Irritable bowel syndrome (IBS) is a common gastro-intestinal disorder in children. IBS is a functional gastrointestinal disorder which is characterized by abdominal pain or discomfort with associated changes in bowel habits. It is a diagnosis based on taking a good history and there are typically few physical findings.
I recently saw a 10 year old boy with episodes of “recurrent abdominal pain” which had been intermittent over the last 6-12 months. When questioned he complained of the sudden onset of
peri-umbilical pain (“around his belly button and in the middle of my stomach”). The pain was sometimes related to meals, but not always, and it “just hurts”. He did not have any associated vomiting and he thought he “pooped on a regular basis”. The pain would last anywhere from 30 minutes to several hours, and he could not think of anything that made it worse, and he felt as if once he pooped he may get better for awhile. His pain occurred at different times throughout the day and has happened at least every couple of weeks for months.
His mother stated that he did not have associated fever, rash, nighttime awakening with abdominal pain or a family history of inflammatory bowel disease. He had never had blood in his stool, but she was “not sure” how often he had bowel movements or what they looked like. When he had the pain he would miss school, a sporting event or even a birthday party. She was worried that “something was twisted in his stomach…”
Looking at my records I could see that he had not lost weight and was growing appropriately. He was currently not having pain (he had the day before), and his physical exam was entirely normal: soft tummy, no point tenderness, and he giggled when I was “mashing around” on his abdomen. He also had a normal rectal exam (Yuck…but painless).
His story is a perfect one for IBS…interestingly his mother also said, “I have had lots of stomach issues and have had lots of tests but they have never shown anything”. “Don’t you think he needs a CT scan” she asked me? “Maybe he has a blockage or twisted intestines?”
About 8-12% of children and a great number of adolescents meet the criteria for IBS. It seems to become more prevalent with age. The problem is that IBS is probably due to some genetic and psycho-social factors as well as studies which are showing some underlying biologic factors within the gut.
Best news for this little boy ( and his Mom) is that he doesn’t have to have a bunch of tests involving blood work or radiation exposure with X-rays and scans. It was also nice to reassure both of them that he did not have a “horrible” disease and that there were things to try to see if we could improve his pain, help him cope with the pain and to let him know that this may be an issue for him intermittently.
For some kids taking probiotics regularly seems to help. There are also some children who will have less episodes of pain on a low-lactose diet, a low gluten-wheat diet, or low fructose diet, and I usually try a trial for a couple of weeks to see if they are better with dietary changes….if no improvement why stay off of food, right? I also try adding fiber to the child’s diet and in some cases prescribe an anti-spasmodic for short term use.
Most importantly is reassurance and some psychosocial interventions to help the child (and parents) deal with the pain. This may be done with a professional if necessary who can do some cognitive behavioral therapy.
In my experience just having validation that their pain is real, and listening to their story is the most helpful. It is often a relief to know that this is not a serious problem and that you are going to work on ways to help alleviate the pain…..referrals to multiple specialists for IBS is not necessary.