Pediatric Irritable Bowel Syndrome Clinical Presentation

Updated: Aug 09, 2016
  • Author: Mohammad F El-Baba, MD; Chief Editor: Carmen Cuffari, MD  more...
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Presentation

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 criteria in the adult population because these criteria seemed to apply equally well to children. The Rome criteria were initially published in 1999 (Rome II) and revised in 2006 (Rome III). Diagnostic Rome III criteria for childhood irritable bowel syndrome:  [16] Must include all of the following criteria, fulfilled at least once per week for at least 2 months prior to diagnosis:

    • Abdominal discomfort or pain associated with 2 or more of the following at least 25% of the time:

      1. Improved with defecation

      2. Onset associated with a change in frequency of stool

      3. Onset associated with a change in form (appearance) of stool

    • No evidence of an inflammatory, anatomic, metabolic, or neoplastic process that explains the subject’s symptoms

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Physical

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  • 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

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  • Irritable bowel syndrome has no identifiable cause (see Pathophysiology).

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