Introduction

Irritable bowel syndrome (IBS) is a common condition which can cause painful symptoms. It affects the digestive system, mainly the stomach and intestine. It usually affects children assigned female at birth (AFAB) more frequently than children assigned male at birth (AMAB) and, in children, it can be caused by multiple factors such as those tied to intolerances, stress, anxiety or infections.¹

So how does Irritable bowel syndrome affect children? What are their symptoms and how can this condition be managed? This article can help us understand this better.

What is irritable bowel syndrome? 

Irritable bowel syndrome is a common condition which can affect both adults and children and is the most common cause of abdominal pain in children globally. Irritable bowel syndrome is a lifelong chronic condition which affects the digestive system, which includes the stomach, intestines and colon, causing painful symptoms. The most common of which is abdominal pain. 

Despite the painful symptoms, in children with irritable bowel syndrome,  examinations and investigations usually do not show any signs of inflammation or damage,  however, their digestive system does not work as it should. IBS  does not affect the child's tissues in the gastrointestinal tract nor does it increase the risk for any serious condition (such as colon cancer), it can however affect your child in the long term.²

What causes irritable bowel syndrome? 

The cause of IBS  is unknown, and there are no genetic modifications which cause this condition, however, studies have shown that there is an increased likelihood of a child being diagnosed with IBS when a parent is also affected.²

While the cause is unknown, individuals with IBS have highly sensitive digestive systems, causing greater levels of reactions than normal. Children may experience irritable bowel syndrome as a result of: 

• Stress
• Hypersensitivity of their bowel
• Overgrowth of bacteria
• Trouble with food motion during digestion 

Other than these conditions environmental factors can contribute to IBS  such as:

• Food intolerance
• Previous use of antibiotics 
• Gastrointestinal infections 

How can irritable bowel syndrome be identified?

Different diagnostic criteria are used to identify irritable bowel syndrome in children. IBS can be divided into various subtypes called IBS-D, IBS-C, and IBS-M.³

• IBS-D is diagnosed as irritable bowel syndrome with diarrhoea, with bowel movements that are loose and watery
• IBS-C is diagnosed as  irritable bowel syndrome with constipation, with bowel movements that are hard and lumpy
• IBS-M is diagnosed as  irritable bowel syndrome with mixed patterns, with bowel movements that are a mixed version of the previously explained 

While studies show an equal distribution of all of these diagnostic patterns, in Europe IBS-C and IBS-M are more common.  Irritable bowel syndrome is diagnosed by gastroenterologists and doctors specialising in the gastrointestinal system and related conditions.

What are the signs and symptoms of irritable bowel syndrome?

Symptoms may vary from child to child.^2,5 Symptoms include:   

• Diarrhoea or constipation
• Continuous stomach pain (may be chronic if it continues for more than 3 months)
• Dizziness
• Loss of appetite
• Stomach cramps
• Swelling, bloating or gas
• Mucus in stool
• Needing to use the toilet right away
• Feeling as if stool evacuation was not complete

 Symptoms may vary based on your child’s age. 

• Babies under 4 months of age may experience colic
• Children aged 4 years or younger may experience chronic diarrhoea
• Those under the age of 2 may experience heartburn, which might reappear as gastroesophageal reflux as an adolescent 

The symptoms of IBS  are not specific, so, consulting your child’s paediatrician is always the recommended first step. 

Older children and teenagers may have worse symptoms during stressful periods, so it is important to monitor and explore psychological issues which can lead to stressful situations for your child. Recent gastrointestinal infections might also be associated with the appearance of the symptoms. 

What are the red flag symptoms of irritable bowel syndrome?

Red flag symptoms are symptoms that might tell you about the presence of a more serious condition which requires further investigation.² Red flags of IBS include:

• Night pain and diarrhoea
• Recurrent fever with no explanation
• Recurrent rectal bleeding (blood in the stools)
• Joint pain
• Slow growth
• Weight loss
• Family members with a medical history of inflammatory bowel disease (such as ulcerative colitis or Crohn's disease)
• Persistent severe vomiting or diarrhoea
• Pallor
• Delay in puberty

It is important to contact your paediatrician when you notice any abrupt changes, such as pain when using the toilet or blood in stools, in your child’s bowel movement lasting more than 2 weeks.

How is irritable bowel syndrome diagnosed?

Medical assessment

The first step in diagnosing IBS is taking a medical history and performing an examination. The healthcare professional will conduct a thorough physical examination on your child measuring them on an appropriate growth chart based on their height, weight and gender.^4,

Other pertinent findings such as weight loss, anaemia, mouth ulcers, skin rash or arthritis might need further investigation, as these signs are unlikely to align with a diagnosis of irritable bowel syndrome.  

Diagnosis

To diagnose irritable bowel syndrome laboratory tests may need to be carried out to rule out the possibility of infections or inflammation, which may be caused by more serious underlying gastrointestinal issues.⁶  

Laboratory investigations might include:

• Serologic screening for coeliac disease
• Liver function test
• Blood tests (when in the presence of anaemia and blood in stools)
• Stool lab examination
• Urine analysis
• Lactose breath hydrogen test

Other diagnostic tests and screening tools include:

• Abdominal x-ray
• Abdominal ultrasound
• Endoscopy
• Colonoscopy

These tests are usually carried out when the diagnosis is unclear or when symptoms might suggest another cause.  A referral to the pediatric gastroenterologist may be required in these cases. 

Diagnosis can be made after the exclusion of other conditions with similar symptoms, and after the doctors have excluded the presence of any red flag symptom.

Can irritable bowel syndrome be treated?

Your child’s paediatrician or gastroenterologist will determine treatment based on:

• Your child’s age, health and medical history
• The severity of the symptoms
• Your child’s tolerance for therapies and medications
• Predicted progression of the condition
• Your parental opinion

There are no treatments for irritable bowel syndrome, however, the right therapy can help your child get back to their normal activities, which is the main objective of the therapy.

Treatments may include changes to diet, medication, probiotics, or stress management. Additionally, if your child suffers from lactose intolerance, lactose-free alternatives, or enzymes to break down lactose may be given to digest this sugar, as lactose can trigger irritable bowel syndrome symptoms. ^7,8

As we said, dietary changes can include:

• Lactose restrictions – this is suggested when your child has lactose intolerance and cannot digest this sugar
• High fibre – this dietary change can be controversial as it can lead to bloating and gas in children, however, it is recommended in adults and children with constipation as it can bring relief
• Probiotics – your child’s paediatrician can decide to add probiotics to your child’s diet to add good bacteria that can aid in digestion
• Other dietary changes – in case of additional intolerances or food allergies further changes to the diet might be made

In rare cases, there might be an additional consultation for pain control, with some therapies like acupuncture or yoga, other relaxation techniques, or cognitive behavioural therapy.

Other complications

Irritable bowel syndrome might cause your child to be frequently unwell, which can lead to emotional distress. Children with diarrhoea might not reach the bathroom timely leading to embarrassment, avoidance of school settings or playtime with friends, leading to depression and anxiety. 

Furthermore, the condition can worsen in the event of specific triggers which can include

• Large meals
• Greasy foods
• Caffeine
• Artificial sweeteners

Summary

Irritable bowel syndrome is a painful lifelong condition, affecting the digestive system.

This condition can also affect children leading to frequent abdominal pain, constipation and diarrhoea. It can be caused by different factors. Some of these are food intolerances and anxiety, but their precise cause is unknown.  It is thought that people with this condition have highly sensitive digestive systems causing it to be overly reactive and leading to painful episodes.

If your child is experiencing any of these symptoms, it is important to seek medical advice from a trained medical professional, as irritable bowel syndrome can be managed through lifestyle alterations and medical treatment.  

Remember to reassure your child about their condition. To not cause additional stress, try to distract them and keep them focused on something fun or distracting during painful episodes. 

Summary of key points

• Irritable bowel syndrome is a chronic condition affecting the digestive system
• It can affect adults and children alike and is slightly more common in  children assigned female at birth (AFAB) than children assigned male at birth (AMAB) 
• It can cause abdominal pain, diarrhoea and constipation
• It can be triggered by overgrowth of bacteria, food intolerance, hypersensitivity and food motion during digestion
• The main cause is unknown, but it is thought to be caused by a highly sensitive digestive system
• There is no cure for irritable bowel syndrome but it can be managed with various therapies (relaxation, medication, change in diet and lifestyle)
• Large meals, greasy and spicy foods, caffeine and artificial sweeteners should be avoided as they can trigger symptoms and worsen the pain