contract (spasm), speeding digestive content through the intestines and causing diarrhea. Intestinal muscles may also temporarily stop contracting, preventing content from moving forward and causing constipation.

IBS is considered a functional disorder because it involves the failure of the large intestine to function as it should. It is not a disease, since no identifiable physical abnormality or intestinal damage can be found in children with IBS. IBS is a chronic condition, in which symptoms can recur throughout a person’s life. Many, but not all children with IBS, have the condition as adults.

Functional problems that appear to be involved in IBS include:

Increased sensitivity of the large intestine.

In children with IBS, the large intestine appears to react strongly to stimuli (e.g., anxiety, stress, certain foods) that do not bother most people. Intestinal nerves may perceive the normal sensations of gas or movement of stool through the digestive tract as excessive and painful.

Rapid or delayed transit of stool.

In children with IBS, stool may travel too quickly or in too large an amount for fluid to be properly absorbed by the intestines. Too much liquid in stool causes diarrhea. Slowed movement of stool can lead to too much fluid being absorbed, resulting in constipation.

Abnormal muscle contractions.

Intestinal muscles may spasm or temporarily stop contracting. Children with IBS may experience strong contractions that can cause cramping and push stool through the digestive tract too quickly, leading to diarrhea. Spasms may trap gas or stool in one area, leaving it unable to move forward, which can cause cramping, constipation and abdominal pain. This may not occur in all children with IBS. It is unclear whether this is a cause or symptom of IBS.

The immune system may also be involved in the development of IBS. In some cases, the condition may occur after severe gastrointestinal (GI) infections such as salmonella or Campylobacter pylori.

IBS does not cause permanent physical harm to a child. Very few children with IBS are later diagnosed with some other GI condition. In addition, children with IBS tend to live as long as those in the general population. Although IBS can be embarrassing and inconvenient for children, it does not have to negatively impact their quality of life. With proper treatment, children with IBS can live a normal lifestyle.

Types and differences of IBS in children

Children with irritable bowel syndrome (IBS) may experience some symptoms more than others. Types of IBS are identified by the child’s predominant symptoms and include:

Diarrhea-predominant IBS (D-IBS).

Characterized by abrupt episodes of diarrhea upon waking, or during or immediately after eating. The sudden urgency to have a bowel movement may lead to unintentional soiling. Additional symptoms may include abdominal pain and bloating.

Constipation-predominant IBS (C-IBS).

Occurs when periodic constipation and pain in the lower abdomen are the primary symptoms. Abdominal pain may be sporadic or experienced as a continuous ache, and may be relieved by having a bowel movement. Stool often contains mucus that is either white or clear in color. Eating often triggers symptoms. Occasionally, other parts of the gastrointestinal tract may be affected in addition to or instead of the colon. Indigestion (involving bloating, gas, nausea and heartburn) may also occur.

Alternating type IBS (A-IBS).

Alternating episodes of both diarrhea and constipation. This is the most common type of IBS in children

Signs and symptoms of IBS in children

Irritable bowel syndrome (IBS) can cause a variety of symptoms. Children with the condition may feel that they have difficulty finishing when they defecate. Or, the child may feel like gas is trapped inside them and unable to come out. In other cases, children may experience diarrhea that occurs suddenly.

Symptoms commonly occur after eating or when the child is under stress. Symptoms may vary among children and can range from mild to severe in intensity. Children with IBS often have more sensitive bowels, so they may feel intense pain in situations that would cause little or no discomfort in children who do not have IBS.

Some of the symptoms associated with IBS – such as cramps and diarrhea – are common, and do not necessarily indicate the presence of IBS. Typically, children with IBS have pain and discomfort that is associated with at least two of the following over a period of at least three months:

Relief from symptoms after having bowel movements
Changes in how often a child needs to defecate
Changes in the appearance of a child’s stool, such as hardened stool or diarrhea

Other symptoms of IBS include:

Abdominal pain.

Abdominal pain or cramping associated with bowel functioning is the most common symptom of IBS. Stress and eating may worsen the pain, which usually occurs in the lower left side of the abdomen. The pain is often alleviated by having a bowel movement.

Diarrhea.

Loose, watery stool. Bowel movements most often occur after eating or upon awakening. Diarrhea is usually preceded by a sense of urgency and may be followed by a sensation of incomplete defecation. Soiling may occur as a result of diarrhea.

Constipation.

Difficulty or straining during a bowel movement, usually involving hard, pellet-shaped stool. Constipation may last days to months in children with IBS. It is occasionally accompanied by a feeling of incomplete defecation, even when the rectum is empty. Mucus may appear in the stool.

Bloating.

Gas buildup in the intestines, which can create a sense of increasing pressure in the abdomen. Children with IBS may experience a swollen or distended abdomen as a result of bloating, as well as an early feeling of fullness when eating. Gas can stretch the bowel and cause cramping or abdominal pain in children with IBS. Belching may also occur.

Potential causes of IBS in children

The cause of irritable bowel syndrome (IBS) is unknown, and there is no apparent disease of the bowel involved. Rather, IBS is related to highly stimulated or reactive nerves and muscles in the large intestine. Research has shown that children with IBS are more sensitive to pain, discomfort and fullness than children without the condition.

In addition, children with IBS are especially sensitive to stress and conflicts, and such emotional trauma is strongly associated with episodes of IBS. Many nerves inside the intestines connect them to the brain. These nerves control functioning and can react adversely to stress. Intestinal muscles may contract too much or too little, leading to chronic diarrhea, constipation or both symptoms. Teething, illness, moving to a new town, starting a new school, family turmoil and other trauma are all potential stress triggers of IBS in children.

Certain foods are also known to trigger IBS symptoms in many children. They include:

Caffeine (e.g., sodas)
Chocolate
Fast foods
Greasy foods
Spicy foods
Carbonated beverages
Milk and other dairy products (especially in lactose-intolerant children)
Eating large meals may cause too much food to be passed through the digestive tract at once and can lead to nutrient and fluid absorption problems, triggering IBS symptoms.

Other sources of IBS symptoms include:

Gas. When the intestines are distended due to trapped gas, this can cause abdominal pain and cramping in children with IBS. Activities such as chewing gum or eating meals quickly can lead to the inadvertent swallowing of air and cause gas.

Medications. Some medications can negatively affect the digestive system (e.g., cause diarrhea or constipation) and may aggravate symptoms in children with IBS.

Menstruation. Girls with IBS may experience more severe symptoms during their menstrual periods.

Research also suggests that children with low birth weight appear to be more likely to develop IBS than those who weigh more than 5.5 pounds at birth.

Among children, boys and girls are equally likely to be diagnosed with IBS. In contrast, adult women are much more likely than adult men to be diagnosed with IBS in Western nations.

Diagnosis methods for IBS in children

A physician may be able to diagnose irritable bowel syndrome (IBS) based on a medical history and physical examination. A medical history can include questions about the duration and severity of symptoms, changes in bowel functioning and the relation of symptoms to bowel functioning.

Many of these questions may be embarrassing for children, as they are likely to focus on subjects such as gas and diarrhea. Parents are urged to explain to their children ahead of time that these questions are likely, and to help them understand that the information is necessary for the physician and should not cause shame.

Diet.

current medications, activity and stress levels may also be discussed. To further pinpoint the source of symptoms, a physician may ask a parent to keep a food diary that lists all of the foods a child eats and any symptoms that accompany those meals. Or, a child may be asked to keep a record of times when they feel particularly stressed. This can be matched with the child’s symptoms to see if there is any correlation between these times of stress and symptom flare-ups.

A physical examination can identify signs of other illness that may be causing the symptoms.

Such illnesses may include lactose intolerance, infection, diverticulosis, thyroid disorders, inflammatory bowel diseases (e.g., Crohn’s disease or ulcerative colitis) or cancer. Tests used to rule out other causes of symptoms in children with IBS include blood tests, fecal tests, lactose intolerance tests (e.g., a breath test or the systematic elimination of dairy products from the diet), barium enema x-ray, endoscopy and others.

Children may be diagnosed with IBS if the examination shows no signs of intestinal disease or damage related to the symptoms. These children must have experienced abdominal pain or discomfort for at least 12 weeks (not necessarily consecutive) in the past year. In addition, children must meet at least two of the following criteria for a diagnosis of IBS:

Pain is relieved with the passage of stool
Change in frequency of bowel movements when pain begins
Change in appearance of stool when pain begins

Treatment options for IBS in children

Because there is no cure for irritable bowel syndrome (IBS), treatment consists of controlling its symptoms. For most children with IBS, this can be accomplished through diet and stress management. In addition, children may be instructed to make sure they have regular bowel movements each day.

The first step in changing a child’s diet is to identify which foods or activities appear to trigger or aggravate the symptoms of IBS. It may be helpful to keep a food diary or log that details the foods eaten each day, the type of symptoms experienced and the times the symptoms occur. Treatment of IBS symptoms typically involves avoiding foods (such as fats) or behaviors that aggravate symptoms.

In contrast, some foods – particularly those high in fiber – can often help to keep a child’s colon functioning properly. Fiber adds bulk to stool in the digestive tract, speeding digestion and helping to alleviate constipation. In addition, fiber keeps the colon mildly distended, which may help prevent muscle contractions (spasms) in children with IBS. It may also improve the consistency of stool, helping to alleviate diarrhea.

Fruits, vegetables and beans are good examples of high-fiber foods that can help fend off symptoms related to IBS. “Fun” foods such as popcorn can also help prevent IBS symptoms. It is important to note that most fiber-rich foods contain both soluble fiber (which dissolves in liquid) and insoluble fiber (which does not dissolve in liquid). Soluble fiber can help relieve both diarrhea and constipation. Insoluble fiber can moderate digestion and alleviate diarrhea. However, the amounts of these types of fiber differ from food to food.

Some experts warn against diets for children that are too high in fiber. Too much fiber may aggravate or cause diarrhea, and may cause flatulence and abdominal distention. Parents and caregivers should consult their child’s pediatrician about choosing the right fiber-rich foods for their child’s diet.

Parents are also encouraged to urge their children to eat smaller meals at a slower pace. Eating large amounts of food in a single sitting should be avoided since it may cause cramping and diarrhea. Five or six smaller meals throughout the day may be easier to digest for children with IBS. In addition, eating meals too quickly can lead to the unintentional swallowing of air, causing gas and bloating and abdominal distension in children with IBS.

Drinking six to eight glasses of water a day is recommended for hydration, especially for children with diarrhea-predominant IBS.

Children with IBS may be more sensitive to emotional stress or tension. Stress management is especially important to reduce or prevent the symptoms of IBS. The methods can include:

Relaxation therapies. Treatments that involve techniques such as controlled breathing may help children to manage stress and other emotional triggers of IBS.
Counseling. Parents and caregivers are urged to talk to their children about feelings of stress related to problems in the home, difficulties at school or problems with friends. In cases of severe stress or emotional difficulty, children may benefit from consultation with a mental health professional.
Regular exercise and sleep. Encouraging children to exercise can help keep the digestive tract functioning normally. This is especially helpful for children with constipation-predominant IBS. In addition, children who get adequate amounts of rest and sleep may feel less stress, which can help facilitate digestion.

A variety of medications are available to treat the symptoms of IBS in adults. In some cases, these medications may be prescribed to children. For example, tricyclic antidepressants may be prescribed to control a child’s pain and anticholinergics may be prescribed to control intestinal cramping. Some medications that are used to treat IBS in adults have not been tested for safety in children and are not used in the treatment of children.

Use of medications is less common in treating IBS in children than in adults because children are at greater risk of the body becoming dependent on certain medications (e.g., laxatives) to function normally. When medications are prescribed, it is usually because a child’s symptoms do not respond to dietary changes and/or stress management. Parents are urged to ensure that their child takes these medications exactly as prescribed to avoid any potential problems.

Irritable Bowel Syndrome in Children