What is irritable bowel syndrome (IBS)?
IBS is a common problem that affects the way the intestine works. If your child has IBS, they may have stomach pain, gas or trouble passing stool (poop). Sometimes, this has to do with how sensitive a person’s digestive system is to the environment and emotions and how the nerves in their intestines communicate to their brain. IBS can be uncomfortable, but it is not life threatening, and people may feel better by changing their diet and lifestyle.
There are different types of IBS
- IBS-C: The person has mostly constipation (hard poop, less frequent poop, painful or hard-to-pass poop) (Types 1 and 2).
- IBS-D: The person has mostly diarrhea (very loose and more frequent poop) (Types 4 and 5).
- IBS-M or IBS-A: The person has a mix (M) of constipation and diarrhea, and sometimes it alternates (A) between diarrhea and constipation.
- IBS-U: The person has symptoms that do not fit into the other types (unclassified), or symptoms are unpredictable.
Remember: Constipation can happen even if your child has daily bowel movements. The type and size of the stool (poop) is as important as how often your child passes stool (the frequency).
The Modified Bristol Stool Chart is often used to help describe stool types.
IBS is not the same as IBD (inflammatory bowel disease). IBS and IBD are two different conditions. IBS affects how the digestive system works but does not damage the intestines. IBD is a disease that involves inflammation that can damage the digestive system and affect overall health.
What does IBS feel like?
IBS affects people in different ways.
Some people have mild symptoms, while others feel really uncomfortable and find that it makes everyday life harder. If your child has IBS, they might:
- have stomach pain or cramps
- feel bloated or full of gas
- poop too often (diarrhea), not poop enough (constipation), or switch between diarrhea and constipation
- feel like they need to poop right away (urgency)
- feel like they did not finish pooping, even after they go (rectal discomfort)
- see mucus (a slippery, jelly-like substance) in their poop
IBS comes and goes.
IBS symptoms can come and go over weeks or months. The pain and pooping problems can keep coming back again. Your child might feel really bad sometimes and fine other times.
IBS is not just tummy problems.
IBS can also cause other problems, such as headaches, tiredness and feeling worried or sad. IBS is not known to cause other serious health problems. However, it can affect mental health, social well-being and quality of life if not managed.
What causes IBS?
The causes of IBS are unknown, but there are some things that might make it more likely to happen.
Gut irritation
Sometimes, IBS can happen after a child has had an infection in their stomach or intestines or has taken antibiotics. Antibiotics can upset or throw off the balance of good bacteria in the gut.
Problems with communication between the gut and the brain
Another reason for IBS might be that the system that connects your child's brain and digestive system (gut), called the gut-brain axis, is not communicating well. This can make the digestive system move slower or faster, causing problems managing digestion, emotion and stress.
Some people's digestive systems are more sensitive to pain. For example, when the intestine stretches because of too much gas or stool (poop), this can cause pain. Some people with IBS may feel more pain or symptoms when they eat certain foods.
Genetics
IBS might run in your family, but we don't know why. If your mom, dad, brother or sister has IBS, you are more likely to have it too.
How common is IBS?
In Canada, about 18 out of 100 Canadians may have IBS.
Who is more likely to have IBS?
People can have IBS at any age, but it often starts during adolescence or young adulthood. Individuals born female are reported to have IBS more often than individuals born male. If a person struggles with anxiety, depression or other mental health issues, they are also more likely to have IBS.
IBS symptoms can get better or worse day to day, but sometimes they can last for a long time. IBS will not cause more serious conditions such as IBD or cancer. Many people with IBS can feel better by changing their diet and lifestyle.
How can a health-care provider know if your child has IBS?
There is no single test to diagnose IBS. This is because the digestive system of someone with IBS is normal. Health-care providers diagnose IBS by asking questions and reviewing your child's symptoms. Your child's health-care provider may also suggest some tests (such as blood work or poop tests) to rule out other conditions, such as IBD or infections.
How is IBS managed?
Most people can manage IBS symptoms with diet and lifestyle changes. How IBS symptoms are best managed is different from person to person and depends on the type of IBS. You may have to try different things to figure out how to best manage your child's IBS.
Lifestyle changes
The following are some lifestyle changes that can help with managing IBS symptoms:
- Getting enough sleep
- Exercising regularly
- Managing stress and anxiety
- Using relaxation techniques (such as deep breathing or yoga)
- Consulting a professional for cognitive behavioural therapy (CBT)
Dietary changes
The following dietary changes may help improve your child's symptoms:
- Drinking lots of water
- Eating smaller and more frequent meals
- Avoiding eating on the run or skipping meals
- Eating more fibre
- Insoluble fibre: Adds bulk (volume) to stools. Insoluble fibre does not dissolve in water. Adding insoluble fibre to your child's diet may help with constipation. Sources of insoluble fibre include nuts, seeds, whole grains and vegetables (including peels).
- Soluble fibre: Dissolves in water and forms a gel-like substance, which helps move stool in the gut and slows down digestion. Adding more soluble fibre to your child's diet may help with diarrhea. Soluble fibre can be found in oats, beans, lentils and some vegetables and fruit.
- It can also be helpful to keep a food diary to see what foods may trigger your child's symptoms.
Your child's health-care provider might recommend trying a low-FODMAP diet. This specialized diet is low in fermentable sugars (carbohydrates). It is only used for a short time and should be followed under the supervision of your child's health-care provider.
Avoid common food triggers
Your child's health-care provider may recommend avoiding these common food triggers if they bother your child:
- High-FODMAP foods (foods containing a type of carbohydrate or sugar that the small intestine can have trouble digesting)
- Ask your child's health-care provider about the low-FODMAP diet.
- Foods high in fat (e.g., deep-fried foods, bacon, pastries)
- Dairy with lactose
- Drinks with caffeine (e.g., coffee, tea, energy drinks or cola)
- Sugar substitutes (sugar alcohols such as mannitol, xylitol, sorbitol) found in sugar-free or reduced-sugar products such as gum, drinks, candy and baked goods
- Carbonated drinks (e.g., soda water, pop, kombucha, drinks from home carbonation systems)
- Spicy foods (e.g., hot chicken wings, hot curry, hot sauce)
- Sugary foods (e.g., sweets, baked goods and candy)
Medicines to help with symptoms
A health-care provider can prescribe medicines for pain and for problems with bowel movements, such as diarrhea, constipation, gas and urgency. Speak to your child's health-care provider about medications if your child is having trouble managing their symptoms.
What can happen if IBS is not managed?
If your child's IBS symptoms are not treated, they may develop health problems.
Having diarrhea, constipation and pain for a long time can cause the following complications:
- Hemorrhoids: swollen and sore veins near the anus
- Anal fissure(s): tear(s) near the anus
- Fecal impaction: poop stuck in the digestive system
- Rectal prolapse: lower part of the digestive system tissue falling out of the anus
- Malnutrition: if your child stops eating a lot of foods because they bother them, your child may not get enough of the nutrients their body needs
- Anxiety and sadness
- Symptoms may affect your child's daily life
Keep a detailed diary about food, activity and bowel movements
It is not always easy to know what is causing IBS symptoms. Keeping a diary can help you identify what triggers your child's symptoms.
Write down the following:
- The foods your child eats and when
- The frequency and consistency of your child's stools
- Events like activities
- When your child's symptoms occur
This can help your child's health-care provider figure out what is working and what is not. You will be able to see how the changes you and your child have made—such as eating differently or being more active—are helping them feel better.
When to seek medical attention
Speak to your child’s health-care provider if your child has:
- repeated episodes of abdominal pain with either diarrhea or constipation several times a month for at least two months
- daily loose, frequent watery stool for more than two weeks
- weight loss or bloody diarrhea
Resources
Canadian Digestive Health Foundation
- Irritable bowel syndrome: https://cdhf.ca/en/digestive-conditions/irritable-bowel-syndrome-ibs/
- IBS toolkit for the newly diagnosed: https://cdhf.ca/en/ibs-toolkit-for-the-newly-diagnosed/
References
Alberta Health Services. (2023). Irritable bowel syndrome (IBS) primary care pathway. Retrieved from https://www.albertahealthservices.ca/assets/about/scn/ahs-scn-dh-pathway-ibs.pdf
American College of Gastroenterology. (n.d.). Irritable bowel syndrome (IBS). Retrieved from https://gi.org/topics/irritable-bowel-syndrome/
Lacey, B.E., Pimentel, M., Brenner, D.M., Chey, W.D., Keefer, L.A., Long, M.D., & Moshiree, B. (2020). ACG clinical guideline: Management of irritable bowel syndrome. American Journal of Gastroenterology, 116(1), 17-44. Retrieved from https://doi.org/10.14309/ajg.0000000000001036
Monash University. (n.d.). IBS central: Your complete network. Retrieved from https://www.monashfodmap.com/ibs-central/