That belly ache isn’t all in your head
© 2010 Roy Benaroch, MD
About 25% of children experience frequent belly aches, and abdominal pain is a very frequent cause of pediatrician visits and school absences. The majority of kids with belly aches don’t have any serious underlying disease, which might lead some parents and doctors to say “It’s all in their heads.” A recent study contradicts that opinion, and reveals some new insights into the cause of belly aches in children.
First, some terminology. Traditionally, we’ve divided abdominal pain into two categories: “organic” and “functional.” Organic means that some organ is involved or broken—there’s something abnormal you can see on a biopsy or blood test. “Functional” pain is an awkward term, but it means that the pain is arising not from tissue damage or pathology, but from the functioning of the gut. We can’t find anything objectively wrong, but there is still pain. Functional abdominal pain is more specifically often diagnosed as “Irritable Bowel Syndrome” (IBS). The older term Chronic Recurrent Abdominal Pain is discouraged, because of its unfortunate acronym.
So what is Irritable Bowel Syndrome, if it isn’t a disease that you can see or prove with a microscope? We know it runs in families, and that the pain can be intensified by emotional stress. Psychotherapy or treatment for depression can help the pain, at least sometimes, as can regular exercise and stress-reduction strategies. Diet can certainly make IBS worse, especially a diet with lots of refined sugars and weird processed chemicals. All of this has been known for years. What’s new is an emerging understanding of what makes kids (or adults) with IBS different from other people.
A study published in the January, 2010 issue of The Journal of Pediatrics looked at a potential new test that could be used to diagnose IBS. (Skip the rest of this paragraph if you’re extra-squeamish, but you’ll be missing the cool part). The authors determined the “Rectal Sensory Threshold for Pain” in kids with abdominal pain caused by IBS versus children with abdominal pain caused by organic diseases. To do this, a balloon was inserted into the rectum, and inflated until the child reported pain. What they found was that most of the children with IBS experienced pain at much lower pressures than children with organic disease. The authors suggest that this method could be used as a diagnostic tool.
The study shows us something more important about children with IBS: they have an increased sensation of pain to stimuli that doesn’t cause pain in other children. Both groups of kids had the same amount of distension from the balloon—not enough to cause any harm—but the children with IBS found that procedure painful. The biopsies and tests are normal because there isn’t any actual tissue damage, yet the pain sensitivity these kids experience is very real and testable. Irritable Bowel Syndrome is a disease of increased sensitivity to pain, when bubbles of air or stool masses or other feelings that most of us do not find uncomfortable cause pain. The pain itself is real, and isn’t “all in their heads”.
If your child is experiencing frequent abdominal pains, go see your pediatrician. There are other potential causes that need to be explored—lactose intolerance and constipation are both common. Usually, a careful history and physical is all that’s needed to confirm a diagnosis, though sometimes some blood or stool tests are needed. If your child does have Irritable Bowel Syndrome, it’s good to know that it’s not serious, and that some simple lifestyle and dietary modifications can help. More severe cases can be referred to a pediatric gastroenterologist for further evaluation and treatment. And the balloons are optional.