Irritable bowel syndrome (IBS) is a long-term (chronic) disorder that affects the small intestine and large intestine (colon). IBS causes painful belly (abdominal) and bowel symptoms.

With IBS, the colon appears normal. But pain and changes in bowel habits occur.

The exact physical cause of IBS is not known. A child with IBS may have a colon that is more sensitive than normal. This means the colon has a strong reaction to things that should not normally affect it.

Children may feel IBS symptoms because of:

• Problems with how food moves through their digestive system.
• Extreme sensitivity of the inside of their bowel to stretching and motion.
• Stress.
• Too much of certain bacteria growing in the small bowel.
• Sensitivity to certain foods, such as lactose, fructose, and sucrose.
• Other conditions that can cause the same type of IBS symptoms, such as celiac disease.

All these things can cause IBS symptoms. Reassure your child that the belly pain is real and not made up (imaginary).

Children are most at risk for IBS if one or both parents have the condition. Teens are more at risk than younger children. IBS affects males and females equally. A history of abuse or stressful situations can increase the risk in both children and adults.

IBS is defined as abdominal pain or cramping with a change in bowel habits, such as diarrhea, constipation, or both. Each child's symptoms may vary.

Symptoms may include:

• Belly pain that keeps coming back. Pain that continues for more than 3 months is long-term (chronic).
• A change in bowel habits, such as diarrhea or constipation.
• Upset stomach (nausea).
• Dizziness.
• Loss of appetite.
• Swelling (bloating) and gas.
• Cramping.
• Needing to have a bowel movement right away.
• Feeling that not all the stool has come out during a bowel movement.
• Mucus in the stool.

Other health problems can cause symptoms similar to IBS. Make sure your child sees a doctor for a diagnosis.

Your child's doctor will ask about your child's health history and do a physical exam. A diagnosis of IBS is made by ruling out other causes of the symptoms.

There are some symptoms that may point to a cause other than IBS. This can help your child's doctor decide what lab tests and procedures may be needed. These symptoms include:

• Weight loss.
• Vomiting.
• Fever for no reason.
• Bloody diarrhea.
• Delayed growth.
• Enlarged liver.

The doctor will order lab tests to check for infection and inflammation. These may include:

• Blood tests. These tests are done to check if your child has anemia, an infection, or an illness caused by inflammation or irritation.
• Urine analysis and culture. These help check for urinary tract infections.
• Stool sample. This checks for bacteria and parasites that may cause diarrhea. It can also check for inflammation in the bowel.
• Stool samples FIT testing This test checks stool for blood. It is done more commonly than the older test, occult blood testing. If blood is found, there may be inflammation in the gastrointestinal (GI) tract.
• Breath tests. Different breath tests can be done to see if bacterial overgrowth exists or if your child isn't digesting some sugars properly, such as lactose, fructose, or sucrose. One example is the lactose breath hydrogen test. This test is done to see if your child can't digest lactose, which is called lactose intolerance. Lactose is a sugar found in milk and milk products.
• Abdominal X-ray. This simple test gives the doctor an idea of how the internal organs look.
• Abdominal ultrasound. This imaging test shows the internal organs as they work. It makes images by using high-frequency sound waves. Sometimes other imaging tests such as an MRI or CT scan are done, if needed, to check for other conditions that may have symptoms similar to IBS.
• EGD (esophagogastroduodenoscopy), or upper endoscopy. This test uses a small, flexible tube with a light and a camera lens at the end (endoscope) to check the inside of part of the digestive tract. Tissue samples (biopsies) from inside the digestive tract may also be taken for testing.
• Colonoscopy. This test uses a long, flexible tube with a light and camera lens at the end (colonoscope) to check inside the large intestine. Tissue samples (biopsies) may also be taken, depending on your child's symptoms and how the colon looks.

There is no cure for IBS. The main goal of treatment is to ease symptoms and help your child get back to normal daily activities. Treatment may include dietary changes, medicine, and stress management.

• Lactose sugar can cause IBS symptoms. If your child can't digest lactose (is lactose-intolerant), it is best to limit lactose. Talk with your child's doctor about giving your child the enzyme that digests the sugar (lactase).
• Try a low-FODMAP diet. This diet limits foods that your child may not digest properly. These foods can cause IBS symptoms. But before you start any specific diet, get guidance from your child's doctor.
• Soluble fiber is often helpful, but insoluble fiber can increase gas and bloating.
• Check with your child's doctor before adding good bacteria (probiotics) to your child's diet. Not all probiotics are the same, and they are not regulated by the U.S. Food and Drug Administration (FDA).
• You may need to make other changes to your child's diet if your child has a food allergy or a food intolerance.
• Ask to talk to a registered dietitian if you have questions or concerns about managing the needed dietary changes.

• If your child has severe symptoms, medicine may be needed.

• When your child has a painful episode of IBS, try to help your child focus on something fun or pleasant.
• In rare cases, specialists may be consulted for pain control. Methods such as biofeedback and acupuncture may help. Mindfulness and yoga can also help. There are many online apps that help teach mindfulness and yoga, and you can also do these with your child at home.
• Keep track of and manage your own stress. Caring for a child with IBS can be emotionally and physically draining. Caring for yourself will help your child deal with their stress as well.

A child with IBS often doesn't feel well. And the physical symptoms of IBS can lead to stress and emotional problems. For example, children with diarrhea may not get to the bathroom in time. This can make them feel embarrassed. They may not want to go to school or play with friends. This can cause depression and anxiety.

Most children with IBS continue to grow and develop normally. But some children may eat less to limit the pain that can go along with digestion. This can lead to weight loss.

IBS symptoms can affect your child's daily activities. It's important to work with your child's doctor to manage the disease. You may need a plan to deal with issues such as diet, school, and emotional or mental health. In an age-appropriate manner, teach your child about IBS, including how to help control the symptoms.

It is important to know the triggers that cause your child's symptoms and then avoid those triggers. Triggers often include:

• Large meals. Eating smaller meals more often during the day may be helpful.
• Fatty foods.
• Milk products.
• Caffeine.
• Artificial sweeteners.

Keeping a food and symptoms diary may help you to better understand your child's triggers.

Help your child find positive ways to cope. This can help them take part in school and other activities. Some methods that may be helpful include:

• Relaxation techniques.
• Distraction.
• Guided imagery.
• Hypnotherapy.
• Cognitive-behavioral therapy.
• Biofeedback.

Talk with your child's doctor and school staff to find methods and techniques that may be right for your child.

If your child is having a hard time coping with IBS, talk with their doctor. Consider having your child see a specialist, such as a:

• Developmental-behavioral pediatrician.
• Teen medicine specialist.
• Mental health provider.
• School psychologist or school counselor.

Contact your child's doctor if your child has any:

• Abdominal (belly) pain.
• Long-term (chronic) diarrhea or constipation.
• Other GI symptoms.
• Unexplained weight loss.

Contact your child's doctor right away if your child has been diagnosed with IBS and develops other symptoms, including:

• Weight loss.
• Vomiting.
• Severe diarrhea.
• Fever.
• Urinary symptoms.
• Bloody diarrhea.
• Skin changes.
• Signs of depression, such as increased isolation, sadness, irritability, or loss of interest in usual activities.

• IBS is a long-term (chronic) condition that affects the small and large intestines.
• IBS causes painful belly and bowel symptoms. It is defined as abdominal pain or cramping with a change in bowel habits, such as diarrhea or constipation.
• Try to find the triggers that cause your child's symptoms. Then teach your child to avoid those triggers.
• There is no cure, but IBS symptoms can improve. The goal of treatment is to ease symptoms and help your child get back to normal daily living.
• IBS symptoms can affect your child's daily activities. Work with your child's doctor to manage the condition.

Here are some tips to help you get the most from a visit to your child's doctor:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of any new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your doctor gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child's condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child's doctor after office hours. This is important if your child becomes ill and you have questions or need advice.