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Irritable Bowel Syndrome

What is irritable bowel syndrome?

Irritable bowel syndrome is one of the manifestations of functional abdominal pain. Functional means that there is no organic disease. Functional abdominal pain describes a constellation of symptoms as a result of intestinal motility disorders. Symptoms may include:

What causes irritable bowel syndrome?

The digestion and propulsion of nutrients and fluids through the gastrointestinal system (GI) is a very complicated and very well organized process. The GI tract has its own intrinsic muscles and nerves that connect, like an electrical circuit, to the spinal cord and brain. Neuromuscular events occurring in the GI tract is relayed to the brain through neural connections, and the response of the brain is also relayed back to the gastrointestinal tract. As a result of this activity, motility and sensation in the bowel is generated. An abnormality in this process results in a disordered propulsion of the intestinal contents and generates the sensation of pain.

The nerves that control the digestive tract may also be more sensitive to the activity associated to the process of digestion. Children with irritable bowel syndrome may be more aware of gas and motion and rumbles of the intestines. They are more aware of these discomforts and hence more irritated when they occur. The child who experiences the symptoms of irritable bowel syndrome is thought to be as a result of the following and their interaction:

All of the above factors can trigger the occurrence of symptoms. It is important to stress to the child with a functional bowel disorder that his/her abdominal pain is real and not imaginary.

Who is affected by irritable bowel syndrome?

Why is irritable bowel syndrome a concern?

Children with irritable bowel syndrome often do not feel well. Those who have diarrhea may have little warning of their need to go to the bathroom, and, therefore, may be embarrassed and avoid going to school or socializing with their schoolmates. Children can become depressed or anxious because of the disorder.

Most children with irritable bowel syndrome continue to grow and develop normally. However, some children may eat less to avoid the pain that can accompany digestion, and therefore, lose weight.

Its greatest morbidity resides in the fact that it affects normal daily activity of the child, affecting school and peer relations.

What are the symptoms of irritable bowel syndrome?

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), irritable bowel syndrome in children tends to produce two types of symptoms: diarrhea or pain, depending on the age of the child. Symptoms may include:

In children, symptoms of functional bowel disorders are variable and are age dependent. For example:

The symptoms of irritable bowel syndrome are not unique for the condition. Altered bowel pattern and abdominal pain could be symptoms of organic disease - one reason why you should always consult your child's physician for a diagnostic work-up.

How is irritable bowel syndrome diagnosed?

Your child's physician will obtain a thorough medical history, perform a full physical examination, and obtain screening laboratories to assess for infection and inflammation. The laboratory tests, imaging studies, and procedures to be performed will be dictated by the history and physical examination. Tests and procedures that your child's physician may order may include the following:

Illustration demonstrating upper endoscopy, part 1
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Illustration demonstrating upper endoscopy, part 2
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Illustration demonstrating upper endoscopy, part 3
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Illustration demonstrating a colonoscopy, part 1
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Illustration demonstrating a colonoscopy, part 2

Treatment for irritable bowel syndrome:

Specific treatment of irritable bowel syndrome will be determined by your child's physician based on:

The main objective of treatment for irritable bowel syndrome to restore normal daily function. Management begins with the positive diagnosis of irritable bowel syndrome. This will give your child reassurance that he/she does not have any life-threatening condition.

Environmental modification is important to identify the stresses surrounding your child and reverse them. Parents and school teachers must support the child rather than concentrating on the pain. Try to help the child focus on something fun or pleasant during a painful episode.

In lactose intolerant patients, restriction of lactose or supplementing the enzyme that digests the sugar (lactase/Lactaid®) is recommended since this sugar can be a trigger for symptoms of irritable bowel syndrome.

A controversial issue is the use of high fiber in children since it could promote flatulence and abdominal distension. It is recommended in the adult population, and it may be beneficial in children in which the symptom of constipation predominates.

Depending on the severity of the symptom, medication may be indicated. In rare cases, pain control needs to be administered by specialists in the field of pain management. Biofeedback has become part of the treatment strategy, as well as acupuncture.

How much fiber is enough?

For children two years of age and older, use the following guideline: The child's age plus five equals the number of grams of fiber that should be eaten daily.

For example, a 4 year old needs four + five grams per day = nine grams of fiber per day.

What foods are high in fiber?

Fiber is found in foods such as:

Suggestions for increasing fiber intake:

  1. Use raw vegetables and fruits with dip.
  2. Use unpeeled potatoes for potato salad or french fries.
  3. Add high-fiber cereal or fruit to ice cream, frozen yogurt, or yogurt.
  4. Add beans to soups, stews, and salads.
  5. Use whole wheat bread for sandwiches.

What are good fiber sources?

FOODS MODERATE FIBER HIGH FIBER
BREAD Whole wheat bread, granola bread, wheat bran muffins, Nutri-Grain® waffles, popcorn
CEREAL Bran Flakes®, Raisin Bran®, Shredded Wheat®, Frosted Mini Wheats®, oatmeal, Muslix®, granola, oat bran All-Bran®, Bran Buds®, Corn Bran®, Fiber One®, 100% Bran®
VEGETABLES Beets, broccoli, brussel sprouts, cabbage, carrots, corn, green beans, green peas, acorn and butternut squash, spinach, potato with skin, avocado
FRUITS Apples with peel, dates, papayas, mangos, nectarines, oranges, pears, kiwis, strawberries, applesauce, raspberries, blackberries, raisins Cooked prunes, dried figs
MEAT SUBSTITUTES Peanut butter, nuts Baked beans, black-eyed peas, garbanzo beans, lima beans, pinto beans, kidney beans, chili with beans, trail mix

High-fiber meal vs. a typical meal:

Typical Meal High-fiber Meal
Breakfast
Corn flakes 1/2 cup
Donut 1
Milk 1/2 cup
Orange juice 1/2 cup

Total grams of fiber = 0.5 grams

Breakfast
Raisin bran 1/2 cup
Bran muffin
Milk 1/2 cup
Orange juice 1/2 cup

Total grams of fiber = 5 grams

Lunch
Beef patty 3 ounces
Hamburger bun
French fries
Green beans 1/2 cup
Canned pears 1/2 cup
Milk 1 cup

Total grams of fiber = 5 grams

Lunch
Beef patty 3 ounces
Whole wheat bun
Baked potato with skin
Baked beans 1/2 cup
Pear with skin
Milk 1 cup

Total grams of fiber = 15 grams

Dinner
Grilled chicken 3 ounces
Lettuce salad
White rice 1/2 cup
Watermelon 1/2 cup
Milk 1/2 cup

Total grams of fiber = 1.5 grams

Dinner
Grilled chicken 3 ounces
Broccoli 1/2 cup
Brown rice 1/2 cup
Strawberries 1/2 cup
Milk 1/2 cup

Total grams of fiber = 6 grams

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