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Irritable Bowel Syndrome (IBS)
What Does IBS Mean?
Irritable bowel syndrome is a subtype of functional abdominal pain syndromes, it describes a disturbance of bowel function that includes symptoms of abdominal pain or discomfort and altered bowel habit (change in frequency or consistency) – chronic or recurrent diarrhoea, constipation, or both in alternation.
"Irritable Bowel" refers to a disturbance in the regulation of bowel function that results in unusual nerve sensitivity and muscle activity.
"Syndrome" refers to a number of symptoms and not one symptom exclusively.
What Are The Symptoms of IBS?
The symptoms of IBS include abdominal pain or discomfort and changes in bowel habits. To meet the definition of IBS, the pain or discomfort should be associated with two of the following three symptoms:
start with bowel movements that occur more or less often than usual
start with stool that appears looser and more watery or harder and more lumpy than usual
improve with a bowel movement
Other symptoms of IBS may include
diarrhoea – having loose, watery stools three or more times a day and feeling urgency to have a bowel movement
constipation – having hard, dry stools; two or fewer bowel movements in a week; or straining to have a bowel movement
feeling that a bowel movement is incomplete
passing mucus, a clear liquid made by the intestines that coats and protects tissues in the GI tract
Children with IBS may also have headache, nausea, or mucus in the stool. Weight loss may occur if a child eats less to try to avoid pain.
How is IBS Diagnosed?
A history that fits the criteria for a diagnosis of IBS, accompanied by a normal physical examination and normal growth history, are consistent with a diagnosis of childhood IBS. A dietary assessment for ingestion of sugars such as sorbitol and fructose and other fermentable carbohydrates is often useful.
A limited laboratory screening is indicated to exclude other disease (see diagnosis of Functional abdominal pain)
Once there is a diagnosis of IBS, the treatment goals are to provide effective reassurance to the child and family, and to reduce or eliminate the symptom(s). The doctor will educate and reassure the child and family that although IBS causes discomfort it does not lead to more serious disease and is not life-threatening.
While there is no cure for IBS the symptoms can usually be reduced. This often includes a combination of approaches including changes in diet, medications, and other therapies.
Large meals can cause cramping and diarrhoea, so eating smaller meals more often, or eating smaller portions, may help IBS 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 IBS symptoms in some children, such as
foods high in fat
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
Low FODMAP diet
Children with IBS 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.
The presence or severity of the pain should not be disputed. A review of the current understanding of IBS and the effects that stress and anxiety can have on worsening the condition helps the child and family to understand why the pain occurs. Psychosocial difficulties and triggering events for symptoms will be asked about and, if present, addressed.
Medications may be used – such as a tricyclic antidepressant (Amitriptyline), which in low doses acts as a chronic pain reliever, or anticholinergics to help control intestinal cramping. However. In those with constipation treatment with stool softeners is recommended.
Psychotherapy and cognitive behavioural therapy- Talking with a therapist may reduce stress and improve IBS symptoms. Two types of talk therapy used to treat IBS are cognitive behavioural therapy and psychodynamic, or interpersonal, therapy. Cognitive behavioural therapy focuses on the child’s thoughts and actions. Psychodynamic therapy focuses on how emotions affect IBS symptoms. This type of therapy often involves relaxation and stress management techniques.
In patients with symptoms that do not respond to treatment, endoscopic evaluation of the colon may be done. Irritable bowel syndrome may coexist with inflammatory bowel disease. Tests can differentiate an inflammatory bowel disease from a functional GI disorder such as IBS.
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Hyams JS, Burke G, Davis PM, Rzepski B, Andrulonis PA. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study. J Pediatr 1996 Aug;129(2):220-226.
Caplan A, Rasquin A. What's new in pediatric functional gastrointestinal disorders. IFFGD Fact Sheet No. 824; 2002.
NIH Publication No. 12-4640. Irritable bowel syndrome in children. July 2012.