Irritable Bowel Syndrome Message Boards | Re: Sherri, this is a really smart plan of attack for your son...

Just some info.

FYI

Defecation Anxiety Linked to Functional Constipation in Children

Charlene Laino

Oct. 15, 2003 (Baltimore) � Children with functional constipation have significantly more anxiety related to toileting behavior than healthy children � anxiety. This anxiety makes them more likely to continue to suffer from the problem, a prospective study suggests.

Moreover, some of these children develop generalized anxiety, reported researchers from the Cleveland Clinic Foundation.

"Constipated kids were not generally anxious overall, but among those with defecation anxiety we saw an increase in general anxiety," said Gerard Banez, PhD, a child psychologist at the Cleveland Clinic Foundation. "This does not prove cause-and-effect, but does suggest that those constipated children with greater defecation anxiety also exhibit increased general anxiety."

Painful bowel movements can make a child fearful of pain, Dr. Banez said. That fear can be generalized to sitting on the toilet.

The research was described here today at the American College of Gastroenterology 68th annual scientific meeting.

Up to 7.5% of children suffer from constipation, which accounts for about 3% of visits to pediatricians and up to 25% of visits to pediatric gastroenterologists, according to data cited in the study.

According to the researchers, constipation carries a host of physical and psychological consequences, and defecation anxiety is often implicated as a primary contributor to constipation.

Dr. Banez and colleagues studied 98 boys and girls aged 6 to 18 years who suffered from functional constipation. The youngsters completed the Defecation Anxiety Scale�Self-Report and Revised Children's Manifest Anxiety Scale, which measures generalized anxiety. The parents also rated their children's defecation anxiety on the Defecation Anxiety Scale�Parent Rating Scales.

By both self-report and parent report, children with functional constipation were found to have significantly more defecation anxiety than healthy children or children with asthma, the researchers said.

Overall, 70% of the children reported defecation anxiety compared with 58% of a control group of healthy children and 65% of children with asthma. The parents reported that 82% of their children suffered from defecation anxiety.

In addition, 30% of the children with constipation reported generalized anxiety. The greater the defecation anxiety, the greater the generalized anxiety, Dr. Banez said. Children with defecation anxiety have a higher chance of having generalized anxiety, although some children with no significant generalized anxiety still had defecation anxiety, he added.

Physicians who see children with constipation anxiety should rule out any medical cause, Dr. Banez said. Also, consider defecation anxiety in the differential diagnosis of any child whose parents report that their child seems to be withholding stool, is tearful at the urge to use the toilet, or shows vigorous resistance to using the toilet, he said.

Also, physicians should discuss strategies that promote relaxed toilet sitting as well as suggest dietary changes � possibly with a stool softener thrown in � to promote softer stools, Dr. Banez said.

William Whitehead, MD, professor of medicine at the University of North Carolina in Chapel Hill, said he has had some luck treating constipation anxiety with biofeedback, although he said that studies in Europe suggest that laxatives work just as well as the relaxation technique.

The question now, he said, is whether anxiety is the cause or the consequence of constipation. ?This study doesn?t really tell us, but it is still a major advance, the first trial I know of where they have linked defecation and anxiety directly using such a systematic approach.?

ACG 68th Annual Scientific Meeting: Abstract 723. Presented Oct. 15, 2003.

Reviewed by Gary D. Vogin, MD

Kids Take Sickness Cue From Parents
Excerpt By Nancy A. Melville, HealthScoutNews

(HealthScoutNews) -- The behavioral patterns of those with irritable bowel syndrome (IBS) can color their children's experiences of their own illnesses.

That's the conclusion of recent research that compared three years of school absences and found the children of IBS parents missed significantly more school days than other children -- 11.2 days per academic year versus 7.6 days.

The study is part of a larger body of ongoing research looking at how parents' reactions to IBS influence children's perceptions of sickness.

"We're looking at how parents teach their children to respond to illness, and whether the children generally are sicker than children of parents without this problem," explains Rona Levy, a professor of social work at the University of Washington and the author of the study, which was presented recently at a meeting of the American College of Gastroenterology.

IBS causes chronic gastrointestinal problems ranging from constipation to diarrhea, as well as abdominal pain, gas and bloating. The condition is estimated to affect about 4.7 million people, most of them women.

The causes of the condition are not known, but experts believe there is a significant psychological factor at play, with reactions to stress or depression manifesting themselves in the gut more severely than normal.

Although Levy thinks there is probably a genetic factor that determines who gets IBS, she says behavioral responses that are "socially learned" may determine who suffers most from the condition.

">"We're building a case where heredity is a component of IBS," she says. "But what children learn from their parents is a much bigger risk factor for the extent people suffer from this disease, and many other chronic diseases."

Such "learned" behavior is fostered in children through the reactions - - and actions - - of their parents to various situations, says Levy.

"We've all seen a child fall down, and various responses among parents," she explains. "Some will brush the kid off, reassure them that they're fine and move on. Others will dwell more seriously on the event, asking the child where it hurts and perhaps making a much bigger deal out of the situation."

"That's a snapshot example of how parents differ in the ways they teach their children to respond to pain," she says.

Such reactions can show up later in life in the form of IBS, adds Levy, when something like a twinge in the gut that many might notice but ignore sends others to the doctor.

"I think a big factor in why some go in one direction and why some go in another is how we learn to respond to things when we're young," she says.

Dr. Douglas Drossman, an IBS expert and co-director of the University of North Carolina Center for Functional GI Disorders, says the role of family behavioral patterns is recognized as an important factor in IBS.

"The patients with the more severe symptoms seem to come from families where there was a focus on going to the doctor and getting medication when the child got sick, rather than addressing what might be the stressors that are playing a role," he says.

"It's not that the stress is believed to entirely cause the condition," he adds. "But the family may reinforce the severity of the symptoms."

Other contributing factors that are believed to play a role in IBS include hormonal fluctuations, dietary issues and infection in the bowel.

In addition, preliminary research on brain scans indicates certain brain functions that respond to pain may be altered in people with IBS.

"Pain signals are sent to the brain, but typically, the brain can naturally reduce those signals," explains Drossman. "But that ability to turn down such signals may be impaired in people with IBS, and that might be correlated with levels of psychological distress."

Treatment for IBS currently involves a combination of physical and mental therapies, says Drossman.

"In milder cases, sometimes just keeping a diary of daily events and diet, and looking at what the triggers are can help. It could be eating a large fatty meal, drinking lots of soda, stress factors," he says.

In more serious cases, medications treat intestinal symptoms and antidepressants are often prescribed.

The American College of Gastroenterology reports that people with IBS make an estimated 3.5 million physician visits, receive 2.2 million drug prescriptions, and undergo 35,000 hospitalizations in the United States each year.

http://preventdisease.com/news/articles/kids_sickness_parents.shtml

FYI

J Spec Pediatr Nurs. 2003 Jul-Sep;8(3):81-9. Related Articles, Links

Recurrent abdominal pain in children: forerunner to adult irritable bowel syndrome?

Jarrett M, Heitkemper M, Czyzewski DI, Shulman R.

Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, USA. jarrett@u.washington.edu

ISSUES AND PURPOSE: Review the etiology and pathophysiology of recurrent abdominal pain (RAP) and its potential role as a precursor to irritable bowel syndrome (IBS) in adults. CONCLUSIONS: Physiological mechanisms not easily identifiable as an organic cause may underlie symptoms in RAP patients. They may be triggered by psychosocial factors that result in greater functional disability, more clinic visits, and lower academic and social competence. Of these children, 25% will experience similar symptoms as adults; many will be diagnosed with IBS. PRACTICE IMPLICATIONS: Nurses can provide early and efficient management of these children's care if they view the issues of abdominal pain/discomfort from a broader focus that includes the context of the child's experiences.

PMID: 12942886

About Kids GI Health

IFFGD is a nonprofit education and research organization. Our mission is to inform, assist, and support people affected by gastrointestinal (GI) disorders. We address issues of digestive health in children through support of education and research. We promote awareness�among the public, health care providers, researchers, and regulators�of conditions such as:

* Functional gastrointestinal disorders
* Gastroesophageal reflux (GER)
* Gastroesophageal reflux disease (GERD), and
* Other conditions that affect gastrointestinal health

www.aboutkidsgi.org/

Hope this helps

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My website on IBS is www.ibshealth.com

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