Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic condition that includes abdominal pain, diarrhea, constipation, or all of those systems that persist for two months or longer. It is considered a brain-gut disorder because it affects the stomach and intestine and is modulated by the brain.

IBS, also known as spastic colon, colitis, nervous colon, and spastic bowel, is the most common cause of recurrent abdominal pain in children: 10 percent to 15 percent of children have IBS at some point. It is one of the predominant functional gastrointestinal disorders. It can cause a decrease in quality of life, emotional suffering, or embarrassment and disrupt a child’s life and activities.

IBS is a real condition, although it is not characterized by severe inflammation of the intestine (like inflammatory bowel disease, or IBD). It is not an early warning of cancer or another underlying GI condition. Stress can trigger the symptoms but does not cause IBS.

Experts have classified IBS into three categories, depending on the symptoms:

• IBS with constipation (IBS-C)
• IBS with diarrhea (IBS-D)
• IBS with mixed bowel habits (IBS-M)

Health care providers need to know what type of IBS a child has so they can make appropriate treatment decisions.

One of the first signs of irritable bowel syndrome (IBS) is often a change in the frequency of a child's bowel movements: the child needs to pass stool more or less often than usual for no apparent reason. It's not unusual for a child to have normal bowel movements on some days and diarrhea or constipation on another day.

Other symptoms include:

• Abdominal discomfort or pain that may feel better after a bowel movement
• Diarrhea, constipation, or both
• A feeling of still needing to go after a bowel movement
• Bloating
• Mucus in the stool

Researchers don't fully understand what causes IBS and believe that different factors contribute to it in different people. In some cases, the condition appears to run in families, though environmental factors often seem to play a role as well.

The following issues are more common in people who have IBS and may play a part in causing the condition:

• Bacterial infection in the digestive tract
• Food intolerance or sensitivity
• Early childhood trauma
• Depression or anxiety

Even though stress can make IBS symptoms more severe, on its own, stress does not cause the disorder.

There is no definitive test to diagnose irritable bowel syndrome (IBS). A clinician will perform a physical exam and take a full medical history to screen the child for a condition with similar symptoms, such as celiac disease or inflammatory bowel disease (IBD). The clinician may ask about family history, recent infections, stress, and medications the child is taking. They may also ask about the child's diet and any signs of food sensitivities.

Other tests may include:

• Blood test
• Stool test
• Urine analysis
• Lactose breath hydrogen test
• Abdominal X-ray
• Abdominal ultrasound
• Colonoscopy

If a child is growing normally, has no signs of another gastrointestinal (GI) disorder and has had symptoms for two months or more, they may be diagnosed with IBS.

IBS is a manageable condition and the goal of treatment is to reduce symptoms so the child can resume daily activities. Depending on the results of the health history and diagnostic tests, treatment may include:

• Dietary changes
• Talk therapy, biofeedback, or acupuncture
• Medication

IBS dietary changes

If child has IBS with constipation, foods high in fiber like fruit, vegetables, and whole-grain bread can make it easier to pass stool. However, fiber can also increase gas so it is important to add fiber to a child’s diet a little at a time to give the child’s stomach a chance to adapt.

If a child has IBS with diarrhea, high-fiber foods could make symptoms worse.

Other foods that a child may need to avoid, depending on the type of IBS they have:

• Caffeine, including coffee and many soft drinks that can have a laxative effect, making diarrhea worse
• Artificial sweeteners like sorbitol, mannitol, xylitol, and maltitol that can have a laxative effect
• Foods like beans and cabbage that produce gassiness
• Milk and other dairy products if the child is lactose intolerant

Talk therapy

The goal of talk therapy is to help the child and family to understand the symptoms, what triggers them, and how to manage the triggers. Talk therapy can include a combination of the following techniques:

• Cognitive behavioral therapy helps the child identify and control thought patterns that may make IBS symptoms worse
• Relaxation training involves learning how to decrease muscle tension that can exacerbate IBS
• Biofeedback provides the child feedback about how their body works so they can learn to recognize IBS symptoms and how to control them

Medications for IBS

Many children with IBS can be treated effectively with dietary changes and talk therapy alone. However, if IBS symptoms are severe or persist despite other treatments, the clinician may recommend medication. The type of medication will depend on the child’s symptoms.

The Division of Gastroenterology, Hepatology and Nutrition at Boston Children's Hospital has more than 50 board-certified physicians to help identify the root cause of your child’s pain. If the diagnosis is IBS, our team can provide the right treatment plan and offer your child support services. For severe cases, we offer a specialized program (the Functional Abdominal Pain Program) that provides multidisciplinary evaluation and treatment.