Irritable bowel syndrome, or IBS, is a chronic disorder of the gastrointestinal system that affects the quality of life in children and adults. Symptoms include varying types of abdominal discomfort and pain.
Not only can it make your child feel miserable, but it can create serious problems that impact daily living, forcing someone to stay home from school, for example, or avoid situations where they would be too far from a bathroom.
[SEE: Best Foods to Eat for an Upset Stomach.]
Symptoms of IBS
Symptoms are variable and may include:
— Bloating and abdominal discomfort.
— Intermittent or long-standing constipation.
— Intermittent or chronic diarrhea.
— Cramping with bowel movements.
— Incomplete feeling of bowel evacuation.
— Urgency with bowel movements.
— Occasionally, some patients may also report nausea.
— Children with IBS may have higher probability of being diagnosed with coexistent dietary fructose intolerance and lactose intolerance.
[READ: Everything You Need to Know About Common Food Allergies]
Types of IBS
Based on symptoms, IBS can be diagnosed as:
— IBS-C, or IBS with predominant constipation symptoms.
— IBS-D, IBD with predominant diarrhea symptoms.
— IBS with mixed symptoms, where constipation and diarrhea can both occur.
What Causes IBS?
The exact reasons as to why your child may have IBS is not clear. Much research in ongoing to delineate the mechanisms of IBS. But there are few proposed possibilities.
One theory is that the bowel, particularly the large intestine (colon), is more sensitive and reactive to the normal intestinal signals. It is possible that these symptoms were triggered by a simple gastrointestinal infection, but the sensitivity persists despite the sensitizing factor being long gone.
Whatever the trigger, the bowels become sensitive in varying intensity with no suggestion of ongoing inflammation of the bowel. In short, the normal gut signals that are transmitted up from the gut and typically dampened, are felt at a much amplified level in patients with IBS. It is also well observed that patients report more stress and anxiety-related symptoms. Your child truly feels the pain in this setting, and this can be life altering to some.
How Is IBS Diagnosed?
If your child has symptoms suggestive of IBS, it is important that you reach out to your child’s primary care provider or gastroenterologist. The provider will elicit a medical history that may provide clues to an IBS diagnosis and perform a medical examination. It is important to know that IBS is a diagnosis of exclusion, and therefore, tests may be performed to rule out other disorders that cause GI inflammation and trigger similar symptoms.
Tests may include:
— Blood tests to rule out anemia, inflammation or any suggestion of infection or celiac disease.
— Stool tests:
— Occult blood test to look for blood that may not be seen visibly and could suggest inflammation.
— Calprotectin. Elevated calprotectin, a protein made by white blood cells, could also suggest an inflammatory process.
— If you child has diarrhea, a stool test may be ordered to look for bacterial infections and microscopic parasites.
— Breath tests: These tests that include a lactose or a fructose breath test, to look for digestive intolerance to lactose, a sugar in milk, or fructose, a sugar present in fruits and juices. These disorders may cause bloating, gassiness and diarrhea or worsen symptoms in patients with IBS.
— Imaging tests: An X-ray of the abdomen or ultrasound of the abdomen may be ordered if indicated by your child’s provider as appropriate.
— Endoscopy or colonoscopy to look at the upper part of your child’s digestive system or the lower part (colon) may be ordered if deemed necessary by your child’s doctor.
[READ: The Low FODMAP Diet for IBS.]
Treatment
How can your child’s IBS be effectively managed?
The basic goal of managing IBS is to reduce the intensity of symptoms and make your child’s life more functional. IBS in that regard can be effectively managed but requires good understanding of what triggers symptoms, be it diet or psychological factors. Symptom improvement can take time and requires input from parents, your child’s doctor, dietitian and, sometimes, the help of a psychologist.
Diet manipulation has an important role in the management of IBS symptoms. If child’s IBS symptoms are dominated with constipation symptoms, increasing fiber intake in the diet by adding more fruits and vegetables can help. Since fiber can cause increased gassiness in some, the quantity of fiber in your child’s diet may be gradually increased to let you child get used to the high fiber diet.
If diarrhea is the predominant symptom, then cutting back fructose or lactose in your child’s diet, based on clinical assessment may be helpful. Caffeinated drinks may worsen diarrhea in some and may need to be cut back. Cutting back on artificial sweeteners — such as sucralose, sorbitol, mannitol and xylitol — which can trigger diarrhea, may be helpful.
Enlisting the help of a dietitian may be worthwhile to help modify your child’s diet as appropriate. Probiotics may be used after discussing with your child’s doctor and may help some children with IBS.
If stress, anxiety and other related problems may be contributing to your child’s IBS symptoms, mental health therapies may help in reducing the intensity of symptoms. Cognitive behavioral therapy may also help identify potential triggers and control symptoms. Relaxation techniques can help relieve stress and symptoms, and biofeedback can also work similarly, by helping your child identify triggers of IBS and controlling symptoms.
In those children with severe symptoms, medications may help. These medications include:
— Antispasmodics: They can help reduce intensity of pain.
— Antidepressants: These medications can reduce gut signaling and also help with stress, anxiety and any depression-related symptoms as appropriate. Medications commonly used include amitriptyline, sertraline and fluoxetine.
— Coated peppermint oil capsules may help decrease gut sensitivity by modulating signaling from the gut.
— Laxatives may be used in those with constipation predominant symptoms. These medications include polyethylene glycol, senna and docusate. Newer medications like linaclotide may be prescribed after thoughtful consideration by your child’s doctor.
— Anti-diarrhea medications like loperamide (Imodium) may be used if diarrhea is the predominant symptom.
The bottom line is to have realistic goals and work towards making your child’s life more functional. Even with diet modification and therapy, your child may have some symptoms at baseline. It is therefore important to identify potential triggers that flare symptoms.
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Irritable Bowel Syndrome (IBS) in Children: Symptoms, Causes Treatment originally appeared on usnews.com
