Irritable bowel syndrome (IBS) is a chronic disorder causing annoying and often painful abdominal and bowel symptoms. IBS is considered a functional bowel disorder, meaning that, although symptoms are clearly present, when the bowel is examined visually and under the microscope, there is no evidence of damage to the tissues. Symptoms include:
The digestion and propulsion of nutrients and fluids through the gastrointestinal system (GI) is a very complicated and very well organized process. The GI tract has its own intrinsic muscles and nerves that connect, like an electrical circuit, to the spinal cord and brain. Neuromuscular events occurring in the GI tract are relayed to the brain through neural connections, and the response of the brain is also relayed back to the gastrointestinal tract. As a result of this activity, motility and sensation in the bowel is generated. An abnormality in this process results in a disordered propulsion of the intestinal contents and generates the sensation of pain.
The exact cause of IBS is unknown. One theory is a person with IBS may have a colon that is more sensitive and reactive than usual, so it responds strongly to stimuli that would not affect others. The nerves that control the digestive tract may also be more sensitive to the activity associated to the process of digestion. Children with irritable bowel syndrome may be more aware of gas and motion and rumbles of the intestines. They are more aware of these discomforts and hence more irritated when they occur. Children may experience the symptoms of irritable bowel syndrome due to:
All of the above factors can trigger the occurrence of symptoms. It is important to stress to the child with a functional bowel disorder that his or her abdominal pain is real and not imaginary.
Children with irritable bowel syndrome often do not feel well. Those who have diarrhea may have little warning of their need to go to the bathroom, and, therefore, may be embarrassed and avoid going to school or socializing with their schoolmates. Children can become depressed or anxious because of the disorder.
Most children with irritable bowel syndrome continue to grow and develop normally. However, some children may eat less to avoid the pain that can accompany digestion, and therefore, lose weight.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, irritable bowel syndrome in children tends to produce two types of symptoms: diarrhea or pain, depending on the age of the child. Symptoms may include:
In children, symptoms of functional bowel disorders are variable and are age dependent. For example:
The symptoms of irritable bowel syndrome are not unique for the condition. Altered bowel pattern and abdominal pain could be symptoms of organic disease--one reason why you should always consult your child's health care provider for a diagnostic work-up.
Your child's health care provider will obtain a thorough medical history, perform a full physical examination, and obtain screening laboratories to assess for infection and inflammation. The laboratory tests, imaging studies, and procedures to be performed will be dictated by the history and physical examination. Tests and procedures that your child's health care provider may order may include the following:
Specific treatment of irritable bowel syndrome will be determined by your child's health care provider based on:
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, and stress management.
Try to help the child focus on something fun or pleasant during a painful episode.
In lactose intolerant patients, restriction of lactose or supplementing the enzyme that digests the sugar (lactase/Lactaid) is recommended since this sugar can be a trigger for symptoms of irritable bowel syndrome.
A controversial issue is the use of high fiber in children since it could promote flatulence and abdominal distension. It is recommended in the adult population, and it may be beneficial in children in which the symptom of constipation predominates.
Depending on the severity of the symptom, medication may be indicated. In rare cases, pain control needs to be administered by specialists in the field of pain management. Biofeedback has become part of the treatment strategy, as well as acupuncture.
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