Irritable Bowel Syndrome In Children Causes, Signs, Symptoms, Diagnosis, Treatment, Prevention, Diet

Irritable Bowel Syndrome In Children Causes, Signs, Symptoms, Diagnosis, Treatment, Prevention, Diet


What is irritable bowel syndrome?


Irritable bowel syndrome is a functional gastrointestinal (GI) disorder, meaning it is a problem caused by changes in how the GI tract works. Children with a functional GI disorder have frequent symptoms, but the GI tract does not become damaged. Irritable bowel syndrome is not a disease; it is a group of symptoms that occur together. The most common symptoms ofIrritable bowel syndrome are abdominal pain or discomfort, often reported as cramping, along with diarrhea, constipation, or both. In the past, Irritable bowel syndrome was called colitis, mucous colitis, spastic colon, nervous colon, and spastic bowel. The name was changed to reflect the understanding that the disorder has both physical and mental causes and is not a product of a person's imagination.

Irritable bowel syndrome is diagnosed when a child who is growing as expected has abdominal pain or discomfort once per week for at least 2 months without other disease or injury that could explain the pain. The pain or discomfort of Irritable bowel syndrome may occur with a change in stool frequency or consistency or may be relieved by a bowel movement.

How common is irritable bowel syndrome in children?


Limited information is available about the number of children with Irritable bowel syndrome. Older studies have reported prevalence rates for recurrent abdominal pain in children of 10 to 20 percent. However, these studies did not differentiate IIrritable bowel syndrome from functional abdominal pain, indigestion, and abdominal migraine. One study of children in North America found that 14 percent of high school students and 6 percent of middle school students have Irritable bowel syndrome. The study also found that Irritable bowel syndrome affects boys and girls equally.

What Causes irritable bowel syndrome?


Muscles in the colon normally contract a few times a day, moving feces along and ultimately resulting in a bowel movement. It is believed that in a person with Irritable bowel syndrome, these muscles are exceptionally sensitive to certain stimuli, or triggers. While they would not normally affect others, triggers such as certain foods, medications, or stress can provoke a strong response in the colon of a person with Irritable bowel syndrome.

Researchers are not certain exactly why the muscles in the colon of a person with Irritable bowel syndrome are more sensitive. We do know, however, that Irritable bowel syndrome is not caused by stress or strong emotions. Some people have their first flare-up of Irritable bowel syndrome symptoms during a stressful period in their life such as the death of a relative or loss of a job. However, these stresses did not cause the condition, but rather aggravated it to the point where it became more noticeable or bothersome.

What are the symptoms of irritable bowel syndrome?


The symptoms of Irritable bowel syndrome can include:

  • Gas
  • Pain
  • Bloating
  • Nausea
  • Vomiting
  • Mucus in the stool
  • Constipation
  • Diarrhea
Cramps are often relieved by a bowel movement, but some people with Irritable bowel syndrome may have cramps and be unable to pass anything. Severity of symptoms varies, and could be anywhere from a mild annoyance to debilitating. Blood in the stool, fever, weight loss, vomiting bile, and persistent pain are not symptoms of Irritable bowel syndrome and may be the result of some other problem. Irritable bowel syndrome does not lead to any organic disease, such as Crohn’s disease or ulcerative colitis, or any type of bowel cancer.

How is irritable bowel syndrome in children diagnosed?


To diagnose Irritable bowel syndrome, a health care provider will conduct a physical exam and take a complete medical history. The medical history will include questions about the child's symptoms, family members with GI disorders, recent infections, medications, and stressful events related to the onset of symptoms. Irritable bowel syndrome is diagnosed when the physical exam does not show any cause for the child's symptoms and the child meets all of the following criteria:

  • has had symptoms at least once per week for at least 2 months
  • is growing as expected
  • is not showing any signs that suggest another cause for the symptoms
Further testing is not usually needed, though the health care provider may do a blood test to screen for other problems. Additional diagnostic tests may be needed based on the results of the screening blood test and for children who also have signs such as

persistent pain in the upper right or lower right area of the abdomen

  • joint pain
  • pain that wakes them from sleep
  • disease in the tissues around the rectum
  • difficulty swallowing
  • persistent vomiting
  • slowed growth rate
  • GI bleeding
  • delayed puberty
  • diarrhea at night
Further diagnostic tests may also be needed for children with a family history of

  • Irritable bowel disease - long-lasting disorders that cause irritation and ulcers, or sores, in the GI tract
  • Celiac disease - an immune disease in which people cannot tolerate gluten, a protein found in wheat, rye, and barley, because it will damage the lining of their small intestine and prevent absorption of nutrients
Additional diagnostic tests may include a stool test, ultrasound, and flexible sigmoidoscopy or colonoscopy.

Stool tests


A stool test is the analysis of a sample of stool. The health care provider will give the child's caretaker a container for catching and storing the child's stool. The sample is returned to the health care provider or a commercial facility and sent to a lab for analysis. The health care provider may also do a rectal exam, sometimes during the physical exam, to check for blood in the stool. Stool tests can show the presence of parasites or blood.

Ultrasound


Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The procedure is performed in a health care provider's office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist - a doctor who specializes in medical imaging; anesthesia is not needed. The images can show problems in the GI tract causing pain or other symptoms.

Flexible sigmoidoscopy or colonoscopy


The tests are similar, but a colonoscopy is used to view the rectum and entire colon, while a flexible sigmoidoscopy is used to view just the rectum and lower colon. These tests are performed at a hospital or outpatient center by a gastroenterologist - a doctor who specializes in digestive diseases. For both tests, a health care provider will give written bowel prep instructions to follow at home. The child may be asked to follow a clear liquid diet for 1 to 3 days before either test. The night before the test, the child may need to take a laxative. One or more enemas may also be required the night before and about 2 hours before the test.

In most cases, light anesthesia, and possibly pain medication, helps the child relax. For either test, the child will lie on a table while the gastroenterologist inserts a flexible tube into the anus. A small camera on the tube sends a video image of the intestinal lining to a computer screen. The test can show signs of problems in the lower GI tract.

The gastroenterologist may also perform a biopsy, a procedure that involves taking a piece of intestinal lining for examination with a microscope. The child will not feel the biopsy. A pathologist - a doctor who specializes in diagnosing diseases - examines the tissue in a lab.

Cramping or bloating may occur during the first hour after the test. Full recovery is expected by the next day.

What Other Conditions Are Related To irritable bowel syndrome?


As many as 60% of persons with Irritable bowel syndrome also suffer from fibromyalgia syndrome (FMS). Conversely, as many as 70% of FMS patients have reported experiencing symptoms of Irritable bowel syndrome.

Fibromyalgia. FMS is a disorder of the musculoskeletal system that is associated with symptoms of general muscle aches, stiffness, overall fatigue, and poor sleeping habits. Symptoms can vary in both severity and duration; the pain may be dull or knife-like, linger persistently, or be intermittent. Like Irritable bowel syndrome, FMS is a functional disorder, therefore tests to find the origins of the pain often come back negative.

The overgrowth of candida, a type of yeast, in the colon is called candidiasis. Growth of candida in the digestive tract is a highly controversial subject, and is not generally accepted by the medical community. It has been suggested that some incidence of Irritable bowel syndrome could be caused by candidiasis. Overgrowth of yeast can be caused by certain medications or other medical conditions, and may cause a variety of seemingly unrelated symptoms. Diagnosis is made by testing the body for candida, and treatment usually involves a strict diet along with some anti-fungal medication and acidophilus and bifidus supplements.

What Medications Are Used To Treat irritable bowel syndrome?


Several different types of drugs may be used to treat Irritable bowel syndrome. The goal of medication is to lessen troublesome Irritable bowel syndrome symptoms such as diarrhea, cramping, pain, or constipation.

Anticholinergics


This class of drugs affects the nerve cells or nerve fibers and are used to calm muscle spasms in the intestine and help symptoms of Irritable bowel syndrome such as cramping pain or diarrhea. Some of the drugs used to treat Irritable bowel syndrome are actually combinations of two drugs: an anticholinergic and a mild sedative.

Dicyclomine (Bentyl)


Dicyclomine relaxes the muscles of the gut and bladder to prevent spasms, and reduces the amount of stomach acid produced. Dicyclomine can be safely used long-term, under the guidance of a physician. Common side effects include constipation, dryness of mouth, nose, throat, or skin and a decreased ability to perspire (which can contribute to heat stroke).

Belladonna/Phenobarbital (Donnatal, Antispas, Barbidonna, Donnapine, Hyosophen, Spasmolin)


This combination of two drugs is used to relax the muscles in the bladder and intestines as well as reduce stomach acid. Phenobarbital is a mild sedative can be habit-forming. Common side effects of belladonna/phenobarbital include headache, nausea, constipation, rash, and vomiting. This drug may take 4 or 5 days to be effective, and, under the supervision of a physician can be safely used long-term.

Hyoscyamine (Levsin, Anaspaz)


This combination of two drugs, belladonna alkaloids and barbiturates, is used to relax the muscles in the bladder and intestines as well as reduce stomach acid. Common side effects include headache, nausea, constipation, rash, and vomiting. Hyoscyamine may be taken long-term under the guidance of a physician as long as side effects are absent or tolerable.

Chlordiazepoxide/clidinium (Librax)


Chlordiazepoxide/clidinium prevents spams in the gut and also the bladder. Chlordiazepoxide is a sedative, and may be habit forming. Common side effects include bloated feeling, decreased sweating, dizziness, drowsiness, dryness of mouth, and headache. This drug may take 4 or 5 days to be effective, and, under the supervision of a physician can be safely used long-term.

Anti-diarrheals


Anti-diarrheals are used to slow down the effect of the bowel. These drugs may used to prevent diarrhea that occurs from Irritable bowel syndrome.

Diphenoxylate/atropine (Lomotil)


The diphenoxylate portion of this drug is used to treat diarrhea, while the atropine relieves muscle spams in the gut. Common side effects include headache, dizziness, drowsiness, blurred vision, dry mouth, and constipation. Although it is not a narcotic, diphenoxylate is derived from narcotics and may be mildly habit-forming. Diphenoxylate/atropine is typically prescribed to control diarrhea in the short-term, and is not recommended for long-term use.

Alosetron hydrochloride (Lotronex)


This newer drug is only used to treat women with severe D-IBS. Alosetron hydrochloride was approved and then pulled from the market by the Food and Drug Administration after several cases of serious side effects in women taking it. It is now only approved for use on a limited basis, and should not be used for C-IBS or A-IBS. Alosetron hydrochloride disrupts the action of seratonin, a chemical in the body that has an affect on intestinal movement and pain. Treatment usually begins with a 4-week trial and may be continued for another 4 weeks under the supervision of a physician.

Tegaserod (Zelnorm, Zelmac)


Tegaserod is used for treating C-IBS in women and works by helping move stool through the intestine. Tegaserod has the same effect on the body as serotonin, a chemical that the body produces naturally. Therapy with tegaserod is normally given for 4 to 6 weeks, but may be extended for up to 12 weeks. Common side effects include headache, abdominal pain, diarrhea, nausea, and gas. Tegaserod is a new drug, therefore, information about long-term effects are not available.

Eating, diet, and nutrition


Large meals can cause cramping and diarrhea, so eating smaller meals more often, or eating smaller portions, may help Irritable bowel syndrome symptoms. Eating meals that are low in fat and high in carbohydrates, such as pasta, rice, whole-grain breads and cereals, fruits, and vegetables may help.

Certain foods and drinks may cause Irritable bowel syndrome symptoms in some children, such as

  • foods high in fat
  • milk products
  • drinks with caffeine
  • drinks with large amounts of artificial sweeteners, which are substances used in place of sugar
  • foods that may cause gas, such as beans and cabbage
Children with Irritable bowel syndrome may want to limit or avoid these foods. Keeping a food diary is a good way to track which foods cause symptoms so they can be excluded from or reduced in the diet.

Dietary fiber may lessen constipation in children with Irritable bowel syndrome, but it may not help with lowering pain. Fiber helps keep stool soft so it moves smoothly through the colon. The Academy of Nutrition and Dietetics recommends children consume "age plus 5" grams of fiber daily. A 7-year-old child, for example, should get "7 plus 5," or 12 grams, of fiber a day.³ Fiber may cause gas and trigger symptoms in some children with Irritable bowel syndrome. Increasing fiber intake by 2 to 3 grams per day may help reduce the risk of increased gas and bloating.