Pediatric Irritable Bowel Syndrome Clinical Presentation

  • Author: Mohammad F El-Baba, MD; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: Dec 22, 2010
 

History

Irritable bowel syndrome (IBS) has a broad range of symptoms; the most common are abdominal pain and altered bowel movements. Although symptoms may vary among patients, a pattern usually develops for each patient. The presence of characteristic symptoms in an otherwise healthy individual is sufficient to make a diagnosis of irritable bowel syndrome in most individuals.

  • The characteristics of abdominal pain vary between patients and even within an individual patient.
    • The pain can be dull, achy, colicky, or sharp.
    • Pain can occur anywhere in the abdomen but is commonly located in the hypogastric or periumbilical regions.
    • The pain has no specific pattern but may be aggravated by stress and food and partially relieved after defecation.
  • Altered bowel habits include constipation, diarrhea, or alternating constipation with diarrhea.
    • Stools are usually of small volume and pasty. Constipation is associated with small, hard, pelletlike stools. Diarrhea characteristically occurs during waking hours and often is precipitated by meals.
    • Mucus can be a component of the stool in as many as 50% of patients with irritable bowel syndrome.
    • In some patients, defecation is associated with a sense of incomplete evacuation that can lead to repeated trips to the bathroom and prolonged straining.
  • Symptoms of abdominal distension (ie, bloating, increased belching, flatulence) are frequently reported by patients with irritable bowel syndrome. They are less common in children than adults.
  • Other GI symptoms (ie, heartburn, dyspepsia, nausea, vomiting) are reported in 25-50% of adult patients with irritable bowel syndrome. Dyspeptic symptoms are present in as many as 30% of pediatric patients with irritable bowel syndrome.
  • Extraintestinal symptoms are also reported. Patients with irritable bowel syndrome frequently report dysmenorrhea, urinary frequency, incomplete bladder emptying, back pain, and headache. These complaints are common in adults but rare in children.
  • Patients may relate a history of inciting events.
    • Exacerbation of irritable bowel syndrome symptoms is sometimes reported to follow stressful experiences, ingestion of specific foods, or consumption of alcohol or caffeine.
    • Menses may exacerbate irritable bowel syndrome symptoms in women.
    • In children, symptom precipitants include school-related problems, overeating, or eating problems.
  • The following clinical features should alert the physician to the possibility of a disorder other than irritable bowel syndrome:
    • Frequent awakening by symptoms
    • Steady progressive course
    • Fever
    • Weight loss
    • Arthritis
    • Rectal bleeding
    • Persistent vomiting
  • The diagnosis of irritable bowel syndrome requires the identification of the symptoms characteristic of irritable bowel syndrome and the exclusion of other medical conditions with similar clinical presentations. Symptom-based criteria have been established for the diagnosis of irritable bowel syndrome, which includes the Manning or, more recently, the Rome criteria. The pediatric working team adopted the Rome II criteria in the adult population because these criteria seemed to apply equally well to children. Rome II criteria apply to children old enough to provide an accurate pain history of at least 12 weeks, which need not to be consecutive, in the preceding 12 months. The history can include the following:
    • The abdominal discomfort or pain has 2 out of the following 3 features: (1) relief with defecation, (2) onset associated with a change in frequency of stool, and (3) onset associated with a change in the form of stool.
    • No structural or metabolic abnormalities exist to explain the symptoms.
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Physical

  • Physical examination findings generally are unremarkable. The patient may appear tense and anxious with sweaty palms. Abdominal tenderness may be present. Tender and palpable sigmoid is found in some patients.
  • Findings against the diagnosis of irritable bowel syndrome include the following:
    • Abdominal rigidity
    • Rebound tenderness
    • Lymphadenopathy
    • Hepatosplenomegaly
    • Positive fecal bleeding test result
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Causes

  • Irritable bowel syndrome has no identifiable cause (see Pathophysiology).
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Contributor Information and Disclosures
Author

Mohammad F El-Baba, MD  Assistant Professor of Pediatrics, Division of Pediatric Gastroenterology, Wayne State University School of Medicine; Division Chief of Pediatric Gastroenterology, Children's Hospital of Michigan

Mohammad F El-Baba, MD is a member of the following medical societies: American Gastroenterological Association and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Specialty Editor Board

Hisham Nazer, MB, BCh, FRCP, DCh, DTM&H  Professor of Pediatrics, Consultant in Pediatric Gastroenterology, Hepatology and Clinical Nutrition, Bushnaq Medical Centre, University of Jordan Faculty of Medicine, Jordan

Hisham Nazer, MB, BCh, FRCP, DCh, DTM&H is a member of the following medical societies: Royal College of Paediatrics and Child Health, Royal College of Physicians, Royal College of Surgeons in Ireland, Royal College of Surgeons of Edinburgh, and Royal Society of Tropical Medicine and Hygiene

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

David A Piccoli, MD  Chief of Pediatric Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia; Professor, University of Pennsylvania School of Medicine

David A Piccoli, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Steven M Schwarz, MD, FAAP, FACN, AGAF  Professor of Pediatrics, Children's Hospital at Downstate, SUNY-Downstate Medical Center

Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research

Disclosure: Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor; Johnson & Johnson, Inc. Grant/research funds Independent contractor

Chief Editor

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

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Severe colitis noted during colonoscopy. The mucosa is grossly denuded, with active bleeding noted. This patient had her colon resected very shortly after this view was obtained.
 
 
 
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