Irritable Bowel Syndrome (IBS)

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When functional abdominal pain includes changes in bowel movement habits (constipation, diarrhea or alternating constipation and diarrhea), it is considered irritable bowel syndrome (IBS).

What causes irritable bowel syndrome?

Although the exact cause is not known, nerve signals or chemicals secreted by the gut or brain, may cause the gut to be more sensitive to triggers that normally do not cause significant pain (such as stretching or gas bloating). The nerve dysfunction also results in change in bowel motility leading to constipation or diarrhea or both.

Children may experience the symptoms of IBS due to:

• Problems with how food moves through the digestive system.
• Hypersensitivity of the inside of the bowel to stretching and motion.
• Stress.
• Overgrowth of bacteria in the bowel.

All of the above factors can trigger symptoms. It is important to stress to the child that his or her abdominal pain is real and not imaginary.

Who is at risk for irritable bowel syndrome?

• IBS occurs in both children and adults. Almost 14 percent of high school students and 6 percent of middle school students complain of IBS-like symptoms.
• Girls and boys are equally affected by the disorder.
• There is no known gene that causes IBS, but the disorder does seem to occur more often in families where either a child or a parent has the disorder.

Why is irritable bowel syndrome a concern?

A child with IBS often does not feel well. A child with diarrhea may have little warning of the need to go to the bathroom and may feel too embarrassed to go to school or socialize with schoolmates or friends. This can lead to depression and anxiety.

Most children with IBS continue to grow and develop normally. However, some children may eat less to avoid the pain that can accompany digestion. This can lead to weight loss.

The symptoms of IBS are not unique to the condition. A change in bowel habits and abdominal pain can be symptoms of other conditions. It is important to work with a pediatric gastroenterologist to ensure a proper diagnosis.

What are the symptoms of irritable bowel syndrome?

IBS in children tends typically results in discomfort or pain and may include:

• Recurrent abdominal pain. The pain becomes chronic when it has been present for more than three months.
• Bloating
• Gastroesophageal reflux (GERD or heartburn) in children younger than 2 that reappears in adolescence and adulthood
• Nausea
• Chronic or intermittent diarrhea
• Chronic or intermittent constipation
• Alternating diarrhea and constipation
• Colic in children younger than 4 months
• Urgency for passing a bowel movement
• Sensation of incomplete passage of bowel movement
• Passage of mucus in the stool
• Nausea
• Dizziness
• Loss of appetite

Symptoms of IBS can resemble those of many other conditions. The pediatric gastroenterologists at CHOC work with children and their families using advanced diagnostics and a complete medical history to come up with a diagnosis and individualized treatment plan for IBS that is mindful of each child’s medical, emotional and physical needs.

How is irritable bowel syndrome diagnosed?

Our pediatric gastroenterologists take a thorough medical history and physical exam. Lab tests are done to check for infection and inflammation. Tests and procedures may include:

• Blood tests. These tests are done to evaluate whether your child is anemic, has an infection, or has an illness caused by inflammation or irritation. Learn more about blood tests at CHOC.
• Urine analysis and culture. These are done to help assess for urinary tract infections.
• Stool sample. This sample is taken to culture to check for bacteria and parasites that may cause diarrhea. Learn more about stool tests at CHOC.
• Stool samples for occult blood. Occult blood cannot be seen and is only detected by a special solution that turns blue when coming into contact with blood. It suggests an inflammatory source in the gastrointestinal tract.
• Lactose breath hydrogen test. This test is done to determine if your child is intolerant to lactose, a sugar present in milk and milk products. Learn more about lactose breath hydrogen tests.
• Abdominal X-ray. A simple study that will give the health care provider an idea of how the internal organs look. Learn more about X-rays.
• Abdominal ultrasound. A diagnostic imaging technique that creates images from the rebound of high frequency sound waves in the internal organs. Learn more about ultrasounds at CHOC.
• Endoscopy. A test that uses a small, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of part of the digestive tract. Tissue samples from inside the digestive tract may also be taken for examination and testing. Learn more about endoscopy.
• Colonoscopy. A test that uses a long, flexible tube with a light and camera lens at the end (colonoscope) to examine inside the large intestine. Learn more about colonoscopy.

What is the treatment for irritable bowel syndrome?

At CHOC we create a treatment plan that is mindful of each patient’s medical, physical, social and emotional well-being both now and in the future. Specific treatment of IBS will be determined based on:

• The child’s age, overall health and medical history.
• Extent of the problem.
• The child’s tolerance for specific medications, procedures or therapies.
• The family’s opinion and preference.

The main objective of treatment for IBS is to restore normal daily function. Management begins with the positive diagnosis of IBS. This will give the child reassurance that he or she does not have any life-threatening condition. Treatment may include:

• Dietary changes, such as a low FODMAP diet. Learn more about the low FODMAP diet.
• Medication
• Probiotics
• Stress management
• In a child who is lactose intolerant, restricting lactose or supplement the enzyme that digests the sugar (lactase/Lactaid). Lactose sugar can be a trigger for symptoms of IBS.
• Neuromodulation therapy, such as IB-Stim.
• In rare cases, specialists may be consulted for pain control. Biofeedback and acupuncture have become part of the treatment strategy. Learn more about biofeedback, acupuncture and other integrative health treatments available at CHOC.

Neuromodulation Treatment for IBS

CHOC was the first program in the world to be named a Center of Excellence for Auricular Neuromodulation (IB-Stim) worldwide by NeurAxis, a medical technology company specializing in innovative neuromodulation therapies. CHOC was one of the first in the nation to offer neuromodulation treatment for IBS.

Neuromodulation treatment is an integrative approach that does not use medication or narcotics to alleviate abdominal pain and nausea. It uses a small device, called an IB-Stim, placed on the patient’s ear that delivers small amounts of electrical impulses to nerve branches in the ear, resulting in decreased pain and nausea. Ears have important nerve endings from the vagus and trigeminal nerves that in turn communicate with the sensory and emotional centers of the brain.

The IB-Stim device is placed once a week for four consecutive weeks and remains on the patient’s ear for at least five days.