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.
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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.
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:
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Cramps
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Bloating and gas
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Nausea
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Dizziness
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Headache
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Rectal pain (near where stool leaves the body)
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Low energy
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Poor appetite
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.
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IBS constipation (IBS-C), is when the child has pain that comes with hard, infrequent stools.
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IBS diarrhea (IBS-D) is when the child has pain linked with multiple loose stools.
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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:
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Weight loss
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Vomiting
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Fever with no clear cause
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Blood in the stool
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:
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Changes in the gut microbiome. These are the bacteria, viruses and fungi that normally live in the digestive tract.
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Certain food that can trigger IBS symptoms. If they produce enough gas to cause distension or bloating, which can lead to pain.
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Emotional stress, anxiety and depression. These are not the cause for IBS but can worsen IBS.
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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.
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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:
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cow milk and milk products
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gassy or fatty foods
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chocolate
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drinks with caffeine (including many sodas and energy drinks)
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:
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Antispasmodic medicines for cramps, spasms and belly pain
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Laxatives and fiber supplements for constipation
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Antidiarrheal medications if your child is having diarrhea
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Probiotics, which may help support a healthy gut microbiome for good digestion
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Antidepressant medications, since IBS is linked with anxiety and depression in children and teens.
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
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7 Common Causes of Abdominal Pain in Kids
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What is a Low-FODMAP Diet? How Can It Help My Child?
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Alternatives to Cow’s Milk
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