April Is Irritable Bowel Syndrome Awareness Month

Every child has a tummy ache now and then. Or a bout of diarrhea or constipation. But when that ache becomes chronic abdominal pain, week after week, it’s time to find out what’s going on. The first step is to consult with your child’s pediatrician to see if he or she needs to be evaluated.

Irritable bowel syndrome (IBS) is a common condition that afflicts more than 20% of children ages 6 to 18.* Its symptoms vary and may mimic those of other gastrointestinal disorders, which makes it difficult to diagnose. Common symptoms may include:

• Abdominal pain for several months
• Constipation, diarrhea
• Gas or flatulence
• Nausea, vomiting
• Not functioning in school
• Weight loss
• Dehydration
• Depression

Your pediatrician will probably start with some basic lab tests to rule out other disorders whose symptoms are similar to those of IBS, such as celiac disease, colitis, peptic ulcer, or inflammatory bowel disease. He or she will likely then want you to see a pediatric gastroenterologist.

To clarify, people sometimes confuse IBS with inflammatory bowel disease (IBD). IBD is a totally different condition, in which there is inflammation in the intestine that is discovered through detailed testing. With IBS, there is no inflammation or any other pathological findings, which makes it difficult to treat.

What causes IBS?

“The brain and the gut have a very close relationship,” notes Sarika Aggarwal, MD, a pediatric gastroenterologist who cares for patients in the East Bay as part of the John Muir Health partnership with Stanford Medicine Children’s Health. “Anything that interferes with the gut-brain axis can result in exaggerated or altered perception of gut pain by the brain, resulting in the inability of the brain to perceive those signals correctly. This can trigger chronic abdominal pain and/or other symptoms.”  

And what factors can interrupt those gut-brain communications? “Stress,” says Dr. Aggarwal. “Anxiety, loneliness, lack of sleep—everyone reacts differently to these stressors, but for many children they can result in abdominal pain, diarrhea, constipation, nausea, or other gastrointestinal disorders that together can fall in the category of IBS.”

One current stressor is the COVID-19 pandemic. Schools have been shut, playing sports has been suspended, get-togethers with friends have been limited—in short, almost any opportunity for social interaction has been curtailed.

“I have definitely seen an increase in patients with IBS this year,” observes Dr. Aggarwal. “Children need socialization for normal development, and the restrictions we’ve all been through have created enormous stress for children and adolescents.”

How is IBS managed?

Though stress doesn’t necessarily cause IBS, it can trigger flare-ups of abdominal pain and other symptoms.

“Psychology and stress management plays a huge role in managing IBS,” says Dr. Aggarwal. “As a pediatric gastroenterologist, I address how to keep IBS symptoms at bay. But I always recommend mental health counseling as part of the therapy for IBS.”

In addition, symptom management may include some of these approaches:

• Dietary changes:Fresh fruits and vegetables, increased dietary fiber intake, whole grains.
• Stress-reduction techniques:Deep breathing, physical activity, yoga.
• Sleep hygiene:Avoiding screen time and caffeine close to bedtime, maintaining a consistent sleep schedule.
• Medications: Stool softeners or laxatives, antispasmodics, antidepressants.

Every child is different, and it may take several months to find the right mix of treatments that work best to control IBS flare-ups. You may also want to consult with a dietitian for more information about dietary modifications for IBS.

IBS symptoms may persist

The best efforts don’t always result in diminishing IBS symptoms. For example, in some children, having a viral infection can trigger a flare-up, but once the infection is gone, the flare-up continues. “It’s as though the brain forgot to tell the gut that it’s time to act normally again,” says Dr. Aggarwal.

The same may be true with any other stressor that goes away but leaves the IBS symptoms intact. “This is a chronic condition,” she says, “and the outcomes are not always predictable, though manageable.”

As parents continue to help their children with IBS, it’s also important to recognize their own possible role in triggering symptoms. “I suggest that parents not overwhelm the child with questions about how they’re doing, do they have pain today, do they feel all right today, and so on, simultaneously giving them adequate support in a way that they don’t feel neglected,” says Dr. Aggarwal.

“Sometimes it’s best to trust that your child will figure out what to do and how to manage symptoms on their own. Show your confidence in them by pulling back a bit and letting them own their condition and come to you when they need you.”

* https://doi.org/10.5056/jnm.2013.19.1.90