Most gastrointestinal (GI) conditions fall into two categories: organic diseases and functional syndromes. Organic diseases have measurable physiological changes, such as the villi damage caused by gluten in celiac disease and the intestinal inflammation found in Crohn’s disease. Functional GI disorders, such as irritable bowel syndrome (IBS), functional dyspepsia, and functional abdominal pain, can cause symptoms that are often debilitating, but they are not currently associated with any physical damage. These functional symptoms can be especially stressful for children since they are less able to cope with the challenges of GI illness, as well as challenging for their parents when physicians cannot identify an organic cause for their child’s discomfort or pain.
IBS Prevalence in Children
Researchers estimate 13-20% of Canadians have IBS and studies suggest that it might be just as prevalent in children as it is in adults. One study involving 345 children found that 22.6% of them had IBS according to the ROME III diagnostic criteria. These children were more likely to suffer from constipation-predominant IBS and to have parents with IBS or mothers who suffer from depression. They also found that more than 80% of the children who met the criteria for IBS also met the criteria for functional dyspepsia.1
Functional Abdominal Pain and Mental Health
Children with functional GI problems can also suffer from mental health problems, such as anxiety and depression. Although it is often unclear which develops first, it might be a self-propelling cycle. A painful bowel movement can increase an already tense child’s anxiety, leading to bathroom avoidance, leading to increased episodes of constipation and abdominal pain, leading to more fear and avoidance, and so on.
In a 2013 study published in the journal Pediatrics,2 researchers tracked 332 children with functional abdominal pain (FAP) and 147 children as control subjects until early adulthood. At follow-up, 41% of the children who had FAP at the start of the study met the standard criteria for functional GI disorders (IBS and functional dyspepsia) as adults. About 62% of these participants had an anxiety disorder at some point during the study, compared to 43% of participants who had FAP in childhood but who did not have a functional GI disorder at follow-up, and only 20% of those who were in the control group. The study suggests there might be a related cause of childhood anxiety and functional abdominal pain and that anxiety, which begins in childhood, along with FAP often continues into adulthood, even if the abdominal pain resolves.
Another study (conducted through phone interviews with the parents of 105 children) found that 40% of children with anxiety issues had symptoms of a functional GI disorder, compared with just 6% of the control group.3
Treatment for functional GI issues might include symptom management and counselling. It is important to stress that although there is no underlying organic disease in functional GI conditions, the pain these children experience is real.
One recent study of 78 children with IBS found that trimebutine maleate, a smooth muscle relaxant used in adult IBS, is also effective for youths, and has approval for patients over the age of 12.1
Further research is required into the potential benefit of psychological therapies for GI problems, not because they are “all in your head” but because current evidence shows anxiety and depression might have a physical effect on the gut. One recent study showed that cognitive behavioural therapy, which helps children with anxiety issues to view neutral situations as not threatening and reduce fear by encouraging healthy situations (e.g., school, socializing, or going to the bathroom) also reduces functional abdominal pain.4 Researchers are optimistic this therapy might also help anxious children who have functional constipation.
Treatment of functional GI conditions with antidepressant medications is helpful for some adults. However, experts do not recommend these therapies for children because they are at an increased risk for side effects, such as suicidal thoughts.5
See your family physician if your child complains of frequent abdominal pain and watch for signs of anxiety and depression.