By: Anthony Porto, MD, MPH, FAAP & Sarah Abu-Alreesh, MD, FAAP
Kids may have digestive troubles when they eat too much, come down with the flu or spend hours worrying about next week's math test. But if they live with frequent
diarrhea or
constipation—or a mix of the two—something more serious might be happening.
Children and teens with a condition called
irritable bowel syndrome (IBS) may feel ashamed or anxious about their bathroom habits—feelings that can make physical symptoms even worse. Read on for more information about IBS and how it is treated.
What is IBS?
Irritable bowel syndrome (IBS) is a group of symptoms. Together, they signal your child's gut is not working the way it should. To understand IBS, we need to take a quick look inside your child's digestive system.
What happens during the process of digestion?
The food your child eats moves into the stomach, where digestive juices start breaking it down so the body can absorb it. From there, special muscles carry partially digested food through the gut, gradually moving it toward the large intestine, or colon.
That's where the body sorts out the parts of food your child's body can't use, turning them into stool (poop). Muscles in the colon squeeze and relax, moving stool downward and eventually, out of your child's body.
How does IBS affect the digestive system?
When your child has IBS, these processes don't work at a steady pace. IBS causes the nerves that control movements of the bowels that propel food down the GI tract (called peristalsis) to become extra sensitive.
As a result, the wall of the GI tract overreacts to things like milk products and emotional stress, and goes into spasms. The squeeze-and-release motion might slow down or speed up, leading to troublesome symptoms.
Unlike with some other conditions, there is no damage to the GI tract tissue and no inflammation in IBS. It is considered a
disorder of the brain-gut axis, the connection between nerves in the brain and the GI tract.
What are the symptoms of IBS?
IBS can cause loose stool that triggers gassy, watery poops several times a day. It can also cause dry, hardened stool that is painful to pass (and might stay in the body for days).
Some kids with IBS go back and forth between these extremes. Others have days when their systems seem to work normally, only for symptoms to come back later.
Pain, mostly in the middle and lower part of the abdomen that come with stool changes, whether in frequency or form, are the hallmark signs of of IBS. Along with painful or frequent poops, kids with IBS may also experience:
Many kids with IBS also sense that they still need to poop, even after they've just gone to the bathroom.
How is IBS diagnosed?
There is no simple test for IBS. Your child's pediatrician will start with a health history and physical exam.
The doctor will ask about symptoms including location of pain, how severe it is, how long it usually lasts. Reassure your child that it's okay to talk with the doctor about poop! This private conversation is the first step toward feeling better.
Your pediatrician may use lab tests to learn more about what's happening in your child's gut. This can rule our other conditions with symptoms similar to IBS.
Blood, stool and urine samples could offer helpful clues. Rarely, an endoscopy and colonoscopy are needed. These are procedures performed under general anesthesia. They provide a look inside your child's digestive tract using an endoscope, a long thin tube with a small camera at the tip.
Are there different types of IBS?
IBS is classified based on the type of bowel movement pattern the child has with the belly pain.
IBS constipation (IBS-C), is when the child has pain that comes with hard, infrequent stools.
IBS diarrhea (IBS-D) is when the child has pain linked with multiple loose stools.
When the constipation and diarrhea alternate, it is called
IBS mixed type.
Be sure to tell your pediatrician about ALL your child's symptoms.
Beyond bloating, pain and watery or hard poops, the doctor needs to know if your child is also having:
Signs like these could point to irritable bowel disease (
IBD). IBD is a group of serious conditions that can damage the digestive tract, interrupt your child's growth and even cause liver damage. If there are signs of IBD, your child's care team will recommend next steps in finding effective care.
How is IBS different than IBD, Crohn's disease & ulcerative colitis?
Irritable bowel syndrome is often referred to wrongly as "colitis" and "mucous colitis." But the suffix "itis" in a medical condition's name suggests inflammation. While inflammation is not a hallmark of IBS, it is for IBD.
Crohn disease and ulcerative colitis are both forms of inflammatory bowel disease. The inflammation that happens with IBD damages the tissue of the small and large bowels. The table below shows some of the differences in symptoms between IBS and IBD.
Symptoms
|
Irritable Bowel Syndrome (IBS) |
Inflammatory Bowel Disease (IBD) |
Crohn's Disease |
Ulcerative Colitis |
Abdominal pain
| ✔ | ✔ | ✔ |
Diarrhea
| ✔ | ✔ | ✔ |
Constipation | ✔
| | |
Bloody stools | |
✔ |
✔ |
Weight loss | | ✔ | ✔ |
Fever | | ✔ | ✔ |
Swelling, pain of joints like knee, ankle | | ✔ | |
Canker like sores in mouth | | ✔ | |
Causes & risk for IBS
Exactly what causes IBS is unknown. We do know that many factors play a role in the development of the syndrome. These include how the muscles in the digestive tract contract and how nerve signals between the digestive tract and brain coordinate.
Other factors that may play a role in IBS include:
Changes in the gut microbiome. These are the bacteria, viruses and fungi that normally live in the digestive tract.
Certain food that can trigger IBS symptoms. If they produce enough gas to cause distension or bloating, which can lead to pain.
Emotional stress, anxiety and depression. These are not the cause for IBS but can worsen IBS.
Bacterial infections affecting the gut. These may be more likely to develop IBS. However, IBS is not contagious, so your child can't catch it from someone else.
Heredity. We need more research to understand IBS, but studies show it runs in families. When parents, grandparents, aunts, uncles and other family members have IBS, a child's risks of having it are higher.
How is IBS treated & managed?
If your child has IBS, your pediatrician will work with you to create a treatment plan based on the symptoms. Even though IBS does not damage your child's digestive system, it can make daily life painful and difficult. There is no cure for IBS, but the right treatment plan can reduce symptoms so your child feels more comfortable at home, school and out in the world.
Your child might need to see more than one medical provider for IBS. For example, your pediatrician might recommend a
gastroenterologist (gut specialist) who treats kids and teens. Your child's care team will focus on known causes of IBS discomfort and work out a plan to relieve your child's specific symptoms.
Changes in diet
Diet can be key, since certain foods have been linked with IBS. Some of these include:
Certain diet changes like adopting
low FODMAP diet can also help by focusing on foods that produce less gas.
Tracking what your child eats and drinks while making notes on any IBS symptoms can help pinpoint possible triggers. Your doctor may recommend working with a registered dietitian to figure out food sensitivities and make changes to your child's diet. Read more about food and IBS
here.
Stress management
Cognitive behavioral therapy may be helpful to help cope with difficult feelings, as stress may aggravate symptoms of IBS. A pediatric gastroenterologist might recommend following up with a psychologist or other mental health professional who specializes in brain-gut axis disorders as part of IBS treatment.
In addition, practices like exercise,
meditation,
yoga and
nature walks can help activate the
"rest and digest" response in your child's body.
Medication & supplements for IBS
Medicines or nutritional supplements your child's doctor may suggest include:
Remember
Although there's no cure for IBS, your child's care team can recommend ways to control symptoms and make everyday life easier. Your pediatrician can help you build an effective care plan. This might include working with a gut specialist (gastroenterologist) or a registered dietitian.
More information
About Dr. Porto
 Anthony Porto, MD, MPH, FAAP, is a board-certified pediatrician and board-certified pediatric gastroenterologist. He is an Associate Professor of Pediatrics and Associate Clinical Chief of Pediatric Gastroenterology at Yale University and Director, Pediatric Gastroenterology at Greenwich Hospital in Greenwich, CT. He is also the medical director of the Yale Pediatric Celiac Program. Within the American Academy of Pediatrics (AAP), Dr. Porto sits on the PREP Gastroenterology Advisory Board and is a member of the Section on Gastroenterology, Hepatology and Nutrition. He is also a member of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition's Public Education Committee, a pediatric expert on nutrition for The Bump's
Real Answers, and is the co-author of
The Pediatrician's Guide to Feeding Babies and Toddlers. You can follow him on Instagram
@Pediatriciansguide.
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About Dr. Abu-Alreesh
 Sarah Abu-Alreesh, MD, FAAP, is a Pediatric Gastroenterology, Hepatology and Nutrition Fellow at Yale University School of Medicine. Within the AAP, Dr. Abu-Alreesh is a member of the Section on Gastroenterology, Hepatology and Nutrition and the Section on Obesity.
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