Definition & Facts

What is appendicitis?

Appendicitis is inflammation of your appendix.

How common is appendicitis?

In the United States, appendicitis is the most common cause of acute abdominal pain requiring surgery. Over 5% of the population develops appendicitis at some point.¹

Who is more likely to develop appendicitis?

Appendicitis most commonly occurs in the teens and twenties but may occur at any age.¹

What are the complications of appendicitis?

If appendicitis is not treated, it may lead to complications. The complications of a ruptured appendix are

• peritonitis, which can be a dangerous condition. Peritonitis happens if your appendix bursts and infection spreads in your abdomen. If you have peritonitis, you may be very ill and have
  • fever
  • nausea
  • severe tenderness in your abdomen
  • vomiting
• an abscess of the appendix called an appendiceal abscess.

References

Symptoms & Causes

What are the symptoms of appendicitis?

The most common symptom of appendicitis is pain in your abdomen.

If you have appendicitis, you’ll most often have pain in your abdomen that

• begins near your belly button and then moves lower and to your right
• gets worse in a matter of hours
• gets worse when you move around, take deep breaths, cough, or sneeze
• is severe and often described as different from any pain you’ve felt before
• occurs suddenly and may even wake you up if you’re sleeping
• occurs before other symptoms

Other symptoms of appendicitis may include

• loss of appetite
• nausea
• vomiting
• constipation or diarrhea
• an inability to pass gas
• a low-grade fever
• swelling in your abdomen
• the feeling that having a bowel movement will relieve discomfort

Symptoms can be different for each person and can seem like the following conditions that also cause pain in the abdomen:

• abdominal adhesions
• constipation
• inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis, long-lasting disorders that cause irritation and ulcers in the GI tract
• intestinal obstruction
• pelvic inflammatory disease

What causes appendicitis?

Appendicitis can have more than one cause, and in many cases the cause is not clear. Possible causes include:

• Blockage of the opening inside the appendix
• enlarged tissue in the wall of your appendix, caused by infection in the gastrointestinal (GI) tract or elsewhere in your body
• inflammatory bowel disease
• stool, parasites, or growths that can clog your appendiceal lumen
• trauma to your abdomen

When should I seek a doctor's help?

Appendicitis is a medical emergency that requires immediate care. See a health care professional or go to the emergency room right away if you think you or a child has appendicitis. A doctor can help treat the appendicitis and reduce symptoms and the chance of complications.

Diagnosis

How do doctors diagnose appendicitis?

Most often, health care professionals suspect the diagnosis of appendicitis based on your symptoms, your medical history, and a physical exam. A doctor can confirm the diagnosis with an ultrasound, x-ray, or MRI exam.

Medical history

A health care professional will ask specific questions about your symptoms and health history to help rule out other health problems. The health care professional will want to know

• when your abdominal pain began
• the exact location and severity of your pain
• when your other symptoms appeared
• your other medical conditions, previous illnesses, and surgical procedures
• whether you use medicines, alcohol, or illegal drugs

Physical exam

Health care professionals need specific details about the pain in your abdomen to diagnose appendicitis correctly. A health care professional will assess your pain by touching or applying pressure to specific areas of your abdomen.

The following responses to touch or pressure may indicate that you have appendicitis:

• Rovsing's sign
• Psoas sign
• Obturator sign
• Guarding
• Rebound tenderness
• Digital rectal exam
• Pelvic exam

Lab tests

Doctors use lab tests to help confirm the diagnosis of appendicitis or find other causes of abdominal pain.

Blood tests. A health care professional draws your blood for a blood test at a doctor’s office or a commercial facility. The health care professional sends the blood sample to a lab for testing. Blood tests can show a high white blood cell count, a sign of infection. Blood tests also may show dehydration or fluid and electrolyte imbalances.

Urinalysis. Urinalysis is testing of a urine sample. You will provide a urine sample in a special container in a doctor’s office, a commercial facility, or a hospital. Health care professionals can test the urine in the same location or send it to a lab for testing. Doctors use urinalysis to rule out a urinary tract infection or a kidney stone.

Pregnancy test. For women, health care professionals also may order blood or urine samples to check for pregnancy.

Imaging tests

Doctors use imaging tests to confirm the diagnosis of appendicitis or find other causes of pain in the abdomen.

Abdominal ultrasound. In an ultrasound, a health care professional uses a device, called a transducer, to bounce safe, painless sound waves off of your organs to create an image of their structure. He or she can move the transducer to different angles to examine different organs.

In an abdominal ultrasound, a health care professional applies a gel to your abdomen and moves a hand-held transducer over your skin. A health care professional performs this procedure in a doctor’s office, an outpatient center, or a hospital, and you don’t need anesthesia.

A radiologist reviews the images, which can show signs of

• a blockage in your appendiceal lumen
• a burst appendix
• inflammation
• other sources of abdominal pain

Health care professionals use an ultrasound as the first imaging test for possible appendicitis in infants, children, young adults, and pregnant women.

Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of your body’s internal organs and soft tissues without using x-rays.

A health care professional performs the procedure in an outpatient center or a hospital. A radiologist reviews the images. Patients don’t need anesthesia, although a health care professional may give light sedation, taken by mouth, to children and people with a fear of small spaces. A health care professional may inject a special dye, called contrast medium, into your body.

In most cases, you’ll lie on a table that slides into a tunnel-shaped device. The tunnel may be open ended or closed at one end.

An MRI can show signs of

• a blockage in your appendiceal lumen
• a burst appendix
• inflammation
• other sources of abdominal pain

When diagnosing appendicitis and other sources of abdominal pain, doctors can use an MRI as a safe, reliable alternative to a computerized tomography (CT) scan.²

CT scan. CT scans use x-rays and computer technology to create images.

A health care professional may give you a solution to drink and an injection of contrast medium. You’ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. X-ray technicians perform CT scans in an outpatient center or a hospital. Radiologists review the images.

Patients don’t need anesthesia, although health care professionals may give children a sedative to help them fall asleep for the test.

A CT scan of the abdomen can show signs of inflammation, such as

• an enlarged or a burst appendix
• an appendiceal abscess
• a blockage in your appendiceal lumen

Women of childbearing age should have a pregnancy test before having a CT scan. The radiation from CT scans can be harmful to a developing fetus.

References

Treatment

How do doctors treat appendicitis?

Doctors typically treat appendicitis with surgery to remove the appendix. Surgeons perform the surgery in a hospital with general anesthesia. Your doctor will recommend surgery if you have continuous abdominal pain and fever, or signs of a burst appendix and infection. Prompt surgery decreases the chance that your appendix will burst.

Health care professionals call the surgery to remove the appendix an appendectomy. A surgeon performs the surgery using one of the following methods:

• Laparoscopic surgery. During laparoscopic surgery, surgeons use several smaller incisions and special surgical tools that they feed through the incisions to remove your appendix. Laparoscopic surgery leads to fewer complications, such as hospital-related infections, and has a shorter recovery time.
• Laparotomy. Surgeons use laparotomy to remove the appendix through a single incision in the lower right area of your abdomen.

After surgery, most patients completely recover from appendicitis and don’t need to make changes to their diet, exercise, or lifestyle. Surgeons recommend that you limit physical activity for the first 10 to 14 days after a laparotomy and for the first 3 to 5 days after laparoscopic surgery.

What if the surgeon finds a normal appendix?

In some cases, a surgeon finds a normal appendix during surgery. In this case, many surgeons will remove it to eliminate the future possibility of appendicitis. Sometimes surgeons find a different problem, which they may correct during surgery.

Can doctors treat appendicitis without surgery?

Some cases of mild appendicitis may be cured with antibiotics alone. All patients suspected of having appendicitis are treated with antibiotics before surgery, and some patients may improve completely before surgery is performed.

How do doctors treat complications of a burst appendix?

Treating the complications of a burst appendix will depend on the type of complication. In most cases of peritonitis, a surgeon will remove your appendix immediately with surgery. The surgeon will use laparotomy to clean the inside of your abdomen to prevent infection and then remove your appendix. Without prompt treatment, peritonitis can cause death.

A surgeon may drain the pus from an appendiceal abscess during surgery or, more commonly, before surgery. To drain an abscess, the surgeon places a tube in the abscess through the abdominal wall. You leave the drainage tube in place for about 2 weeks while you take antibiotics to treat infection. When the infection and inflammation are under control, about 6 to 8 weeks later, surgeons operate to remove what remains of the burst appendix.

Eating, Diet, & Nutrition

How can your diet help prevent or relieve appendicitis?

Researchers have not found that eating, diet, and nutrition cause or prevent appendicitis.?

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.?

Definition & Facts

What is obesity?

Obesity is defined as having a body mass index (BMI) of 30 or more. BMI is a measure of your weight in relation to your height. Class 1 obesity means a BMI of 30 to 35, Class 2 obesity is a BMI of 35 to 40, and Class 3 obesity is a BMI of 40 or more. Classes 2 and 3, also known as severe obesity, are often hard to treat with diet and exercise alone.

Calculate your BMI to learn your BMI category.

What is bariatric surgery?

Bariatric surgery is an operation that helps you lose weight by making changes to your digestive system. Some types of bariatric surgeries make your stomach smaller, allowing you to eat and drink less at one time and making you feel full sooner. Other bariatric surgeries also change your small intestine—the part of your body that absorbs calories and nutrients from foods and beverages.

Bariatric surgery may be an option if you have severe obesity and have not been able to lose weight or keep from gaining back any weight you lost using other methods such as lifestyle treatment or medications. Bariatric surgery also may be an option if you have serious health problems, such as type 2 diabetes or sleep apnea, related to obesity. Bariatric surgery can improve many of the medical conditions linked to obesity, especially type 2 diabetes.

Does bariatric surgery always work?

Studies show that many people who have bariatric surgery lose about 15 to 30 percent of their starting weight on average, depending on the type of surgery they have. However, no method, including surgery, is sure to produce and maintain weight loss. Some people who have bariatric surgery may not lose as much as they hoped. Over time, some people regain a portion of the weight they lost. The amount of weight people regain may vary. Factors that affect weight regain may include a person’s level of obesity and the type of surgery he or she had.

Bariatric surgery does not replace healthy habits, but may make it easier for you to consume fewer calories and be more physically active. Choosing healthy foods and beverages before and after the surgery may help you lose more weight and keep it off long term. Regular physical activity after surgery also helps keep the weight off. To improve your health, you must commit to a lifetime of healthy lifestyle habits and following the advice of your health care providers.

How much does bariatric surgery cost?

On average, bariatric surgery costs between $15,000 and $25,000, depending on what type of surgery you have and whether you have surgery-related problems. Costs may be higher or lower based on where you live. The amount your medical insurance will pay varies by state and insurance provider.

Medicare and some Medicaid programs cover three common types of bariatric surgery—gastric bypass, gastric band, and gastric sleeve surgery—if you meet certain criteria and have a doctor’s recommendation. Some insurance plans may require you to use approved surgeons and facilities. Some insurers also require you to show that you were unable to lose weight by completing a nonsurgical weight-loss program or that you meet other requirements.

Your health insurance company or your regional Medicare or Medicaid office will have more information about bariatric surgery coverage, options, and requirements.

Types of Bariatric Surgery

The type of surgery that may be best to help a person lose weight depends on a number of factors. You should discuss with your doctor what kind of surgery might be best for you or your teen.

What is the difference between open and laparoscopic surgery?

In open bariatric surgery, surgeons make a single, large cut in the abdomen. More often, surgeons now use laparoscopic surgery, in which they make several small cuts and insert thin surgical tools through the cuts. Surgeons also insert a small scope attached to a camera that projects images onto a video monitor. Laparoscopic surgery has fewer risks than open surgery and may cause less pain and scarring than open surgery. Laparoscopic surgery also may lead to a faster recovery.

Open surgery may be a better option for certain people. If you have a high level of obesity, have had stomach surgery before, or have other complex medical problems, you may need open surgery.

What are the surgical options?

In the United States, surgeons use three types of operations most often:

• laparoscopic adjustable gastric band
• gastric sleeve surgery, also called sleeve gastrectomy
• gastric bypass

Surgeons use a fourth operation, biliopancreatic diversion with duodenal switch, less often.

Laparoscopic Adjustable Gastric Band

In this type of surgery, the surgeon places a ring with an inner inflatable band around the top of your stomach to create a small pouch. This makes you feel full after eating a small amount of food. The band has a circular balloon inside that is filled with salt solution. The surgeon can adjust the size of the opening from the pouch to the rest of your stomach by injecting or removing the solution through a small device called a port placed under your skin.

After surgery, you will need several follow-up visits to adjust the size of the band opening. If the band causes problems or is not helping you lose enough weight, the surgeon may remove it.

The U.S. Food and Drug Administration (FDA) has approved use of the gastric band for people with a BMI of 30 or more who also have at least one health problem linked to obesity, such as heart disease or diabetes.

Gastric Sleeve

In gastric sleeve surgery, also called vertical sleeve gastrectomy, a surgeon removes most of your stomach, leaving only a banana-shaped section that is closed with staples. Like gastric band surgery, this surgery reduces the amount of food that can fit in your stomach, making you feel full sooner. Taking out part of your stomach may also affect gut hormones or other factors such as gut bacteria that may affect appetite and metabolism. This type of surgery cannot be reversed because some of the stomach is permanently removed.

Gastric Bypass

Gastric bypass surgery, also called Roux-en-Y gastric bypass, has two parts. First, the surgeon staples your stomach, creating a small pouch in the upper section. The staples make your stomach much smaller, so you eat less and feel full sooner.

Next, the surgeon cuts your small intestine and attaches the lower part of it directly to the small stomach pouch. Food then bypasses most of the stomach and the upper part of your small intestine so your body absorbs fewer calories. The surgeon connects the bypassed section farther down to the lower part of the small intestine. This bypassed section is still attached to the main part of your stomach, so digestive juices can move from your stomach and the first part of your small intestine into the lower part of your small intestine. The bypass also changes gut hormones, gut bacteria, and other factors that may affect appetite and metabolism. Gastric bypass is difficult to reverse, although a surgeon may do it if medically necessary.

Duodenal Switch

This surgery, also called biliopancreatic diversion with duodenal switch, is more complex than the others. The duodenal switch involves two separate surgeries. The first is similar to gastric sleeve surgery. The second surgery redirects food to bypass most of your small intestine. The surgeon also reattaches the bypassed section to the last part of the small intestine, allowing digestive juices to mix with food.

This type of surgery allows you to lose more weight than the other three. However, this surgery is also the most likely to cause surgery-related problems and a shortage of vitamins, minerals, and protein in your body. For these reasons, surgeons do not perform this surgery as often.

Most Common Weight-loss Surgeries

Gastric Band

What it is

Surgeon places an inflatable band around top part of stomach, creating a small pouch with an adjustable opening.

Pros

• Can be adjusted and reversed.
• Short hospital stay and low risk of surgery-related problems.
• No changes to intestines.
• Lowest chance of vitamin shortage.

Cons

• Less weight loss than other types of bariatric surgery.
• Frequent follow-up visits to adjust band; some people may not adapt to band.
• Possible future surgery to remove or replace a part or all of the band system.

Gastric Sleeve

What it is

Surgeon removes about 80 percent of stomach, creating a long, banana-shaped pouch.

Pros

• Greater weight loss than gastric band.
• No changes to intestines.
• No objects placed in body.
• Short hospital stay.

Cons

• Cannot be reversed.
• Chance of vitamin shortage.
• Higher chance of surgery-related problems than gastric band.
• Chance of acid reflux.

Gastric Bypass

What it is

Surgeon staples top part of stomach, creating a small pouch and attaching it to middle part of small intestine.

Pros

• Greater weight loss than gastric band.
• No objects placed in body.

Cons

• Difficult to reverse.
• Higher chance of vitamin shortage than gastric band or gastric sleeve.
• Higher chance of surgery-related problems than gastric band.
• May increase risk of alcohol use disorder.

Adapted from: Bariatric surgery procedures. American Society for Metabolic and Bariatric Surgery (ASMBS) website. asmbs.org/patients/bariatric-surgery-procedures. Accessed May 24, 2016.

Image credit: Walter Pories, M.D., FACS.

What should I expect before surgery?

Before surgery, you will meet with several health care providers, such as a dietitian, a psychiatrist or psychologist, an internist, and a bariatric surgeon.

• The doctor will ask about your medical history, do a thorough physical exam, and order blood tests. If you are a smoker, he or she will likely ask you to stop smoking at least 6 weeks before your surgery.
• The surgeon will tell you more about the surgery, including how to prepare for it and what type of follow-up you will need.
• The dietitian will explain what and how much you will be able to eat and drink after surgery and help you to prepare for how your life will change after surgery.
• The psychiatrist or psychologist may do an assessment to see if bariatric surgery is an option for you.

These health care providers also will advise you to become more active and adopt a healthy eating plan before and after surgery. In some cases, losing weight and bringing your blood sugar levels closer to normal before surgery may lower your chances of having surgery-related problems.

Some bariatric surgery programs have groups you can attend before and after surgery that can help answer questions about the surgery and offer support.

What should I expect after surgery?

After surgery, you will need to rest and recover. Although the type of follow-up varies by type of surgery, you will need to take supplements that your doctor prescribes to make sure you are getting enough vitamins and minerals.

Walking and moving around the house may help you recover more quickly. Start slowly and follow your doctor’s advice about the type of physical activity you can do safely. As you feel more comfortable, add more physical activity.

After surgery, most people move from a liquid diet to a soft diet such as cottage cheese, yogurt, or soup, and then to solid foods over several weeks. Your doctor, nurse, or dietitian will tell you which foods and beverages you may have and which ones you should avoid. You will need to eat small meals and chew your food well.

How much weight can I expect to lose?

The amount of weight people lose after bariatric surgery depends on the individual and on the type of surgery he or she had. A study following people for 3 years after surgery found that those who had gastric band surgery lost an average of about 45 pounds. People who had gastric bypass lost an average of 90 pounds.¹ Most people regained some weight over time, but weight regain was usually small compared to their initial weight loss.

Researchers know less about the long-term results of gastric sleeve surgery, but the amount of weight loss seems to be similar to or slightly less than gastric bypass.

Your weight loss could be different. Remember, reaching your goal depends not just on the surgery but also on sticking with healthy lifestyle habits throughout your life.

Weight-loss Devices

The FDA has approved several new weight-loss devices that do not permanently change your stomach or small intestine. These devices cause less weight loss than bariatric surgery, and some are only temporary. The devices may have risks, so talk with your doctor if you’re thinking about any of these options. Researchers haven’t studied any of them over a long period of time and don’t know the long-term risks and benefits.

• The electrical stimulation system uses a device implanted in your abdomen, by way of laparoscopic surgery, that blocks nerve activity between your stomach and brain. The device works on the vagus nerve, which helps signal the brain that the stomach feels full or empty.
• The gastric balloon system consists of one or two balloons placed in your stomach through a tube inserted through your mouth. Your doctor or nurse will give you a sedative before the procedure. Once the balloons are in your stomach, doctors inflate them with salt water so they take up space in your stomach and help you feel fuller. You will need to have the balloons removed after 6 months or a year.
• A new device uses a pump to drain part of the food in your stomach after a meal. The device includes a tube that goes from the inside of your stomach to a port on the outside of your abdomen. The port is a small valve that fits over the opening in your abdomen. About 20 to 30 minutes after eating, you attach tubing from the port to the pump and open the valve. The pump drains your stomach contents through a tube into the toilet, so that your body doesn’t absorb about 30 percent of calories you ate. You can have the device removed at any time.

¹ Inge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. The New England Journal of Medicine. 2016;374(2):113–123.

Bariatric Surgery Benefits

What are the benefits of bariatric surgery?

Bariatric surgery can help you lose weight and improve many health problems related to obesity. These health problems include

• type 2 diabetes
• high blood pressure
• unhealthy cholesterol levels
• sleep apnea
• urinary incontinence
• body pain
• knee and hip pain

You may be better able to move around and be physically active after surgery. You might also notice your mood improve and feel like your quality of life is better.

Bariatric Surgery Side Effects

What are the side effects of bariatric surgery?

Side effects may include

• bleeding
• infection
• leaking from the site where the sections of the stomach or small intestine, or both, are stapled or sewn together
• diarrhea
• blood clots in the legs that can move to the lungs and heart

Rarely, surgery-related problems can lead to death.

Other side effects may occur later. Your body may not absorb nutrients well, especially if you don’t take your prescribed vitamins and minerals. Not getting enough nutrients can cause health problems, such as anemia and osteoporosis. Gallstones can occur after rapid weight loss. Some doctors prescribe medicine for about 6 months after surgery to help prevent gallstones. Gastric bands can erode into the stomach wall and need to be removed.

Other problems that could occur later include strictures and hernias. Strictures—narrowing of the new stomach or connection between the stomach and small intestine—make it hard to eat solid food and can cause nausea, vomiting, and trouble swallowing. Doctors treat strictures with special instruments to expand the narrowing. Two kinds of hernias may occur after bariatric surgery—at the incision site or in the abdomen. Doctors repair hernias with surgery.

Some research suggests that bariatric surgery, especially gastric bypass, may change the way your body absorbs and breaks down alcohol, and may lead to more alcohol-related problems after surgery.

Potential Candidates for Bariatric Surgery

Who is a good adult candidate for bariatric surgery?

Bariatric surgery may be an option for adults who have

• a body mass index (BMI) of 40 or more, OR
• a BMI of 35 or more with a serious health problem linked to obesity, such as type 2 diabetes, heart disease, or sleep apnea
• a BMI of 30 or more with a serious health problem linked to obesity, for the gastric band only

Having surgery to lose weight is a serious decision. If you are thinking about having bariatric surgery, you should know what’s involved. Your answers to the following questions may help you decide if surgery is an option for you:

• Have you been unable to lose weight or keep it off using nonsurgical methods such as lifestyle changes or drug treatment?
• Do you understand what the operation involves and its risks and benefits?
• Do you understand how your eating and physical activity patterns will need to change after you have surgery?
• Can you commit to following lifelong healthy eating and physical activity habits, medical follow-up, and the need to take extra vitamins and minerals?

Who is a good teen candidate for bariatric surgery?

Doctors sometimes use bariatric surgery to treat teens with severe obesity who also have obesity-related health problems. Bariatric surgery often improves health problems that could grow worse in adulthood if the teen remains obese.

Surgery may be an option for teens who have gone through puberty and reached their adult height, and have

• a BMI of 35 or more with serious obesity-related health problems, such as type 2 diabetes or severe sleep apnea, OR
• a BMI of 40 or more with less severe health problems, such as high blood pressure or high cholesterol²

Studies suggest that bariatric surgery is fairly safe for teens and can improve health problems such as type 2 diabetes for at least 3 years after surgery. Teens who took part in a study that followed them for 3 years after surgery lost an average of 90 pounds and kept most of the weight off.³ They also reported improved quality of life related to their weight. Researchers continue to study the long-term effects, which currently are unknown.

Like adults, teens who are thinking about weight-loss surgery should be prepared for the lifestyle changes they will need to make after the surgery. A surgical center that focuses on the unique needs of youth may help the teen patient prepare for and adjust to these changes. Parents and caregivers also should be prepared and ready to support their child.

References

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease in people of all ages. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out more about clinical trials.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

What is the Longitudinal Assessment of Bariatric Surgery?

From 2003 to 2016, the NIDDK partnered with researchers to create the Longitudinal Assessment of Bariatric Surgery, or LABS. The researchers examined the safety and effectiveness of weight-loss surgery in adults. A separate group of researchers are doing similar research with teens, called Teen-LABS.

LABS found that weight-loss surgery performed by experienced surgeons is relatively safe, leads to large weight loss, and improves many weight-related health problems. Three years after surgery, about half of adult gastric bypass patients had lost at least 90 pounds, or almost one-third of their starting weight. Half of gastric band patients had lost at least 44 pounds, or 16 percent of their starting weight.⁴

Teens who had gastric bypass or gastric sleeve surgery had similar results. Three years after surgery, teens lost an average of 27 percent of their starting weight, with improved overall health and quality of life.⁵

References

Definition & Facts

What is Barrett's Esophagus?

Barrett’s esophagus is a condition in which tissue that is similar to the lining of your intestine replaces the tissue lining your esophagus. Doctors call this process intestinal metaplasia.

Are people with Barrett’s esophagus more likely to develop cancer?

People with Barrett’s esophagus are more likely to develop a rare type of cancer called esophageal adenocarcinoma.

The risk of esophageal adenocarcinoma in people with Barrett’s esophagus is about 0.5 percent per year.¹ Typically, before this cancer develops, precancerous cells appear in the Barrett’s tissue. Doctors call this condition dysplasia and classify the dysplasia as low grade or high grade.

You may have Barrett’s esophagus for many years before cancer develops. Visit the National Cancer Institute to learn more about esophageal adenocarcinoma.

How common is Barrett’s esophagus?

Experts are not sure how common Barrett’s esophagus is. Researchers estimate that it affects 1.6 to 6.8 percent of people.²

Who is more likely to develop Barrett’s esophagus?

Men develop Barrett’s esophagus twice as often as women, and Caucasian men develop this condition more often than men of other races.¹ The average age at diagnosis is 55.³ Barrett’s esophagus is uncommon in children.³

References

Symptoms & Causes

What are the symptoms of Barrett’s esophagus?

While Barrett’s esophagus itself doesn’t cause symptoms, many people with Barrett’s esophagus have gastroesophageal reflux disease (GERD), which does cause symptoms.

What causes Barrett’s esophagus?

Experts don’t know the exact cause of Barrett’s esophagus. However, some factors can increase or decrease your chance of developing Barrett’s esophagus.

What factors increase a person’s chances of developing Barrett’s esophagus?

Having GERD increases your chances of developing Barrett’s esophagus. GERD is a more serious, chronic form of gastroesophageal reflux, a condition in which stomach contents flow back up into your esophagus. Refluxed stomach acid that touches the lining of your esophagus can cause heartburn and damage the cells in your esophagus.

Between 10 and 15 percent of people with GERD develop Barrett’s esophagus.⁴

Obesity—specifically high levels of belly fat—and smoking also increase your chances of developing Barrett’s esophagus. Some studies suggest that your genetics, or inherited genes, may play a role in whether or not you develop Barrett’s esophagus.

What factors decrease a person’s chances of developing Barrett’s esophagus?

Having a Helicobacter pylori (H. pylori) infection may decrease your chances of developing Barrett’s esophagus. Doctors are not sure how H. pylori protects against Barrett’s esophagus. While the bacteria damage your stomach and the tissue in your duodenum, some researchers believe the bacteria make your stomach contents less damaging to your esophagus if you have GERD.

Researchers have found that other factors may decrease the chance of developing Barrett’s esophagus, including

• frequent use of aspirin or other nonsteroidal anti-inflammatory drugs
• a diet high in fruits, vegetables, and certain vitamins

References

Diagnosis

How do doctors diagnose Barrett’s esophagus?

Doctors diagnose Barrett’s esophagus with an upper gastrointestinal (GI) endoscopy and a biopsy. Doctors may diagnose Barrett’s esophagus while performing tests to find the cause of a patient’s gastroesophageal reflux disease (GERD) symptoms.

Medical history

Your doctor will ask you to provide your medical history. Your doctor may recommend testing if you have multiple factors that increase your chances of developing Barrett’s esophagus.

Upper GI endoscopy and biopsy

In an upper GI endoscopy, a gastroenterologist, surgeon, or other trained health care provider uses an endoscope to see inside your upper GI tract, most often while you receive light sedation. The doctor carefully feeds the endoscope down your esophagus and into your stomach and duodenum. The procedure may show changes in the lining of your esophagus.

The doctor performs a biopsy with the endoscope by taking a small piece of tissue from the lining of your esophagus. You won’t feel the biopsy. A pathologist examines the tissue in a lab to determine whether Barrett’s esophagus cells are present. A pathologist who has expertise in diagnosing Barrett’s esophagus may need to confirm the results.

Barrett’s esophagus can be difficult to diagnose because this condition does not affect all the tissue in your esophagus. The doctor takes biopsy samples from at least eight different areas of the lining of your esophagus.

Who should be screened for Barrett’s esophagus?

Your doctor may recommend screening for Barrett’s esophagus if you are a man with chronic—lasting more than 5 years—and/or frequent—happening weekly or more—symptoms of GERD and two or more risk factors for Barrett’s esophagus. These risk factors include

• being age 50 and older
• being Caucasian
• having high levels of belly fat
• being a smoker or having smoked in the past
• having a family history of Barrett’s esophagus or esophageal adenocarcinoma

Treatment

How do doctors treat Barrett’s esophagus?

Your doctor will talk about the best treatment options for you based on your overall health, whether you have dysplasia, and its severity. Treatment options include medicines for GERD, endoscopic ablative therapies, endoscopic mucosal resection, and surgery.

Periodic surveillance endoscopy

Your doctor may use upper gastrointestinal endoscopy with a biopsy periodically to watch for signs of cancer development. Doctors call this approach surveillance.

Experts aren’t sure how often doctors should perform surveillance endoscopies. Talk with your doctor about what level of surveillance is best for you. Your doctor may recommend endoscopies more frequently if you have high-grade dysplasia rather than low-grade or no dysplasia. Read whether people with Barrett’s esophagus are more likely to develop cancer.

Medicines

If you have Barrett’s esophagus and gastroesophageal reflux disease (GERD), your doctor will treat you with acid-suppressing medicines called proton pump inhibitors (PPIs). These medicines can prevent further damage to your esophagus and, in some cases, heal existing damage.

PPIs include

• omeprazole (Prilosec, Zegerid)
• lansoprazole (Prevacid)
• pantoprazole (Protonix)
• rabeprazole (AcipHex)
• esomeprazole (Nexium)
• dexlansoprazole (Dexilant)

All of these medicines are available by prescription. Omeprazole and lansoprazole are also available in over-the-counter strength.

Your doctor may consider anti-reflux surgery if you have GERD symptoms and don’t respond to medicines. However, research has not shown that medicines or surgery for GERD and Barrett’s esophagus lower your chances of developing dysplasia or esophageal adenocarcinoma.

Endoscopic ablative therapies

Endoscopic ablative therapies use different techniques to destroy the dysplasia in your esophagus. After the therapies, your body should begin making normal esophageal cells.

A doctor, usually a gastroenterologist or surgeon, performs these procedures at certain hospitals and outpatient centers. You will receive local anesthesia and a sedative. The most common procedures are the following:

• Photodynamic therapy. Photodynamic therapy uses a light-activated chemical called porfimer (Photofrin), an endoscope, and a laser to kill precancerous cells in your esophagus. A doctor injects porfimer into a vein in your arm, and you return 24 to 72 hours later to complete the procedure.

• Radiofrequency ablation. Radiofrequency ablation uses radio waves to kill precancerous and cancerous cells in the Barrett’s tissue. An electrode mounted on a balloon or an endoscope creates heat to destroy the Barrett’s tissue and precancerous and cancerous cells.

Endoscopic mucosal resection

In endoscopic mucosal resection, your doctor lifts the Barrett’s tissue, injects a solution underneath or applies suction to the tissue, and then cuts the tissue off. The doctor then removes the tissue with an endoscope. Gastroenterologists perform this procedure at certain hospitals and outpatient centers. You will receive local anesthesia to numb your throat and a sedative to help you relax and stay comfortable.

Before performing an endoscopic mucosal resection for cancer, your doctor will do an endoscopic ultrasound.

Complications can include bleeding or tearing of your esophagus. Doctors sometimes combine endoscopic mucosal resection with photodynamic therapy.

Surgery

Surgery called esophagectomy is an alternative to endoscopic therapies. Many doctors prefer endoscopic therapies because these procedures have fewer complications.

Esophagectomy is the surgical removal of the affected sections of your esophagus. After removing sections of your esophagus, a surgeon rebuilds your esophagus from part of your stomach or large intestine. The surgery is performed at a hospital. You’ll receive general anesthesia, and you’ll stay in the hospital for 7 to 14 days after the surgery to recover.

Surgery may not be an option if you have other medical problems. Your doctor may consider the less-invasive endoscopic treatments or continued frequent surveillance instead.

Eating, Diet, & Nutrition

How can your diet help prevent Barrett’s esophagus?

Researchers have not found that diet and nutrition play an important role in causing or preventing Barrett’s esophagus.?

If you have gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD), you can prevent or relieve your symptoms by changing your diet. Dietary changes that can help reduce your symptoms include

• decreasing fatty foods
• eating small, frequent meals instead of three large meals

Avoid eating or drinking the fol?lowing items that may make GER or GERD worse:

• ?chocolate
• coffee
• peppermint
• greasy or spicy foods?
• tomatoes and tomato products
• alcoholic drinks

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.?

Definition & Facts

What is binge eating disorder?

Binge eating is when you eat a large amount of food in a short amount of time and feel that you can’t control what or how much you are eating. If you binge eat regularly—at least once a week for 3 months, you may have binge eating disorder.

If you have binge eating disorder, you may be very upset by your binge eating. You also may feel ashamed and try to hide your problem. Even your close friends and family members may not know you binge eat.

How is binge eating disorder different from bulimia nervosa?

Unlike people with binge eating disorder, people who have bulimia nervosa try to prevent weight gain after binge eating by vomiting, using laxatives or diuretics, fasting, or exercising too much.

How common is binge eating disorder?

Binge eating disorder is the most common eating disorder in the United States. About 3.5 percent of adult women and 2 percent of adult men have binge eating disorder. For men, binge eating disorder is most common in midlife, between the ages of 45 to 59.¹

For women, binge eating disorder most commonly starts in early adulthood, between the ages of 18 and 29. About 1.6 percent of teenagers are affected.² A much larger number of adults and children have episodes of binge eating or loss-of-control eating, but the episodes do not occur frequently enough to meet the criteria for binge eating disorder.

Binge eating disorder affects African Americans as often as whites. More research is needed on how often binge eating disorder affects people in other racial and ethnic groups.

Who is more likely to develop binge eating disorder?

Binge eating disorder can occur in people of average body weight but is more common in people with obesity, particularly severe obesity. However, it is important to note that most people with obesity do not have binge eating disorder.

Painful childhood experiences—such as family problems and critical comments about your shape, weight, or eating—also are associated with developing binge eating disorder. Binge eating disorder also runs in families, and there may be a genetic component as well.

What other health problems can you have with binge eating disorder?

Binge eating disorder may lead to weight gain and health problems related to obesity. Overweight and obesity are associated with many health problems, including type 2 diabetes, heart disease, and certain types of cancer. People with binge eating disorder may also have mental health problems such as depression or anxiety. Some people with binge eating disorder also have problems with their digestive system, or joint and muscle pain.

References

Symptoms & Causes

What are the symptoms of binge eating disorder?

If you have binge eating disorder, you may

• eat a large amount of food in a short amount of time; for example, within 2 hours³
• feel you lack control over your eating; for example, you cannot stop eating or control what or how much you are eating

You also may

• eat more quickly than usual during binge episodes
• eat until you feel uncomfortably full
• eat large amounts of food even when you are not hungry
• eat alone because you are embarrassed about the amount of food you eat
• feel disgusted, depressed, or guilty after overeating⁴

If you think that you or someone close to you may have binge eating disorder, share your concerns with a health care provider. He or she can connect you to helpful sources of care.

What causes binge eating disorder?

No one knows for sure what causes binge eating disorder. Like other eating disorders, binge eating disorder may result from a mix of factors related to your genes, your thoughts and feelings, and social issues. Binge eating disorder has been linked to depression and anxiety. 

For some people, dieting in unhealthy ways—such as skipping meals, not eating enough food, or avoiding certain kinds of food—may contribute to binge eating. 

References

Diagnosis & Treatment

How do doctors diagnose binge eating disorder?

Most of us overeat from time to time, and some of us often feel we have eaten more than we should have. Eating a lot of food does not necessarily mean you have binge eating disorder.

To determine if you have binge eating disorder, you may want to talk with a specialist in eating disorders, such as a psychiatrist, psychologist, or other mental health professional. He or she will talk with you about your symptoms and eating patterns. If a health care provider determines you have binge eating disorder, he or she can work with you to find the best treatment options. 

How do doctors treat binge eating disorder?

Talk to your doctor if you think you have binge eating disorder. Ask him or her to refer you to a mental health professioinal in your area. A specialist, such as a psychiatrist, psychologist or other mental health professional, may be able to help you choose the best treatment for you.

Treatment may include therapy to help you change your eating habits, as well as thoughts and feelings that may lead to binge eating and other psychological symptoms. Types of therapy that have been shown to help people with binge eating disorder are called psychotherapies and include cognitive behavioral therapy, interpersonal psychotherapy, and dialectical behavior therapy. Your psychiatrist or other health care provider may also prescribe medication to help you with your binge eating, or to treat other medical or mental health problems.

Should you try to lose weight if you have binge eating disorder?

Losing weight may help prevent or reduce some of the health problems related to carrying excess weight. Binge eating may make it hard to lose weight and keep it off. If you have binge eating disorder and are overweight, a weight-loss program that also offers treatment for eating disorders may help you lose weight. However, some people with binge eating disorder do just as well in a behavioral treatment program designed only for weight loss as people who do not binge eat. Talk with your health care professional to help you decide whether you should try to manage your binge eating before entering a weight management program.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Definition & Facts

What are bladder control problems in children?

Children may have a bladder control problem—also called urinary incontinence (UI)—if they leak urine by accident and are past the age of toilet training. A child may not stay dry during the day, called daytime wetting; or through the night, called bedwetting.

Children normally gain control over their bladders somewhere between ages 2 and 4—each in their own time. Occasional wetting is common even in 4- to 6-year-old children.

By age 4, when most children stay dry during the day, daytime wetting can be very upsetting and embarrassing. By ages 5 or 6, children might have a bedwetting problem if the bed is wet once or twice a week over a few months.

Most bladder control problems disappear naturally as children grow older. When needed, a health care professional can check for conditions that may lead to wetting.

Loss of urine is almost never due to laziness, a strong will, emotional problems, or poor toilet training. Parents and caregivers should always approach this problem with understanding and patience.

Learn more about the urinary tract and how it works.

Do bladder control problems have another name?

Bladder control problems are also called urinary incontinence or enuresis.

• Primary enuresis is wetting in a child who has never regularly stayed dry.
• Secondary enuresis is wetting that begins after at least 6 months of staying dry.

What are the types of bladder control problems in children?

Children usually have one of two main bladder control problems:

• daytime wetting, also called diurnal enuresis
• bedwetting, also called nocturnal enuresis

Some children may have trouble controlling their bladders both day and night.

Daytime wetting

For infants and toddlers, wetting is a normal part of development. Children gradually learn to control their bladders as they grow older. Problems that can occur during this process and lead to daytime wetting include

• Holding urine too long. Your child’s bladder can overfill and leak urine.
• Overactive bladder. Your child’s bladder squeezes without warning, causing frequent runs for the toilet and wet clothes.
• Underactive bladder. Your child uses the toilet only a few times a day, with little urge to do so. Children may have a weak or interrupted stream of urine.
• Disordered urination. Your child’s bladder muscles and nerves do not work together smoothly. Certain muscles cut off urine flow too soon. Urine left in the bladder may leak.

Bedwetting

Children who wet the bed fall into two groups: those who have never been dry at night, and children who started wetting the bed again after staying dry for 6 months.

How common are bladder control problems in children?

Bladder control problems are common in children. About 1 in 10 children has trouble with daytime wetting at age 5.¹ Nighttime wetting is more common than daytime wetting.

Who is more likely to have bladder control problems?

Daytime wetting is more common in girls than boys.

Bedwetting is more common in boys—and in all children whose parents wet the bed when they were young. Your child’s chances of wetting the bed are about 1 in 3 when one parent was affected as a child. If both parents were affected, the chances that your child will wet the bed are 7 in 10.²

Most children with bladder control problems are physically and emotionally normal. Certain health conditions can make a child more likely to experience wetting, including

• a bladder or kidney infection (urinary tract infection)
• constipation—fewer than two bowel movements a week, or bowel movements in which stool is painful or hard to pass
• nerve problems, such those seen with spina bifida, a birth defect
• vesicouretal reflux (VUR), backward flow of urine from the bladder to the kidneys
• diabetes, a condition in which blood glucose, also called blood sugar, is too high
• problems with the structure of the urinary tract, such as a blockage or a narrowed urethra
• obstructive sleep apnea (OSA), a condition in which breathing is interrupted during sleep, often because of inflamed or enlarged tonsils
• ADHD, or attention deficit hyperactivity disorder

What are the complications of bladder control problems?

Children can manage or outgrow most bladder control problems with no lasting health effects. However, accidental wetting can cause emotional distress and poor self-esteem for a child as well as frustration for families.

Bladder control problems can sometimes lead to bladder or kidney infections (UTIs). Bedwetting that is never treated during childhood can last into the teen years and adulthood, causing emotional distress.

References

Symptoms & Causes

What are the signs and symptoms of bladder control problems in children?

Losing urine by accident is the main sign of a bladder control problem. Your child may often have wet or stained underwear—or a wet bed.

Daytime Wetting

Signs that your child may have a condition that causes daytime wetting include

• the urgent need to urinate, often with urine leaks
• urinating 8 or more times a day, called frequency
• infrequent urination—emptying the bladder only 2 to 3 times a day, rather the usual 4 to 7 times a day
• incomplete urination—not fully emptying the bladder during bathroom visits
• squatting, squirming, leg crossing, or heel sitting to avoid leaking urine

Bedwetting

Nighttime wetting is normal for many children—and is often not considered a health problem at all—especially when it runs in the family.

At ages 5 and older, signs that your child may have a nighttime bladder control problem—whether due to slow physical development, an illness, or any cause—can include

• never being dry at night
• wetting the bed 2 to 3 times a week over 3 months or more
• wetting the bed again after 6 months of dry nights

When should my child see a doctor about bladder control problems?

If you or your child are worried about accidental wetting, talk with a health care professional. He or she can check for medical problems and offer treatment, or reassure you that your child is developing normally.

Take your child to a health care professional if there are signs of a medical problem, including

• symptoms of bladder infection such as
  • pain or burning when urinating
  • cloudy, dark, bloody, or foul-smelling urine
  • urinating more often than usual
  • strong urges to urinate, but passing only a small amount of urine
  • pain in the lower belly area or back
  • crying while urinating
  • fever
  • restlessness
• your child dribbles urine or has a weak urine stream, which can be signs of a birth defect in the urinary tract
• your child was dry, but started wetting again

Although each child is unique, providers often use a child’s age to decide when to look for a bladder control problem. In general,

• by age 4, most children are dry during the day
• by ages 5 or 6, most children are dry at night

Seek care right away

If your child has symptoms of a bladder or kidney infection, or has a fever without a clear cause, see a health care professional within 24 hours. Quick treatment is important to prevent a urinary tract infection from causing more serious health problems.

What causes bladder control problems in children?

Bathroom habits, such as holding urine too long, and slow physical development cause many of the bladder control problems seen in children. Less often, a medical condition can cause wetting. Learn which children are more likely to have bladder control problems.

What causes daytime wetting in children?

Daytime wetting in children is commonly caused by holding urine too long, constipation, or bladder systems that don’t work together smoothly. Health problems can sometimes cause daytime wetting, too, such as bladder or kidney infections (UTIs), structural problems in the urinary tract, or nerve problems.

When children hold their urine too long, it can trigger problems in how the bladder works or make existing problems worse. These bladder problems include:

Overactive bladder or urge incontinence

Bladder muscles squeeze at the wrong time, without warning, causing a loss of urine. Your child may have strong, sudden urges to urinate. She may urinate frequently—8 or more times a day.

Underactive bladder

Children only empty the bladder a few times a day, with little urge to urinate. Bladder contractions can be weak, and your child may strain when urinating, have a weak stream, or stop-and-go urine flow.

Disordered urination

Muscles and nerves of the bladder may not work together smoothly. As the bladder empties, sphincter or pelvic floor muscles may cut off urine flow too soon, before the bladder empties all the way. Urine left in the bladder may leak.

What causes bedwetting in children?

Nighttime wetting is often related to slow physical development, a family history of bedwetting, or making too much urine at night. In many cases, there is more than one cause. Children almost never wet the bed on purpose—and most children who wet the bed are physically and emotionally normal.

Sometimes a health condition can lead to bedwetting, such as diabetes or constipation.

Slow physical development

Between ages 5 and 10, slow physical development can cause your child to wet the bed. Your child may have a small bladder, deep sleep cycles, or a nervous system that’s still growing and developing. The nervous system handles the body’s alarms—sending signals about a full or emptying bladder—and the need to wake up.

Family history

Bedwetting often runs in families. Researchers have found genes that are linked to bedwetting. Genes are parts of the master code that children inherit from each parent for hair color and many other features and traits.

Making too much urine

Your child’s kidneys may make too much urine overnight, leading to an overfull bladder. If your child doesn’t wake up in time, a wet bed is likely. Often this excess urine at night is due to low levels of a natural substance called antidiuretic hormone (ADH). ADH tells the kidneys to release less water at night.

Sleep disorders

Sleepwalking and obstructive sleep apnea (OSA) can lead to bedwetting. With OSA, children breathe poorly and get less oxygen, which triggers the kidneys to make extra urine at night. Bedwetting can be a sign that your child has OSA. Other symptoms include snoring, mouth breathing, ear and sinus infections, a dry mouth in the morning, and daytime sleepiness.

Stress

Stress can sometimes lead to bedwetting, and worry about daytime or nighttime wetting can make the problem worse. Stresses that may affect your child include a new baby in the family, sleeping alone, moving or starting a new school, abuse, or a family crisis.

Diagnosis

How do doctors diagnose bladder control problems in children?

To diagnose a bladder control problem, doctors use a child’s

• medical history
• physical exam
• lab tests
• imaging tests, if needed

In addition, doctors will ask questions about

• symptoms
• when and how often the wetting happens
• dry periods
• family history of bedwetting

Bladder and liquids diary

Before an office visit, it’s helpful to use a bladder diary (PDF, 487 KB) to keep track your child’s bathroom habits and how much liquid your child drinks. Write down when your child uses the toilet, the amount of urine passed, and when your child leaks urine. Record the timing and amount of liquid your child drinks, too, including whether your child drinks fluids before bedtime.

Because constipation can cause wetting or make it worse, your child’s doctor may ask you to record how often your child passes stool and whether it’s hard or soft.

What tests do doctors use to diagnose bladder control problems in children?

Lab tests

Health care professionals often test a urine sample, which is called urinalysis, to help diagnose bladder control problems in children. The lab may also perform a urine culture, if requested. White blood cells and bacteria in the urine can be signs of a urinary tract infection.

Other tests

In a few cases, health care professionals may order imaging tests or tests of how the urinary tract works. These tests can show a birth defect or a blockage in the urinary tract that may lead to wetting. Special tests can find nerve or spine problems. Testing can also help show a small bladder, weak muscles, or muscles that don’t work together well.

Ultrasound. An ultrasound uses sound waves to look at structures inside the body without exposing your child to radiation. During this painless test, your child lies on a padded table. A technician gently moves a wand called a transducer over your child’s belly and back. No anesthesia is needed.

Voiding cystourethrogram (VCUG). A voiding cystourethrogram uses x-rays of the bladder and urethra to show how urine flows. A technician uses a catheter to fill your child’s bladder with a special dye. The technician then takes x-rays before, during and after your child urinates. A VCUG uses only a small amount of radiation. Anesthesia is not needed, but the doctor may offer your child a calming medicine, called a sedative.

MRI. Magnetic resonance imaging (MRI) uses magnets and radio waves to make pictures of the urinary tract and spine. During this test, your child lies on a table inside a tunnel-like machine. MRI scans do not expose your child to radiation. No anesthesia is needed, but the doctor may offer your child a calming medicine or suggest watching a children’s program during the test.

Urodynamic testing. Urodynamic testing is a group of tests that look at how well the bladder, sphincters, and urethra are storing and releasing urine. These studies are not used often, but they may be helpful when simple bladder management methods are not as successful as expected.

Learn more about imaging tests of the urinary tract.

Treatment

How can my child’s doctor and I treat a bladder control problem?

When a health condition causes the wetting—such as diabetes or a birth defect in the urinary tract—doctors will treat the health problem, and the wetting is likely to stop.

Other common treatments for wetting include bladder training, moisture alarms, medicines, and home care. Teamwork is important among you, your child, and your child’s doctor. You should reward your child for following a program, rather than for staying dry—because a child often cannot control wetting.

If your child wets both day and night, the doctor is likely to treat daytime wetting first. Children usually stay dry during the day before they gain bladder control at night.

Daytime wetting

Treatments for daytime wetting depend on what’s causing the wetting, and will often start with changes in bladder and bowel habits. Your child’s doctor will treat any constipation, so that hard stools don’t press against the bladder and lead to wetting.

Bladder training

Bladder training helps your child get to the bathroom sooner and may help reset bladder systems that don’t work together smoothly. Programs can include

• urinating on schedule every 2 to 3 hours, called timed voiding.
• urinating twice during one visit, called double voiding. This method may help the bladder empty completely in children who have an underactive or “lazy” bladder or vesicoureteral reflux (VUR)
• relaxing the pelvic floor muscles so children can empty the bladder fully. A few sessions of biofeedback can retrain muscles that don’t work together in the right order.

In extremely rare cases, doctors may suggest using a thin, flexible tube, called a catheter, to empty the bladder. Occasional use of a catheter may help develop better bladder control in children with a weak, underactive bladder.

Medicine

Your child’s doctor may suggest medicine to limit daytime wetting or prevent a urinary tract infection (UTI).

Oxybutynin (Ditropan) is often the first choice of medicine to calm an overactive bladder until a child matures and outgrows the problem naturally.

If your child often has bladder infections, the doctor may prescribe an antibiotic, which is a medicine that kills the bacteria that cause infections. Your child’s doctor may suggest taking a low-dose antibiotic for several months to prevent repeated bladder infections.

Home care and support

Changes in your child’s routines and behavior may greatly improve daytime wetting, even without other treatments. Encourage your child to

• use the bathroom whenever the urge occurs.
• drink more liquid, mainly water, if the doctor suggests doing so. Drinking more liquid produces more urine and more trips to the bathroom.
• take extra time in the bathroom to relax and empty the bladder completely.
• avoid drinks with caffeine or bubbles, citrus juices, and sports drinks. These drinks may irritate the bladder or produce extra urine.

Children need plenty of support from parents and caregivers to overcome daytime wetting, not blame or punishment. Calming your child’s stresses may help—stresses about a new baby or new school, for example. A counselor or psychologist can help treat anxiety.

Bedwetting

If your child’s provider suggests treatment, it’s likely to start with ways to motivate your child and change his or her behavior. The next steps include moisture alarms or medicine.

For a bedwetting treatment program to work, both the parent and child must be motivated. Treatment doesn’t always completely stop bedwetting—and there are likely to be some setbacks. However, treatment can greatly reduce how often your child wets the bed.

Motivational therapy

For motivational therapy, you and your child agree on ways to manage bedwetting and rewards for following the program. Keep a record of your child’s tasks and progress, such as a calendar with stickers. You can give rewards to your child for remembering to use the bathroom before bed, helping to change and clean wet bedding, and having a dry night.

Motivational therapy helps children gain a sense of control over bedwetting. Many children learn to stay dry with this approach, and many others have fewer wet nights. Taking back rewards, shaming, penalties, and punishments don’t work; your child is not wetting the bed on purpose. If there’s no change in your child’s wetting after 3 to 6 months, talk with a health care professional about other treatments.

Moisture alarms

Moisture alarms detect the first drops of urine in a child’s underwear and sound an alarm to wake the child. A sensor clips to your child’s clothes or bedding. At first you may need to wake your child, get him or her to the bathroom, and clean up wet clothes and bedding. Eventually, your child learns to wake up when his or her bladder is full and get to the bathroom in time.

Moisture alarms work well for many children and can end bedwetting for good. Families need to use the alarm regularly for 3 to 4 months as the child learns to sense his or her signals and control the bladder. Signs of progress usually appear in the first few weeks—smaller wet spots, fewer alarms each night, and your child waking on his or her own.

Medicine

Your child’s doctor may suggest medicine when other treatments haven’t worked well.

Desmopressin (DDAVP) is often the first choice of medicine for bedwetting. This medicine slows the amount of urine your child’s body makes overnight, so the bladder doesn’t overfill and leak. Desmopressin can work well, but bedwetting often returns when a child stops taking the medicine. You can use desmopressin for sleepovers, camp, and other short periods of time. You can also keep a child on desmopressin safely for long periods of time.

Home care

Changes in your child’s routines may improve bedwetting, when used alone or with other treatments. Encourage your child to

• drink most of his or her liquids during the morning and early afternoon.
• urinate regularly during the day—every 2 to 3 hours—and just before bed, which is a total of about 4 to 7 times a day.
• urinate twice before bedtime (about a half hour apart) to fully empty the bladder and allow room for new urine made overnight.
• avoid drinks with caffeine or bubbles, citrus juices, and sports drinks. These drinks may irritate the bladder or produce extra urine.

How can I help my child cope with bladder control problems?

Your patience, understanding, and encouragement are vital to help your child cope with a bladder control problem. If you think a health problem may be causing your child’s wetting, make an appointment with your child’s health care provider.

Clothing, bedding, and wearable products

For children with daytime wetting, clothes that come on and off easily may help prevent accidents. A wristwatch alarm set to vibrate can privately remind your child to visit the toilet, without help from a teacher or parent.

For children who wet the bed, the following practices can make life easier and may boost your child’s confidence:

• Leave out dry pajamas and towels so your child can clean up easily.
• Layer waterproof pads and fitted sheets on the bed. Your child can quickly pull off wet bedding and put it in a hamper. Fewer signs of wetting may help your child feel less embarrassed.
• Have your child help with the clean-up and laundry the next day. However, don’t make it a punishment.
• Be sure your child showers or bathes every day to wash away the smell of urine.
• Plan to stop using diapers, training pants, or disposable training pants, except when sleeping away from home. These items may discourage your child from getting out of bed to use the toilet.

Don’t make a habit of waking your child during the night to use the bathroom. Researchers don’t think it helps children overcome bedwetting.³

Emotional support

Let your child know that bedwetting is very common and most children outgrow it. If your child is age 4 or older, ask him or her for ideas on how to stop or manage the wetting. Involving your child in finding solutions may provide a sense of control.

Calming your child’s stresses may help—stresses about a new baby or new school, for example. A counselor or psychologist can help treat anxiety.

References

Prevention

How can I help my child prevent bladder control problems?

Often, you can’t prevent a bladder control problem, especially bedwetting, which is a common pattern of normal child development. However, good habits may help your child have more dry days and nights, including

• avoid or treat constipation.
• urinate every 2 to 3 hours during the day—4 to 7 times total in a day.
• drink the right amount of liquid, with most liquids consumed between morning and about 5 p.m. Ask your child’s health care provider how much liquid is healthy, based on age, weather, and activities.
• avoid drinks with caffeine or bubbles, citrus juices, and sports drinks. These drinks may irritate the bladder or produce extra urine.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many diseases and conditions.

What are clinical trials and what role do children play in research?

Clinical trials are research studies involving people of all ages. Clinical trials look at safe and effective new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving quality of life. Research involving children helps scientists

• identify care that is best for a child
• find the best dose of medicines
• find treatments for conditions that only affect children
• treat conditions that behave differently in children
• understand how treatment affects a growing child’s body

Find out more about clinical trials and children.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Definition & Facts

What is a bladder infection?

A bladder infection is an illness caused by bacteria. Bladder infections are the most common type of urinary tract infection (UTI).¹ A UTI can develop in any part of your urinary tract, including your urethra, bladder, ureters, or kidneys.

Your body has ways to defend against infection in the urinary tract. For example, urine normally flows from your kidneys, through the ureters to your bladder. Bacteria that enter your urinary tract are flushed out when you urinate. This one-way flow of urine helps to keep bacteria from infecting your urinary tract. Learn more about your urinary tract and how it works.

Sometimes your body’s defenses fail and the bacteria may cause a bladder infection. If you have bladder infection symptoms, see a health care professional.

Most of the time, getting treatment right away for an infection in your urethra or bladder can prevent a kidney infection. A kidney infection can develop from a UTI that moves upstream to one or both of your kidneys. Kidney infections are often very painful and can cause serious health problems, so it’s best to get early treatment for a UTI.

When a bladder infection or other UTI is diagnosed and treated properly, most people won't have complications.

Is there another name for a bladder infection?

Bladder infections are also called cystitis. Sometimes people use the more general term, urinary tract infection (UTI), to mean a bladder infection, although UTIs can occur in other parts of the urinary system. UTIs that occur in the urethra only are called urethritis. A kidney infection is called pyelonephritis.

How common are bladder infections?

Bladder infections are common, especially among women. Research suggests that at least 40 to 60 percent of women develop a UTI during their lifetime, and most of these infections are bladder infections. One in 4 women is likely to have a repeat infection.¹

Who is more likely to develop a bladder infection?

People of any age or sex can develop bladder infections, but women are at higher risk than men. Some people are more prone to getting these infections than others, especially those who have certain medical conditions or lifestyle factors.

You are more likely to develop a bladder infection if you

• are sexually active
• are a woman who has gone through menopause
• are a woman who uses certain types of birth control, such as diaphragms or spermicide
• have trouble emptying your bladder completely, like people with a spinal cord injury or nerve damage around the bladder
• have a problem in your urinary tract that blocks, or obstructs, the normal flow of urine, such as a kidney stone or enlarged prostate
• have an abnormality of the urinary tract, such as vesicoureteral reflux (VUR)
• have diabetes or problems with your body’s immune, or natural defense, system
• recently used a urinary catheter
• had a UTI in the past

Women are more likely to develop a bladder infection than men, mainly due to differences in anatomy:

• Women have a shorter urethra than men, which means bacteria have a shorter distance to travel to reach and infect a woman’s bladder.
• In women, the opening to the urethra is closer to the rectum, where the bacteria that cause bladder infections live.

What are the complications of bladder infections?

If infections in the lower urinary tract, such as bladder infections, are not treated, they can lead to kidney infections. If you have a kidney infection, a health care professional will provide treatment to relieve your symptoms and help prevent complications.

Health care professionals routinely test pregnant women for bacteria in the urine because a bladder infection during pregnancy is more likely to become a kidney infection.

Complications from bladder infections are rare when you work with your health care provider to find the best treatment and complete it. If your infection is treated with antibiotics, it’s important to follow directions carefully and finish all the medicine, even after you start to feel better. If you stop taking antibiotics too soon, you may get another infection that is harder to treat.

References

Symptoms & Causes

What are the symptoms of a bladder infection?

Symptoms of a bladder infection may include

• a burning feeling when you urinate
• frequent or intense urges to urinate, even when you have little urine to pass

Seek care right away

If you have symptoms of a bladder infection, see a health care professional right away, especially if you have severe pain in your back near your ribs or in your lower abdomen, along with vomiting and nausea, fever, or other symptoms that may indicate a kidney infection.

Kidney infections are often very painful and can cause serious health problems, so it’s best to get early treatment.

What causes a bladder infection?

Most of the time a bladder infection is caused by bacteria that are normally found in your bowel. The bladder has several systems to prevent infection. For example, urination most often flushes out bacteria before it reaches the bladder. Sometimes your body can’t fight the bacteria and the bacteria cause an infection. Read the reasons you may be at risk for UTIs.

Diagnosis

How do health care professionals diagnose a bladder infection?

Health care professionals use your medical history, a physical exam, and tests to diagnose a bladder infection.

A health care professional will ask if you have a history of health conditions that make you more likely to develop any type of UTI. During a physical exam, the health care professional will ask you about your symptoms.

Which tests do health care professionals use to diagnose a bladder infection?

Health care professionals typically test a sample of your urine to diagnose a bladder infection. In rare cases, a health care professional may also order another test to look at your urinary tract.

Lab tests

Urinalysis. You will collect a urine sample in a special container at a doctor’s office or at a lab. A health care professional will test the sample for bacteria and white blood cells, which the body produces to fight infection. Bacteria also can be found in the urine of healthy people, so a bladder infection is diagnosed based both on your symptoms and lab tests.

Urine culture. In some cases, a health care professional may culture your urine to find out what type of bacteria is causing the infection. Urine culture is not required in every case, but is important in certain circumstances, such as having repeated UTIs or certain medical conditions. The results of a urine culture take about 2 days to return and will help your health care professional determine the best treatment for you.

Imaging and other tests

If you have repeated bladder infections or have a complicated infection, a doctor may order imaging tests to look at your urinary tract. A complicated UTI is an infection linked to certain other conditions, such as a kidney stone, or a structural problem in your urinary tract. Read more about imaging tests for your urinary tract.

Doctors may use cystoscopy to look inside the urethra and bladder. Doctors use a cystoscope, a tube-like instrument, during cystoscopy to look for swelling, redness, and other signs of infection in addition to structural problems that may be causing the infection.

Doctors may also use urodynamic testing, which is any procedure that shows how well your bladder, sphincters, and urethra are storing and releasing urine.

Treatment

How do health care professionals treat a bladder infection?

If you have a bladder infection caused by bacteria, a health care professional is likely to prescribe antibiotics. If the diagnosis is not certain, based on your symptoms or lab test results, you may not need antibiotics. Instead, your health care professional will work to find the cause and the best treatment for your symptoms.

Medicines

Which antibiotic you take is based on the type of bacteria causing your infection and any allergies you may have to antibiotics.

The length of treatment depends on

• how severe the infection is
• whether your symptoms and infection go away
• whether you have repeated infections
• whether you have problems with your urinary tract

Men may need to take antibiotics longer because bacteria can move into the prostate gland, which surrounds the urethra. Bacteria can hide deep inside prostate tissue.

Follow your health care professional’s instructions carefully and completely when taking antibiotics. Although you may feel relief from your symptoms, make sure to take the entire antibiotic treatment.

If needed, a health care professional may prescribe other medicines to relieve any pain or discomfort from your bladder infection.

At-home treatments

Drink a lot of liquids and urinate often to speed healing. Water is best. Talk with a health care professional if you can’t drink a lot of liquids due to other health problems, such as urinary incontinence, urinary frequency, or heart or kidney failure.

A heating pad on your back or abdomen may help you manage pain from a kidney or bladder infection.

Research

Researchers are studying ways to treat or prevent bladder infections without taking antibiotics. The bacteria that cause these infections can become stronger and harder to fight when a person takes antibiotics repeatedly. Alternate approaches include probiotics, vaginal estrogen, and "watchful waiting." Talk to your health care professional about any treatment for a bladder infection before you start it, including home remedies and supplements. Some supplements can have side effects or react poorly with other medications you take.

How can I prevent a bladder infection?

Changing some of your daily habits and lifestyle choices may help you prevent repeated bladder infections.

Drink enough liquids

Most people should try drinking six to eight, 8-ounce glasses of liquid a day. Talk with a health care professional if you can’t drink this amount due to other health problems, such as urinary incontinence, urinary frequency, or heart or kidney failure.

Be aware of your bathroom habits

Urinate often and when you first feel like you need to go. Bacteria can grow when urine stays in the bladder too long and can cause an infection. Urinate shortly after having sex to flush away bacteria that might have entered your urethra during sex.

After urinating or having a bowel movement, always wipe from front to back. This step is most important after a bowel movement to keep from getting bacteria into your urethra.

Wear loose-fitting clothing

Consider wearing cotton underwear and loose-fitting clothes so air can keep the area around the urethra dry.

Consider switching birth control methods if you have repeat bladder infections

If you have trouble with repeat bladder infections, talk with a health care professional about your birth control. Consider switching to a new form of birth control if you use diaphragms, unlubricated condoms, or spermicide, all of which can increase your chances of developing a bladder infection. Consider using lubricated condoms without spermicide or using a nonspermicidal lubricant.

Eating, Diet, & Nutrition

Can my eating, diet, and nutrition help prevent bladder infections?

Experts don’t think eating, diet, and nutrition play a role in preventing or treating bladder infections. Although some research shows that cranberry juice, extract, or pills may help prevent these infections, not enough evidence shows this. Research shows that cranberry products are not effective in treating a bladder infection if you already have one.²

Can drinking liquid help prevent or relieve bladder infections?

Yes. Drink six to eight, 8-ounce glasses of liquid a day. Talk with a health care professional if you can’t drink this amount due to other health problems, such as urinary incontinence, urinary frequency, or kidney failure. The amount of liquid you need to drink depends on the weather and your activity level. If you live, work, or exercise in hot weather, you may need more liquid to replace the fluid you lose through sweat.

References

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Definition & Facts

What is fecal incontinence?

Fecal incontinence, also called accidental bowel leakage, is the accidental passing of bowel movements—including solid stools, liquid stools, or mucus—from your anus.

The most common type of fecal incontinence is called urge incontinence. When you have urge incontinence, you feel a strong urge to have a bowel movement but cannot stop it before reaching a toilet. If you have urge incontinence, your pelvic floor muscles may be too weak to hold back a bowel movement due to muscle injury or nerve damage.

Another type of fecal incontinence is called passive incontinence. When you have passive incontinence, leakage occurs without you knowing it. If you have passive incontinence, your body may not be able to sense when your rectum is full.

Fecal incontinence can be upsetting and embarrassing. Some people may feel ashamed and try to hide the problem. You may be afraid or embarrassed to talk about fecal incontinence with your doctor. However, talking openly and honestly with your doctor is important in diagnosing and treating your fecal incontinence.

Does fecal incontinence have other names?

Fecal incontinence is also called

• accidental bowel leakage
• bowel incontinence
• encopresis—a term used mostly for fecal incontinence in children

How common is fecal incontinence?

Medical experts consider fecal incontinence a common problem, affecting about 1 in 3 people who see a primary health care provider.¹

• Fecal incontinence is more common in older adults.²
• Among adults who are not in hospitals or nursing homes, between 7 and 15 out of 100 have fecal incontinence.¹
• Among adults who are in hospitals, between 18 and 33 out of 100 have fecal incontinence.³
• Among adults who are in nursing homes, between 50 and 70 out of 100 have fecal incontinence.²

Fecal incontinence occurs in about 2 out of 100 children.⁴

Who is more likely to have fecal incontinence?

You may be more likely to have fecal incontinence if you

• are older than age 65
• are not physically active
• have certain chronic diseases, medical conditions, or health problems
• have had your gallbladder removed
• are a current smoker

Children who were born with certain birth defects of the spinal cord, anus, or rectum are more likely to have fecal incontinence. Children who are constipated are also more likely to have fecal incontinence.

What other health problems do people with fecal incontinence have?

If you have fecal incontinence, you may also have other health problems, including

• diarrhea
• poor overall health
• chronic diseases and disorders such as
  • irritable bowel syndrome
  • type 2 diabetes
  • diseases that affect the nerves of your anus, pelvic floor, or rectum
  • inflammatory bowel disease
• damage to or weakness of the muscles of your anus, pelvic floor, or rectum
• damage to the nerves in your anus, pelvic floor, or rectum
• urinary incontinence
• proctitis

What problems may fecal incontinence cause?

The problems that fecal incontinence may cause include

• discomfort or irritation of the skin around the anus
• emotional and social distress, such as fear, embarrassment, social isolation, loss of self-esteem, anger, or depression
• quality-of-life issues, such as not being able to exercise, work, attend school, or go to social gatherings

References

Symptoms & Causes

What are the symptoms of fecal incontinence?

The symptoms of fecal incontinence depend on the type.

• If you have urge fecal incontinence, you will know when you need to pass stool but not be able to control passing stool before reaching a toilet.
• If you have passive fecal incontinence, you will pass stool or mucus from your anus without knowing it.

Some medical experts include streaks or stains of stool or mucus on your underwear—called soiling—as a symptom of fecal incontinence.

When should I see a doctor for fecal incontinence?

You should see a doctor if your fecal incontinence is frequent or severe. Although some people are able to manage mild or infrequent fecal incontinence on their own, you should see a doctor if your fecal incontinence is affecting your quality of life or causing emotional or social distress.

What causes fecal incontinence in adults?

Fecal incontinence has many causes, including digestive tract disorders and chronic diseases. Some causes of fecal incontinence, such as childbirth by vaginal delivery, happen only in women.

Diarrhea

Loose, watery stools from diarrhea fill your rectum quickly and are harder to hold in than solid stools. Diarrhea is the most common risk factor for fecal incontinence for people not staying in hospitals, nursing homes, or other similar institutions. Diarrhea may be caused by digestive tract problems such as

• inflammatory bowel disease
• irritable bowel syndrome
• proctitis

Constipation

Constipation can lead to large, hard stools that are difficult to pass. The hard stools stretch and, over time, weaken the muscles in your rectum. The weakened muscles let watery stools that build up behind the hard stool leak out.

Muscle injury or weakness

If the muscles in your anus, pelvic floor, or rectum are injured or weakened, they may not be able to keep your anus closed, letting stool leak out. These muscles can be injured or weakened by

• surgery to
  • remove cancer in the anus or rectum
  • remove hemorrhoids
  • treat anal abscesses and fistulas
• trauma

Nerve damage

If the nerves that control your anus, pelvic floor, and rectum are damaged, the muscles can’t work the way they should. Damage to the nerves that tell you when there is stool in your rectum makes it hard to know when you need to look for a toilet. Nerves can be damaged by

• a long-term habit of straining to pass stool
• brain injury
• spinal cord injury

Neurologic diseases

Neurologic diseases that affect the nerves of the anus, pelvic floor, or rectum can cause fecal incontinence. These diseases include

• dementia
• multiple sclerosis
• Parkinson’s disease
• stroke
• type 2 diabetes

Loss of stretch in the rectum

If your rectum is scarred or inflamed, it becomes stiff and can’t stretch as much to hold stool. Your rectum can get full quickly, and stool can leak out. Rectal surgery, radiation therapy in the pelvic area, and inflammatory bowel disease can cause scarring and inflammation in your rectum.

Hemorrhoids

Hemorrhoids can keep the muscles around your anus from closing completely, which lets small amounts of stool or mucus to leak out.

Rectal prolapse

Rectal prolapse—a condition that causes your rectum to drop down through your anus—can also keep the muscles around your anus from closing completely, which lets small amounts of stool or mucus leak out.

Physical inactivity

If you are not physically active, especially if you spend many hours a day sitting or lying down, you may be holding a lot of stool in your rectum. Liquid stool can then leak around the more solid stool. Frail, older adults are most likely to develop constipation-related fecal incontinence for this reason.

Childbirth by vaginal delivery

Childbirth sometimes causes injuries to the anal sphincters, which can cause fecal incontinence. The chances are greater if

• your baby was large
• forceps were used to help deliver your baby
• you had a vacuum-assisted delivery
• the doctor made a cut, called an episiotomy, in your vaginal area to prevent the baby’s head from tearing your vagina during birth

Rectocele

Rectocele is a condition that causes your rectum to bulge out through your vagina. Rectocele can happen when the thin layer of muscles separating your rectum from your vagina becomes weak. Stool may stay in your rectum because the rectocele makes it harder to push stool out.

What causes fecal incontinence in children?

For children older than age 4, the most common cause of fecal incontinence is constipation with a large amount of stool in the rectum. When this happens, a child may not be able to sense when a new stool is coming into the rectum. The child may not know that he or she needs to have a bowel movement. A large amount of stool in the rectum can cause the internal anal sphincters to become chronically relaxed, which lets soft stool seep around hard stool in the rectum and leak out.

Birth defects of the anus, rectum, or colon, such as Hirschsprung disease, can cause fecal incontinence in children. These birth defects may weaken pelvic floor muscles or damage nerves in the anus or rectum. Injuries to the nerves in the anus and rectum can also cause fecal incontinence, as can spinal cord injuries and birth defects of the spinal cord.

Diagnosis

How do doctors diagnose fecal incontinence?

Doctors use your medical history, a physical exam, and medical tests to diagnose fecal incontinence and its causes.

Medical history

In addition to reviewing your general medical history, your doctor may ask the following questions:

• When did your fecal incontinence start?
• Did your fecal incontinence start after
  • the birth of your child?
  • a motor vehicle accident?
  • a fall?
  • the start of another illness?
• How often does your fecal incontinence happen?
• How much stool passes?
• Do you pass liquid or solid stool?
• Do you have a strong urge to have a bowel movement before your fecal incontinence happens?
• Do you know when you need to have a bowel movement before it happens?
• Does your fecal incontinence happen without you knowing?
• Do you leak liquid stool or mucus?
• Do you have fecal incontinence when you have diarrhea or constipation?
• Is your fecal incontinence worse after eating?
• Do certain foods seem to make your fecal incontinence worse?
• How does fecal incontinence affect your daily life?

Your doctor may ask you to keep a stool diary to help answer these questions. A stool diary is a chart for recording details of your daily bowel movements. Your doctor may give you a stool diary form that he or she has created. Or, you can create your own stool diary form or record your bowel movement details in a notebook.

You may feel embarrassed or shy about answering your doctor’s questions. However, your doctor will not be shocked or surprised. The more details and examples you can give about your problem, the better your doctor will be able to help you. You can play an active role in your diagnosis by talking openly and honestly with your doctor.

Physical exam

Your doctor will perform a physical exam, including a

• digital rectal exam
• pelvic exam—an exam to check if internal female reproductive organs are normal by feeling their shape and size

What medical tests do doctors use to diagnose fecal incontinence?

Lab tests

Your doctor may use one or more of the following lab tests to look for signs of certain diseases and conditions that may be causing your fecal incontinence.

• Blood tests can show signs of anemia, inflammation, and infection.
• Stool tests can show the presence of blood and signs of infection and inflammation.
• Urine tests can show signs of diseases such as type 2 diabetes.

Bowel function tests

Your doctor may perform one or more of the following tests to see how well the muscles and nerves in your anus, pelvic floor, and rectum are working:

• anorectal manometry—a test that checks how sensitive your rectum is, how well it works, and how well the anal sphincters work
• defecography—an x-ray of the area around the anus and rectum to see how well you can hold and release stool
• electromyography—a test that checks how well the muscles and nerves of your anus and pelvic floor are working

Endoscopy

Your doctor may perform an endoscopy to look inside your anus, rectum, and colon for signs of inflammation and digestive tract problems that may be causing your fecal incontinence. Endoscopies for fecal incontinence include

• anoscopy
• colonoscopy
• flexible sigmoidoscopy
• rectoscopy—a procedure similar to an anoscopy to look inside your rectum

Imaging tests

To look for problems in the anus, pelvic floor, or rectum that may be causing your fecal incontinence, your doctor may perform an imaging test such as

• lower GI series
• magnetic resonance imaging
• ultrasound

Treatment

The first step in treating your fecal incontinence is to see a doctor. Your doctor will talk to you about the causes of fecal incontinence and how they can be treated. Simple treatments—such as diet changes, medicines, bowel training, and exercises to strengthen your pelvic floor muscles—can improve symptoms by about 60 percent.⁵ These treatments can stop fecal incontinence in 1 out of 5 people.⁵

Your doctor can recommend ways you can help manage and treat your fecal incontinence. Your doctor can also recommend ways to relieve anal discomfort and cope with your fecal incontinence.

You can play an active role in your treatment by talking openly and honestly with your doctor about your symptoms and how well your treatments are working.

How can I manage and treat my fecal incontinence?

You can help manage and treat your fecal incontinence in the following ways.

Wearing absorbent pads

Wearing absorbent pads inside your underwear is the most frequently used treatment for fecal incontinence. For milder forms of fecal incontinence—few bowel leakage accidents, small volumes of stool, or staining of underwear—wearing absorbent pads may make a big difference in your quality of life. Wearing absorbent pads can be combined with other treatments.

Diet changes

Changing what you eat can help prevent or relieve your fecal incontinence. If diarrhea is the problem, your doctor will recommend avoiding foods and drinks that make your diarrhea worse. To find out which foods and drinks make your fecal incontinence better or worse, your doctor may recommend keeping a food diary to track

• what you eat each day
• how much of certain foods you eat
• when you eat
• what symptoms you have
• what types of bowel movements you have, such as diarrhea or constipation
• when your fecal incontinence happens
• which foods or drinks make your fecal incontinence better or worse

Take your food diary to your doctor to talk about the foods and drinks that affect your fecal incontinence.

If constipation or hemorrhoids are causing your fecal incontinence, your doctor may recommend eating more fiber and drinking more liquids. Talk with your doctor or a dietitian about how much fiber and liquids are right for you.

Over-the-counter medicines

Depending on the cause, over-the-counter medicines can help reduce or relieve your fecal incontinence. If diarrhea is causing your fecal incontinence, your doctor may recommend medicines such as loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol, Kaopectate). If constipation is causing your fecal incontinence, your doctor may recommend laxatives, stool softeners, or fiber supplements such as psyllium (Metamucil) or methylcellulose (Citrucel).

Bowel training

Your doctor may recommend that you train yourself to have bowel movements at certain times of the day, such as after meals. Developing regular bowel movements may take weeks to months to improve fecal incontinence.

Pelvic floor muscle exercises

Pelvic floor muscle exercises, also called Kegel exercises, can improve fecal incontinence symptoms. Tightening and relaxing your pelvic floor muscles many times a day can strengthen the muscles in your anus, pelvic floor, and rectum. Your doctor can help make sure you’re doing the exercises the right way.

How do doctors treat fecal incontinence?

How doctors treat fecal incontinence depends on the cause. Your doctor may recommend one or more of the following treatments:

Biofeedback therapy

Biofeedback therapy uses devices to help you learn how to do exercises to strengthen your pelvic floor muscles. This therapy can also help you learn how to

• sense when stool is filling your rectum if you have passive incontinence
• control strong sensations of urgency if you have urge incontinence

Biofeedback therapy can be more effective than learning pelvic floor exercises on your own. Ask your doctor about getting a biofeedback machine or device.

Sacral nerve stimulation

The sacral nerves control the anal sphincters, colon, and rectum. Doctors use sacral nerve stimulation—a type of electrical stimulation—when the nerves are not working properly. For this treatment, your doctor places thin wires under your skin near the sacral nerves, just above the tailbone. A battery-operated device sends mild electrical pulses through the wires to the sacral nerves.

Electrical stimulation of the sacral nerves helps them work properly. The electrical pulses do not hurt. You can turn the electrical stimulation on or off at any time.

Prescription medicines

If over-the-counter medicines to treat your fecal incontinence aren’t helping your symptoms, your doctor may prescribe prescription medicines that are stronger. These medicines may treat the causes of fecal incontinence, such as irritable bowel syndrome, Crohn’s disease, and ulcerative colitis.

Vaginal balloons

For women with fecal incontinence, your doctor may prescribe a device that inflates a balloon inside your vagina. The balloon puts pressure on the wall of your rectum through the vaginal wall. Pressure on the wall of your rectum keeps stool from passing. After your doctor makes sure the device fits right, you can add or remove air from the device as needed to control the passing of stool.

Nonabsorbable bulking agents

Nonabsorbable bulking agents are substances injected into the wall of your anus to bulk up the tissue around the anus. The bulkier tissues make the opening of your anus narrower so the sphincters are able to close better.

Surgery

Surgery may be an option for fecal incontinence that fails to improve with other treatments, or for fecal incontinence caused by injuries to the pelvic floor muscles or anal sphincters.

Sphincteroplasty. Sphincteroplasty—the most common fecal incontinence surgery—reconnects the separated ends of an anal sphincter torn by childbirth or another injury.

Artificial anal sphincter. This surgery involves placing a cuff around your anus and implanting a small pump under the skin so that you can inflate or deflate the cuff. Inflating the cuff controls the passage of stool. This surgery is not a common treatment because it may cause side effects.

Colostomy. Colostomy is a surgery in which the colon is brought through an opening in the abdominal wall, and stools are collected in a bag on the outside of the abdomen. Doctors may recommend this surgery as a last resort for the treatment of fecal incontinence. However, this surgery is rarely used to treat fecal incontinence because of the colostomy’s effect on quality of life.

Other surgeries. Doctors may perform other surgeries to treat the causes of fecal incontinence, such as

• hemorrhoids
• rectal prolapse
• rectocele

What should I do about anal discomfort?

Fecal incontinence can cause anal discomfort such as irritation, pain, or itching. You can help relieve anal discomfort by

• washing the anal area after a bowel movement
• changing soiled underwear as soon as possible
• keeping the anal area dry
• using a moisture-barrier cream in the area around your anus
• using nonmedicated powders
• using wicking pads or disposable underwear
• wearing clothes and underwear that let air pass through easily

Talk with your doctor or a health care professional about which moisture-barrier creams and nonmedicated powders are right for you.

How do I cope with my fecal incontinence?

Doing the following can help you cope with your fecal incontinence:

• using the toilet before leaving home
• carrying a bag with cleanup supplies and a change of clothes when leaving the house
• finding public restrooms before one is needed
• wearing absorbent pads inside your underwear
• wearing disposable underwear
• using fecal deodorants—over-the-counter pills that reduce the smell of stool and gas
• taking over-the-counter medicines to help prevent diarrhea before eating in restaurants or at social gatherings

As part of coping with your fecal incontinence, remember that fecal incontinence

• isn't something to be ashamed of—it's simply a medical problem
• can often be treated—a wide range of successful treatments are available
• isn't always a normal part of aging
• won't usually go away on its own—most people need treatment

What should I do if my child has fecal incontinence?

If your child has fecal incontinence and is older than age 4 and toilet trained, you should see a doctor to find out the cause. How the doctor treats your child’s incontinence depends on the cause.

References

Eating, Diet, & Nutrition

How can my diet help prevent or relieve fecal incontinence?

Depending on the cause, changing what you eat and drink can help prevent or relieve your fecal incontinence.

What should I eat if I have fecal incontinence?

You should eat a healthy, well-balanced diet. Your doctor or a dietitian can recommend a healthy eating plan that is right for you.

If your fecal incontinence is caused by constipation or hemorrhoids, eating more fiber and drinking more liquids can improve your symptoms. Talk with your doctor or a dietitian about how much fiber and liquids are right for you.

What should I avoid eating if I have fecal incontinence?

If your fecal incontinence is caused by diarrhea, you should avoid foods that make your symptoms worse, such as

• alcoholic beverages
• drinks and foods containing caffeine
• dairy products such as milk, cheese, and ice cream
• fatty and greasy foods
• drinks and foods containing fructose
• fruits such as apples, peaches, and pears
• spicy foods
• products, including candy and gum, with sweeteners ending in “–ol,” such as sorbitol, mannitol, xylitol, and maltitol

Keeping a food diary

Your doctor or dietitian may recommend keeping a food diary, which can help you find out which foods and drinks make your symptoms better or worse. After a few days, the diary may show a link between certain foods and drinks and your fecal incontinence. Changing the foods and drinks linked to your fecal incontinence may improve your symptoms.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Definition & Facts

What is celiac disease?

Celiac disease is a digestive disorder that damages the small intestine. The disease is triggered by eating foods containing gluten. Gluten is a protein found naturally in wheat, barley, and rye, and is common in foods such as bread, pasta, cookies, and cakes. Many pre-packaged foods, lip balms and lipsticks, hair and skin products, toothpastes, vitamin and nutrient supplements, and, rarely, medicines, contain gluten.

Celiac disease can be very serious. The disease can cause long-lasting digestive problems and keep your body from getting all the nutrients it needs. Celiac disease can also affect the body outside the intestine.

Celiac disease is different from gluten sensitivity or wheat intolerance. If you have gluten sensitivity, you may have symptoms similar to those of celiac disease, such as abdominal pain and tiredness. Unlike celiac disease, gluten sensitivity does not damage the small intestine.

Celiac disease is also different from a wheat allergy. In both cases, your body’s immune system reacts to wheat. However, some symptoms in wheat allergies, such as having itchy eyes or a hard time breathing, are different from celiac disease. Wheat allergies also do not cause long-term damage to the small intestine.¹

How common is celiac disease?

As many as one in 141 Americans has celiac disease, although most don’t know it.²

Who is more likely to develop celiac disease?

Although celiac disease affects children and adults in all parts of the world, the disease is more common in Caucasians and more often diagnosed in females. You are more likely to develop celiac disease if someone in your family has the disease. Celiac disease also is more common among people with certain other diseases, such as Down syndrome, Turner syndrome, and type 1 diabetes.

What other health problems do people with celiac disease have?

If you have celiac disease, you also may be at risk for

• Addison’s disease
• Hashimoto’s disease
• primary biliary cirrhosis
• type 1 diabetes

What are the complications of celiac disease?

Long-term complications of celiac disease include

• malnutrition, a condition in which you don’t get enough vitamins, minerals, and other nutrients you need to be healthy
• accelerated osteoporosis or bone softening, known as osteomalacia
• nervous system problems
• problems related to reproduction

Rare complications can include

• intestinal cancer
• liver diseases
• lymphoma, a cancer of part of the immune system called the lymph system that includes the gut

In rare cases, you may continue to have trouble absorbing nutrients even though you have been following a strict gluten-free diet. If you have this condition, called refractory celiac disease, your intestines are severely damaged and can’t heal. You may need to receive nutrients through an IV.

References

Symptoms & Causes

What are the symptoms of celiac disease?

Most people with celiac disease have one or more symptoms. However, some people with the disease may not have symptoms or feel sick. Sometimes health issues such as surgery, a pregnancy, childbirth, bacterial gastroenteritis, a viral infection, or severe mental stress can trigger celiac disease symptoms.

If you have celiac disease, you may have digestive problems or other symptoms. Digestive symptoms are more common in children and can include

• bloating, or a feeling of fullness or swelling in the abdomen
• chronic diarrhea
• constipation
• gas
• nausea
• pale, foul-smelling, or fatty stools that float
• stomach pain
• vomiting

For children with celiac disease, being unable to absorb nutrients when they are so important to normal growth and development can lead to

• damage to the permanent teeth’s enamel
• delayed puberty
• failure to thrive in infants
• mood changes or feeling annoyed or impatient
• slowed growth and short height
• weight loss

Adults are less likely to have digestive symptoms and, instead, may have one or more of the following:

• anemia
• a red, smooth, shiny tongue
• bone or joint pain
• depression or anxiety
• dermatitis herpetiformis
• headaches
• infertility or repeated miscarriage
• missed menstrual periods
• mouth problems such a canker sores or dry mouth
• seizures
• tingling numbness in the hands and feet
• tiredness
• weak and brittle bones

Adults who have digestive symptoms with celiac disease may have

• abdominal pain and bloating
• intestinal blockages
• tiredness that lasts for long periods of time
• ulcers, or sores on the stomach or lining of the intestine

Celiac disease also can produce a reaction in which your immune system, or your body’s natural defense system, attacks healthy cells in your body. This reaction can spread outside your digestive tract to other areas of your body, including your

• bones
• joints
• nervous system
• skin
• spleen

Depending on how old you are when a doctor diagnoses your celiac disease, some symptoms, such as short height and tooth defects, will not improve.

Dermatitis herpetiformis

Dermatitis herpetiformis is an itchy, blistering skin rash that usually appears on the elbows, knees, buttocks, back, or scalp. The rash affects about 10 percent of people with celiac disease. The rash can affect people of all ages but is most likely to appear for the first time between the ages of 30 and 40. Men who have the rash also may have oral or, rarely, genital sores. Some people with celiac disease may have the rash and no other symptoms.

Why are celiac disease symptoms so varied?

Symptoms of celiac disease vary from person to person. Your symptoms may depend on

• how long you were breastfed as an infant; some studies have shown that the longer you were breastfed, the later celiac disease symptoms appear
• how much gluten you eat
• how old you were when you started eating gluten
• the amount of damage to your small intestine
• your age—symptoms can vary between young children and adults

People with celiac disease who have no symptoms can still develop complications from the disease over time if they do not get treatment.

What causes celiac disease?

Research suggests that celiac disease only happens to individuals who have particular genes. These genes are common and are carried by about one-third of the population. Individuals also have to be eating food that contains gluten to get celiac disease. Researchers do not know exactly what triggers celiac disease in people at risk who eat gluten over a long period of time. Sometimes the disease runs in families. About 10 to 20 percent of close relatives of people with celiac disease also are affected.³

Your chances of developing celiac disease increase when you have changes in your genes, or variants. Certain gene variants and other factors, such as things in your environment, can lead to celiac disease.

References

Diagnosis

How do doctors diagnose celiac disease?

Celiac disease can be hard to diagnose because some of the symptoms are like symptoms of other diseases, such as irritable bowel syndrome (IBS) and lactose intolerance. Your doctor may diagnose celiac disease with a medical and family history, physical exam, and tests. Tests may include blood tests, genetic tests, and biopsy.

Medical and family history

Your doctor will ask you for information about your family’s health—specifically, if anyone in your family has a history of celiac disease.

Physical exam

During a physical exam, a doctor most often

• checks your body for a rash or malnutrition, a condition that arises when you don’t get enough vitamins, minerals, and other nutrients you need to be healthy
• listens to sounds in your abdomen using a stethoscope
• taps on your abdomen to check for pain and fullness or swelling

Dental exam

For some people, a dental visit can be the first step toward discovering celiac disease. Dental enamel defects, such as white, yellow, or brown spots on the teeth, are a pretty common problem in people with celiac disease, especially children. These defects can help dentists and other health care professionals identify celiac disease.

What tests do doctors use to diagnose celiac disease?

Blood tests

A health care professional may take a blood sample from you and send the sample to a lab to test for antibodies common in celiac disease. If blood test results are negative and your doctor still suspects celiac disease, he or she may order more blood tests.

Genetic tests

If a biopsy and other blood tests do not clearly confirm celiac disease, your doctor may order genetic blood tests to check for certain gene changes, or variants.⁴ You are very unlikely to have celiac disease if these gene variants are not present. Having these variants alone is not enough to diagnose celiac disease because they also are common in people without the disease. In fact, most people with these genes will never get celiac disease.

Intestinal biopsy

If blood tests suggest you have celiac disease, your doctor will perform a biopsy to be sure. During a biopsy, the doctor takes a small piece of tissue from your small intestine during a procedure called an upper GI endoscopy.

Skin biopsy

If a doctor suspects you have dermatitis herpetiformis, he or she will perform a skin biopsy. For a skin biopsy, the doctor removes tiny pieces of skin tissue to examine with a microscope.

A doctor examines the skin tissue and checks the tissue for antibodies common in celiac disease. If the skin tissue has the antibodies, a doctor will perform blood tests to confirm celiac disease. If the skin biopsy and blood tests both suggest celiac disease, you may not need an intestinal biopsy.

Do doctors screen for celiac disease?

Screening is testing for diseases when you have no symptoms. Doctors in the United States do not routinely screen people for celiac disease. However, blood relatives of people with celiac disease and those with type 1 diabetes should talk with their doctor about their chances of getting the disease.

Many researchers recommend routine screening of all family members, such as parents and siblings, for celiac disease.⁵ However, routine genetic screening for celiac disease is not usually helpful when diagnosing the disease.

References

Treatment

How do doctors treat celiac disease?

A gluten-free diet

Doctors treat celiac disease with a gluten-free diet. Gluten is a protein found naturally in wheat, barley, and rye that triggers a reaction if you have celiac disease. Symptoms greatly improve for most people with celiac disease who stick to a gluten-free diet. In recent years, grocery stores and restaurants have added many more gluten-free foods and products, making it easier to stay gluten free.

Your doctor may refer you to a dietitian who specializes in treating people with celiac disease. The dietitian will teach you how to avoid gluten while following a healthy diet. He or she will help you

• check food and product labels for gluten
• design everyday meal plans
• make healthy choices about the types of foods to eat

For most people, following a gluten-free diet will heal damage in the small intestine and prevent more damage. You may see symptoms improve within days to weeks of starting the diet. The small intestine usually heals in 3 to 6 months in children. Complete healing can take several years in adults. Once the intestine heals, the villi, which were damaged by the disease, regrow and will absorb nutrients from food into the bloodstream normally.

Gluten-free diet and dermatitis herpetiformis

If you have dermatitis herpetiformis—an itchy, blistering skin rash—skin symptoms generally respond to a gluten-free diet. However, skin symptoms may return if you add gluten back into your diet. Medicines such as dapsone, taken by mouth, can control the skin symptoms. People who take dapsone need to have regular blood tests to check for side effects from the medicine.

Dapsone does not treat intestinal symptoms or damage, which is why you should stay on a gluten-free diet if you have the rash. Even when you follow a gluten-free diet, the rash may take months or even years to fully heal—and often comes back over the years.

Avoiding medicines and nonfood products that may contain gluten

In addition to prescribing a gluten-free diet, your doctor will want you to avoid all hidden sources of gluten.  If you have celiac disease, ask a pharmacist about ingredients in

• herbal and nutritional supplements
• prescription and over-the-counter medicines
• vitamin and mineral supplements

You also could take in or transfer from your hands to your mouth other products that contain gluten without knowing it. Products that may contain gluten include

• children’s modeling dough, such as Play-Doh
• cosmetics
• lipstick, lip gloss, and lip balm
• skin and hair products
• toothpaste and mouthwash
• communion wafers

Medications are rare sources of gluten. Even if gluten is present in a medicine, it is likely to be in such small quantities that it would not cause any symptoms.

Reading product labels can sometimes help you avoid gluten. Some product makers label their products as being gluten-free. If a product label doesn’t list the product’s ingredients, ask the maker of the product for an ingredients list.

What if changing to a gluten-free diet isn't working?

If you don’t improve after starting a gluten-free diet, you may still be eating or using small amounts of gluten. You probably will start responding to the gluten-free diet once you find and cut out all hidden sources of gluten. Hidden sources of gluten include additives made with wheat, such as

• modified food starch
• malt flavoring
• preservatives
• stabilizers

If you still have symptoms even after changing your diet, you may have other conditions or disorders that are more common with celiac disease, such as irritable bowel syndrome (IBS), lactose intolerance, microscopic colitis, dysfunction of the pancreas, and small intestinal bacterial overgrowth.

Eating, Diet, & Nutrition

What should I avoid eating if I have celiac disease?

Avoiding foods with gluten, a protein found naturally in wheat, rye, and barley, is critical in treating celiac disease. Removing gluten from your diet will improve symptoms, heal damage to your small intestine, and prevent further damage over time. While you may need to avoid certain foods, the good news is that many healthy, gluten-free foods and products are available.

You should avoid all products that contain gluten, such as most cereal, grains, and pasta, and many processed foods. Be sure to always read food ingredient lists carefully to make sure the food you want to eat doesn’t have gluten. In addition, discuss gluten-free food choices with a dietitian or health care professional who specializes in celiac disease.

What should I eat if I have celiac disease?

Foods such as meat, fish, fruits, vegetables, rice, and potatoes without additives or seasonings do not contain gluten and are part of a well-balanced diet. You can eat gluten-free types of bread, pasta, and other foods that are now easier to find in stores, restaurants, and at special food companies. You also can eat potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour.

In the past, doctors and dietitians advised against eating oats if you have celiac disease. Evidence suggests that most people with the disease can safely eat moderate amounts of oats, as long as they did not come in contact with wheat gluten during processing. You should talk with your health care team about whether to include oats in your diet.

When shopping and eating out, remember to

• read food labels—especially on canned, frozen, and processed foods—for ingredients that contain gluten
• identify foods labelled “gluten-free;” by law, these foods must contain less than 20 parts per million, well below the threshold to cause problems in the great majority of patients with celiac disease
• ask restaurant servers and chefs about how they prepare the food and what is in it
• find out whether a gluten-free menu is available
• ask a dinner or party host about gluten-free options before attending a social gathering

Foods labeled gluten-free tend to cost more than the same foods that have gluten. You may find that naturally gluten-free foods are less expensive. With practice, looking for gluten can become second nature.

If you have just been diagnosed with celiac disease, you and your family members may find support groups helpful as you adjust to a new approach to eating.

Is a gluten-free diet safe if I don't have celiac disease?

In recent years, more people without celiac disease have adopted a gluten-free diet, believing that avoiding gluten is healthier or could help them lose weight. No current data suggests that the general public should maintain a gluten-free diet for weight loss or better health. ^{6, 7}

A gluten-free diet isn’t always a healthy diet. For instance, a gluten-free diet may not provide enough of the nutrients, vitamins, and minerals the body needs, such as fiber, iron, and calcium. Some gluten-free products can be high in calories and sugar.

If you think you might have celiac disease, don’t start avoiding gluten without first speaking with your doctor. If your doctor diagnoses you with celiac disease, he or she will put you on a gluten-free diet.

Gluten-free food labeling requirements

The U.S. Food and Drug Administration (FDA) published a rule defining what “gluten-free” means on food labels. The "gluten-free" for food labeling rule requires that any food with the terms “gluten-free,” “no gluten,” "free of gluten,” and “without gluten” on the label must meet all of the definition’s requirements.

While the FDA rule does not apply to foods regulated by the U.S. Department of Agriculture, including meat and egg products, it is often still observed.

References

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.?

Definition & Facts

What is chronic diarrhea in children?

Chronic diarrhea is passing loose, watery stools three or more times a day for at least 4 weeks. Children with chronic diarrhea may have loose, watery stools continually, or their diarrhea may come and go. Chronic diarrhea can affect children of any age.

Diarrhea that lasts only a short time is called acute diarrhea. Acute diarrhea, a common problem in children, usually lasts a few days and goes away on its own.

What are the complications of chronic diarrhea in children?

Malabsorption

Certain diseases and conditions that cause chronic diarrhea may cause malabsorption—a condition in which a child’s body can’t absorb nutrients from foods, resulting in shortages of protein, calories, and vitamins. See a list of malabsorption symptoms.

A child who does not absorb enough nutrients from the food he or she eats may become malnourished. Malnourishment during the years when nutrition is important to a child’s normal growth and development can result in health problems.

Dehydration

Chronic diarrhea may lead to dehydration. With diarrhea, especially acute diarrhea, a child’s body loses more fluid and electrolytes in loose stools than solid stools. See a list of dehydration symptoms.

Symptoms & Causes

What are the symptoms of chronic diarrhea in children?

The main symptom of chronic diarrhea in children is passing loose, watery stools three or more times a day for at least 4 weeks.

Depending on the cause, children with chronic diarrhea may also have one or more of the following symptoms:

• bloody stools
• chills
• fever
• loss of control of bowel movements
• nausea or vomiting
• pain or cramping in the abdomen

Chronic diarrhea may cause malabsorption and may lead to dehydration.

What are the symptoms of malabsorption and dehydration in children?

Malabsorption

Symptoms of malabsorption may include

• bloating
• changes in appetite
• gas
• loose, greasy, foul-smelling bowel movements
• weight loss or poor weight gain

Dehydration

Symptoms of dehydration may include

• thirst
• urinating less than usual, or no wet diapers for 3 hours or more
• lack of energy
• dry mouth
• no tears when crying
• decreased skin turgor, meaning that when your child’s skin is pinched and released, the skin does not flatten back to normal right away
• sunken eyes, cheeks, or soft spot in the skull

What causes chronic diarrhea in children?

Common diseases and disorders that cause chronic diarrhea in children include

• infections of the digestive tract
• celiac disease
• functional gastrointestinal (GI) disorders
• food allergies and intolerances
• inflammatory bowel disease
• small intestinal bacterial overgrowth

Infections of the digestive tract

Infections from harmful viruses, bacteria, or parasites sometimes lead to chronic diarrhea. Children may become infected through contaminated water, beverages, or food; or through person-to-person contact. After an infection, some children have problems digesting carbohydrates such as lactose or proteins in foods such as milk, milk products, or soy. These problems can cause prolonged diarrhea—often for up to 6 weeks—after an infection. Also, some bacterial and parasitic infections that cause diarrhea do not go away quickly without treatment.

Read more about infections that cause diarrhea, such as foodborne illnesses and viral gastroenteritis.

Celiac disease

Celiac disease is a digestive disorder that damages the small intestine. The disease is triggered by eating foods containing gluten. Gluten is a protein found naturally in wheat, barley, and rye. Gluten is common in foods such as bread, pasta, cookies, and cakes. Celiac disease can cause chronic diarrhea in children of any age.

Functional GI disorders

In functional GI disorders, symptoms are caused by changes in how the digestive tract works. Children with a functional GI disorder have frequent symptoms, yet the digestive tract does not become damaged. Functional GI disorders are not diseases; they are groups of symptoms that occur together.

Two functional GI disorders that cause chronic diarrhea in children are toddler’s diarrhea and irritable bowel syndrome (IBS).

Toddler’s diarrhea
Toddler’s diarrhea—also called functional diarrhea, or chronic nonspecific diarrhea of childhood—is a common cause of chronic diarrhea in toddlers (ages 1 to 3), and preschool-age children (ages 3 to 5). Children with toddler’s diarrhea pass four or more watery or loose stools a day and do not have any other symptoms. They typically are growing well, gaining weight, and are healthy.

Toddler’s diarrhea develops between the ages of 6 months and 3 years, and it usually goes away on its own by the time children begin grade school. Researchers think that drinking too many sugar-sweetened beverages, especially those high in high-fructose corn syrup and sorbitol, may cause toddler’s diarrhea.

IBS
The most common symptoms of IBS are abdominal pain, discomfort, or cramping; along with diarrhea, constipation, or both. The pain or discomfort of IBS typically gets better with the passage of stool or gas. IBS does not cause symptoms such as weight loss, vomiting, or blood in the stool.

IBS is a common cause of chronic diarrhea in grade school-age children and adolescents. Doctors rarely diagnose IBS in younger children because younger children are not able to report symptoms of IBS such as abdominal pain or discomfort.

Food allergies and intolerances

Food allergies, lactose intolerance, fructose intolerance, and sucrose intolerance are common causes of chronic diarrhea.

Food allergies
Milk, milk products, and soy allergies are the most common food allergies that affect the digestive tract in children. Food allergies usually appear in the first year of life. Many children outgrow allergies to milk, milk-products, and soy by age 3. Allergies to other foods such as cereal grains, eggs, and seafood may also affect the digestive tract in children.

Lactose intolerance
Lactose intolerance is a common condition that may cause diarrhea after eating foods or drinking beverages that contain milk or milk products. Low levels of lactase—the enzyme that helps digest lactose—or lactase deficiency, and malabsorption of lactose cause lactose intolerance.

The most common type of lactase deficiency in children develops over time, beginning after about age 2, when a child’s body begins to produce less lactase. Children who have lactase deficiency may not experience symptoms of lactose intolerance until they become older teenagers or adults.

Infants—newborns to age 1—rarely have lactose intolerance at birth. However, premature infants may experience lactose intolerance for a short time after birth. People sometimes mistake milk allergy, which can cause diarrhea in infants, for lactose intolerance.

Fructose intolerance
Fructose intolerance is a condition that may cause diarrhea after eating foods or drinking beverages that contain fructose, a sugar found in fruits, fruit juices, and honey. Fructose is added to many foods and soft drinks as a sweetener called high-fructose corn syrup. Fructose malabsorption causes fructose intolerance. The amount of fructose that a child’s body can absorb varies. A child’s ability to absorb fructose increases with age. Some children may be able to tolerate more fructose as they get older.

Sucrose intolerance
Sucrose intolerance is a condition that may cause diarrhea after eating foods or drinking beverages that contain sucrose, also known as table sugar or white sugar. Sucrose malabsorption causes sucrose intolerance. Children who are sucrose intolerant lack the enzyme that helps digest sucrose. Most children with sucrose intolerance are better able to tolerate sucrose as they get older.

Inflammatory bowel disease (IBD)

The two main types of IBD are Crohn’s disease and ulcerative colitis. These disorders can affect children at any age. However, they commonly begin in the grade school years or in adolescence.

Small intestinal bacterial overgrowth (SIBO)

SIBO is an increase in the number of bacteria or a change in the type of bacteria in your small intestine. SIBO is often related to diseases that damage the digestive system such as Crohn’s disease.

Diagnosis

How do doctors find the cause of chronic diarrhea in children?

To find the cause of a child’s chronic diarrhea, doctors may use information from the child’s medical and family history, a physical exam, or tests.

Medical and family history

Your child’s doctor will ask you for information about your child’s symptoms, such as

• how long your child has had diarrhea
• how much stool your child passes
• how often your child has diarrhea
• how your child’s stool looks, such as color and consistency
• whether your child has other symptoms along with diarrhea

The doctor will ask about the foods your child eats and beverages he or she drinks. The doctor may recommend keeping a diary of what your child eats and drinks and his or her bowel habits.

Your child’s doctor may also ask about family medical history. Some of the conditions that cause chronic diarrhea, such as Crohn’s disease and ulcerative colitis, run in families.

Physical exam

During a physical exam, a doctor typically

• checks blood pressure and pulse
• checks for symptoms of dehydration and malabsorption
• listens to sounds in your child’s abdomen using a stethoscope
• taps on your child’s abdomen to check for pain or tenderness

What tests do doctors use to find the cause of chronic diarrhea in children?

Doctors may use the following tests to help find the cause of a child’s chronic diarrhea:

Stool test

Stool tests can show the presence of blood and signs of infection, food allergies, and digestive tract problems, such as malabsorption of certain sugars, proteins, or nutrients. A health care professional will give you a container for catching and storing a sample of your child’s stool, along with instructions on where to send or take the sample for testing. A doctor may also do a digital rectal exam to check for blood in your child’s stool.

Blood tests

A health care professional may take a sample of your child’s blood to test for signs of certain diseases or disorders that can cause chronic diarrhea, such as infections or celiac disease.

Hydrogen breath tests

This test measures the amount of hydrogen in a child’s breath. Normally, little hydrogen is found in your child’s breath. However, bacteria break down sugars—such as lactose, fructose, and sucrose—that are not digested by the small intestine and produce high levels of hydrogen. By measuring the amount of hydrogen in your child’s breath, a doctor can diagnose

• lactose intolerance
• fructose intolerance
• sucrose intolerance
• small intestinal bacterial overgrowth (SIBO)

For a lactose intolerance test, your child will drink a beverage that contains a known amount of lactose. For a fructose intolerance test, your child will drink a beverage that contains a known amount of fructose For a sucrose intolerance test, your child will drink a beverage that contains a known amount of sucrose. For a SIBO test, your child will drink a beverage that contains a known amount of sugar. Your child will then breathe into a balloon-type container that measures hydrogen. If the hydrogen level is high, your doctor will diagnose one of these disorders.

Fasting tests

To find out if a food allergy or intolerance is causing your child’s chronic diarrhea, the doctor may recommend that your child avoid foods with lactose, carbohydrates, wheat, or other ingredients to see if a change in diet reduces or stops the diarrhea.

Endoscopy

Your doctor may use endoscopy to look inside your child’s body to help find the cause of his or her chronic diarrhea. Endoscopic procedures include

• colonoscopy
• flexible sigmoidoscopy
• upper gastrointestinal (GI) endoscopy

Treatment

How do doctors treat chronic diarrhea in children?

How doctors treat chronic diarrhea in children depends on the cause. Doctors may be able to reduce or stop chronic diarrhea by treating the cause.

Infections of the digestive tract

Your child’s doctor may prescribe antibiotics to treat bacterial infections and medicines that target parasites to treat parasitic infections. If your child has long-lasting problems digesting certain carbohydrates or proteins after an infection, a doctor may recommend changes in the foods your child eats.

Your child’s doctor may prescribe antibiotics to treat your child’s small intestinal bacterial overgrowth (SIBO) and may recommend changes in what your child eats.

Functional GI disorders

Toddler’s diarrhea
For toddler’s diarrhea, treatment is usually not needed. Most children outgrow toddler’s diarrhea by the time they start school (around age 5). In many children, reducing sugar-sweetened beverages and increasing the amount of fiber and fat in the diet may improve symptoms of toddler’s diarrhea.

Irritable bowel syndrome
A doctor may treat your child’s irritable bowel syndrome with changes in what your child eats and medicines.

Food allergies and intolerances

Food allergies
If your child has a food allergy, his or her doctor will recommend avoiding foods that trigger the allergy. Keeping a diary of what your child eats and drinks and his or her bowel habits will help your child’s doctor find out what foods trigger the allergy.

Celiac disease
If your child has celiac disease, his or her doctor will recommend avoiding all foods and products that contain gluten.

Lactose intolerance
If your child is lactose intolerant, his or her doctor will recommend reducing or avoiding foods and beverages that contain milk or milk products. Most children with lactose intolerance can tolerate some amount of lactose in what they eat or drink. The amount of change needed in what a child eats or drinks depends on how much lactose a child can consume without symptoms. Your child’s doctor may recommend dietary supplements that contain lactase, the enzyme that helps digest lactose. Your child’s doctor may also recommend calcium supplements.

Fructose intolerance
If your child is fructose intolerant, his or her doctor will recommend reducing or avoiding foods and beverages that contain fructose.

Sucrose intolerance
If your child is sucrose intolerant, his or her doctor will recommend reducing or avoiding foods and beverages that contain sucrose.

Inflammatory bowel disease

A doctor may use medicines, surgery, and changes in what your child eats to treat inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis.

Eating, Diet, & Nutrition

How can what a child eats help prevent or treat chronic diarrhea?

Eating, diet, and nutrition play a major role in treating chronic diarrhea in children. Depending on the cause, changing what your child eats can reduce or stop chronic diarrhea. Changing what your child eats may also help manage symptoms of some of the causes of chronic diarrhea. Talk with your child’s doctor before changing what he or she eats. Your child’s doctor or a dietitian can recommend a healthy eating plan that is right for your child.

What should a child with chronic diarrhea eat?

A child with chronic diarrhea should eat foods that may improve symptoms and ensure good nutrition for normal growth and development.

Children whose chronic diarrhea was caused by an infection of the digestive tract should eat the foods they normally eat. If your child has long-lasting problems digesting certain carbohydrates or proteins after an infection, talk with your child’s doctor about what foods your child should eat.

Increasing the amount of fat and fiber your child eats may improve symptoms of toddler’s diarrhea.

What should a child with chronic diarrhea avoid eating?

What foods your child should avoid eating depends on the cause of chronic diarrhea. In general, your child should avoid foods that make symptoms worse.

To find out if certain foods trigger your child’s symptoms, keep a diary and track

• what your child eats each day
• what symptoms your child has
• when the symptoms occur
• what foods make the symptoms worse

Take your notes to your child’s doctor and talk about which foods seem to make your child’s symptoms worse. Your child may need to avoid these foods or eat less of them.

More information on what your child should eat or avoid eating if he or she has chronic diarrhea caused by certain digestive tract problems is available in these NIDDK health topics:

• Celiac Disease
• Crohn’s Disease
• Irritable Bowel Syndrome (IBS) in Children
• Lactose Intolerance
• Ulcerative Colitis

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many diseases and conditions.

What are clinical trials and what role do children play in research?

Clinical trials are research studies involving people of all ages. Clinical trials look at safe and effective new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving quality of life. Research involving children helps scientists

• identify care that is best for a child
• find the best dose of medicines
• find treatments for conditions that only affect children
• treat conditions that behave differently in children
• understand how treatment affects a growing child’s body

Find out more about clinical trials and children.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.??

Definition & Facts

What are colon polyps?

Colon polyps are growths on the lining of your colon and rectum. You can have more than one colon polyp.

Are colon polyps cancerous?

Colon and rectal cancer—also called colorectal cancer—most often begins as polyps. Most polyps are not cancerous, but some may turn into cancer over time. Removing polyps can help prevent colorectal cancer. Colorectal cancer is the second leading cause of cancer death in the United States.¹

How common are colon polyps?

Colon polyps are common in American adults. Anywhere between 15 and 40 percent of adults may have colon polyps. Colon polyps are more common in men and older adults.²

Who is more likely to develop colon polyps?

Although anyone can develop colon polyps, you may have a greater chance of developing them if you

• are over age 50
• have someone in your family who has had polyps or colorectal cancer
• have inflammatory bowel disease such as ulcerative colitis or Crohn’s disease
• have obesity³
• smoke cigarettes³

When should I start colon polyp screening?

Screening is testing for diseases when you have no symptoms. Finding and removing polyps can help prevent colorectal cancer. Your doctor will recommend screening for colorectal cancer starting at age 50 if you don’t have health problems or other factors that make you more likely to develop colorectal cancer.⁴

If you are at higher risk for colorectal cancer, your doctor may recommend screening at a younger age. You also may need to be tested more often.

If you are older than age 75, talk with your doctor about whether you should be screened. For more information, read the current colorectal cancer screening guidelines from the U.S. Preventive Services Task Force.

References

Symptoms & Causes

What are the symptoms of colon polyps?

Most people with colon polyps don’t have symptoms. You can’t tell that you have polyps because you feel well. When colon polyps do cause symptoms, you may

• have bleeding from your rectum. You might notice blood on your underwear or on toilet paper after you’ve had a bowel movement.
• have blood in your stool. Blood can make stool look black or can show up as red streaks in your stool.
• feel tired because you have anemia and not enough iron in your body. Bleeding from colon polyps can lead to anemia and a lack of iron.

Many other health problems can also cause these symptoms. However, if you have bleeding from your rectum or blood in your stool, contact your doctor right away.

What causes colon polyps?

Experts aren’t sure what causes colon polyps. However, research suggests that certain factors, such as age and family history, can raise your chances of developing colon polyps. Learn who is more likely to develop colon polyps.

Diagnosis

How do doctors diagnose colon polyps?

Doctors can find colon polyps only by using certain tests or procedures, such as a colonoscopy or imaging study. Your doctor may first take a medical and family history and perform a physical exam to help decide which test or procedure is best for you.

For example, your doctor may ask if you have any symptoms. He or she may also ask if you have a family history of colon polyps or colorectal cancer. After taking a medical and family history, your doctor may perform a physical exam.

Tests and procedures

• Flexible sigmoidoscopy. For a flexible sigmoidoscopy, a trained medical professional uses a sigmoidoscope—a flexible, narrow tube with a light and tiny camera on one end—to look inside your rectum and lower colon. Flexible sigmoidoscopy can show irritated or swollen tissue, ulcers, polyps, and cancer.
• Colonoscopy. During a colonoscopy, a trained medical professional uses a long, flexible, narrow tube with a light and tiny camera on one end, called a colonoscope, to look inside your rectum and colon. Colonoscopy can show irritated and swollen tissue, ulcers, polyps, and cancer.
• Virtual colonoscopy. Virtual colonoscopy uses x-rays and a computer to create images of your rectum and colon from outside the body. Virtual colonoscopy can show ulcers, polyps, and cancer. Doctors can’t remove polyps during virtual colonoscopy.
• Lower gastrointestinal series. For a lower gastrointestinal (GI) series, a doctor uses x-rays and a chalky liquid called barium to view your large intestine. The barium will make your large intestine easier to see on an x-ray. A lower GI series is also called a barium enema.

Treatment

How do doctors treat colon polyps?

Doctors treat colon polyps by removing them.

In most cases, doctors use special tools during a colonoscopy or flexible sigmoidoscopy to remove colon polyps. After doctors remove the polyp, they send it for testing to check for cancer. A pathologist will review the test results and send a report to your doctor. Doctors can remove almost all polyps without surgery.

If you have colon polyps, your doctor will ask you to get tested regularly in the future because you have a higher chance of developing more polyps.

Seek Care Right Away

Call your doctor right away if you have any of the following symptoms after he or she removes a colon polyp:

• severe pain in your abdomen
• fever
• bloody bowel movements that do not get better
• bleeding from your anus that does not stop
• dizziness
• weakness

How can I prevent colon polyps?

Researchers don’t know a sure way to prevent colon polyps. However, you can take steps to lower your chances of developing colon polyps.

Eating, diet, and nutrition

Eating, diet, and nutrition changes—such as eating less red meat and more fruits and vegetables—may lower your chances of developing colon polyps.

Healthy lifestyle choices

You can make the following healthy lifestyle choices to help lower your chances of developing colon polyps:

• get regular physical activity (PDF, 1.07 MB)
• don’t smoke cigarettes, and if you do smoke, quit
• avoid drinking alcohol
• lose weight if you’re overweight

Aspirin

Taking a low dose of aspirin every day for a long period of time may help prevent polyps from developing into colorectal cancer in some people.⁵ However, taking aspirin daily may cause side effects such as bleeding in your stomach or intestines. Talk with your doctor before you start taking aspirin daily.

References

Eating, Diet, & Nutrition

What type of eating plan is best to prevent colon polyps?

Research suggests that making the following changes may have health benefits and may lower your chances of developing colon polyps:

• eating more fruits, vegetables, and other foods with fiber, such as beans and bran cereal.
• losing weight if you’re overweight and not gaining weight if you’re already at a healthy weight

Foods to limit

Research suggests that eating less of the following foods may have health benefits and may lower your chances of developing polyps:

• fatty foods, such as fried foods
• red meat, such as beef and pork
• processed meat, such as bacon, sausage, hot dogs, and lunch meats

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Definition & Facts

What is Constipation?

Constipation is a condition in which you typically have:

• fewer than three bowel movements a week
• bowel movements with stools that are hard, dry, and small, making them painful or difficult to pass

Some people think they are constipated if they don’t have a bowel movement every day. However, people can have different bowel movement patterns. Some people may have three bowel movements a day. Other people may only have three bowel movements a week.

Constipation most often lasts for only a short time and is not dangerous. You can take steps to prevent or relieve constipation.

How common is constipation?

Constipation is one of the most common gastrointestinal (GI) problems, affecting about 42 million people in the United States.¹

Who is more likely to become constipated?

Constipation is common among all ages and populations in the United States, yet certain people are more likely to become constipated, including

• women, especially during pregnancy or after giving birth
• older adults
• non-Caucasians
• people with lower incomes
• people who just had surgery
• people taking medicines to treat depression or to relieve pain from things such as a broken bone, a pulled tooth, or back pain

What are the complications of constipation?

Chronic, or long-lasting, constipation can lead to health problems such as hemorrhoids, anal fissures, rectal prolapse, or fecal impaction.

Hemorrhoids

Hemorrhoids are swollen and inflamed veins around your anus or in your lower rectum. You can develop hemorrhoids if you strain to have a bowel movement. If you have hemorrhoids, you may have bleeding in your rectum. You have bleeding in the rectum when you see bright red blood in your stool, on toilet paper, or in the toilet after a bowel movement.

Anal fissures

Anal fissures are small tears in your anus that may cause itching, pain, or bleeding.

Rectal prolapse

Rectal prolapse happens when your rectum slips so that it sticks out of your anus. Rectal prolapse can happen if you strain during bowel movements, among other reasons. Rectal prolapse may cause mucus to leak from your anus. Rectal prolapse is most common in older adults with a history of constipation, and is also more common in women than men, especially postmenopausal women.²

Fecal impaction

Fecal impaction happens when hard stool packs your intestine and rectum so tightly that the normal pushing action of your colon is not enough to push the stool out. Fecal impaction occurs most often in children and older adults.

References

Symptoms & Causes

What are the symptoms of constipation?

The most common symptoms of constipation are

• fewer-than-normal bowel movements
• stool that is difficult or painful to pass
• pain or bloating in your abdomen

What causes constipation?

Constipation can happen for many reasons, and constipation may have more than one cause at a time. Among the most common causes of constipation are

• slow movement of stool through the colon
• delayed emptying of the colon from pelvic disorders, especially in women
• a form of irritable bowel syndrome (IBS) that has symptoms of both IBS and constipation, also called IBS with constipation, or IBS-C.

Constipation may become worse because of the following factors:

Diets low in fiber

Fiber helps stool stay soft. Drink liquids to help fiber keep stool soft.

Older adults commonly have constipation because of limited dietary fiber, lack of physical activity, and medications.

Lack of physical activity

If you don’t exercise or move around regularly you may get constipated. For example, people may be less active because they

• have other health problems
• sit all day and don’t exercise regularly
• have to stay in bed most of the time because of an illness or accident

Medicines

Some medicines that doctors prescribe to treat other health problems can cause constipation. Medicines that can cause constipation include

• antacids—used to neutralize stomach acid—that contain aluminum and calcium
• anticholinergics—used to treat muscle spasms in the intestines
• anticonvulsants—used to decrease abnormal electrical activity in the brain to prevent seizures
• antispasmodics—used to reduce muscle spasms in the intestines
• calcium channel blockers—used to treat high blood pressure and heart disease
• diuretics—used to help the kidneys remove fluid from the blood
• iron supplements—used to build up higher iron levels in the blood
• medicines used to treat Parkinson’s disease
• narcotics—used to treat severe pain
• some medicines used to treat depression

Life changes or daily routine changes

Constipation can happen when your life or daily routine changes. For example, your bowel movements can change

• when you travel
• if you become pregnant
• as you get older

Ignoring the urge to have a bowel movement

If you ignore the urge to have a bowel movement, over time, you may stop feeling the need to have one. You may delay having a bowel movement because you do not want to use toilets outside of your home, do not have access to a toilet, or may feel you are too busy. This habit can lead to constipation.

Certain health problems

Some health problems can make stool move more slowly through your colon, rectum, or anus, causing constipation. These health problems include

• disorders that affect your brain and spine, such as Parkinson’s disease
• spinal cord or brain injuries
• diabetes
• hypothyroidism

Gastrointestinal (GI) tract problems

Problems in your GI tract that compress or narrow your colon and rectum can cause constipation. These problems include

• tumors
• inflammation, or swelling, such as diverticulitis or inflammatory bowel disease

Functional GI disorders

Functional GI disorders happen when your GI tract behaves in an abnormal way, yet without evidence of damage due to a disease. For example, IBS is a common functional GI disorder, and many people with IBS can have IBS with constipation.

Diagnosis

How do doctors diagnose constipation?

Doctors diagnose constipation by

• taking a medical history
• performing a physical exam
• performing diagnostic tests, such as a blood test

Medical history

The medical history will include questions about your constipation, such as

• how often you have a bowel movement
• how long you’ve had symptoms
• what your stools look like and whether you have blood in your stool
• your eating habits
• your level of physical activity
• the medicines you take

Physical exam

The physical exam may include a digital rectal exam. During a digital rectal exam, your doctor will have you bend over a table or lie on your side while holding your knees close to your chest. After putting on a glove, the doctor slides a lubricated finger into your anus to check for tenderness, blockage, or blood, and will ask you to squeeze your anal muscles.

Diagnostic tests

The tests your doctor may order for constipation depend on

• how long you’ve been constipated
• how severe your constipation is
• your age
• whether you’ve had blood in your stool, recent changes in your bowel movement pattern, or weight loss

What tests do doctors use to diagnose constipation?

A doctor may use one or more of the following tests to diagnose constipation.

Blood test

A health care professional may take a blood sample from you to test for certain conditions that can cause constipation, such as anemia or hypothyroidism.

Flexible sigmoidoscopy or colonoscopy

Although the tests are similar, doctors use a colonoscopy to view your rectum and entire colon, while they use a flexible sigmoidoscopy to view just your rectum and lower colon. For either procedure, you’ll lie on a table while your doctor inserts a flexible tube into your anus. A small camera on the tube sends a video image of your bowel lining to a monitor. The procedures can show signs of problems in your lower gastrointestinal (GI) tract.

During these two tests, your doctor may also perform a biopsy. The doctor may take several small pieces of tissue from different areas of your bowel lining. A pathologist will look at the tissue using a microscope. You won’t feel the biopsy.

Colorectal transit studies

Colorectal transit studies are tests that show how well stool moves through your colon.

• Radiopaque markers. For this test, you swallow capsules with small radioactive markers that doctors can see on an x-ray. Three to 7 days after you swallow the capsules, a health care professional will take several x-rays of your abdomen that track the movement of the markers through your colon. You eat a high-fiber diet to help stool and the markers move through your GI tract. The markers pass when you have a bowel movement.
• Scintigraphy. For this test, you eat a meal that contains radioactive substances. The dose of radioactive substances is small, so scintigraphy isn’t likely to damage your cells. A health care professional will use computers and special cameras placed outside your body over your abdomen to create pictures of the radioactive substances as they move through your intestines.

Anorectal function tests

Anorectal function tests can show problems in your anus or rectum.

• Anal manometry uses pressure sensors and a balloon that a health care professional inflates inside your rectum to check how sensitive your rectum is and how well it works. Anal manometry also checks the tightness of the muscles around your anus and how well they respond to nerve signals. For this test, a health care professional puts a thin tube that has pressure sensors and a balloon on its tip into your anus. Once the balloon reaches your rectum and the pressure sensors are in your anus, the health care professional slowly pulls the tube out to measure muscle tone and contractions. The test takes about 30 minutes.

• Balloon expulsion tests consist of a health care professional filling a balloon with different amounts of water after he or she places it into your rectum. The health care professional will give you a stopwatch and instructions to go to the restroom and measure the amount of time it takes you to push the balloon out. If you can’t push out a balloon filled with less than 150 milliliters of water, or it takes longer than 1 minute to push the balloon out, you may have a problem pushing out stool.

Lower GI series

A lower GI series is an x-ray exam that doctors use to look at your large intestine. A health care professional will perform the procedure at a hospital or an outpatient center. A health care professional may give you written instructions about what to do at home before the procedure, called a bowel prep.

The health care professional may ask you to follow a clear liquid diet for 1 to 3 days before the procedure. You may also need to use a laxative or an enema before the procedure. Laxatives and enemas cause diarrhea, so you should stay close to a bathroom during the bowel prep.

For the procedure, you’ll lie on a table while your doctor inserts a flexible tube into your anus. Your doctor then fills your large intestine with barium, which makes signs of problems that may be causing constipation show up more clearly on x-rays.

Traces of barium in your large intestine can cause white or light-colored stools for several days. Enemas and repeated bowel movements may cause anal soreness. A health care professional will give you specific instructions about eating and drinking after the procedure.

Defecography

Defecography is a video x-ray of the area around your anus and rectum. The procedure may show problems with how you have a bowel movement.

During the test, a health care professional fills your rectum with a soft paste that shows up on x-rays and feels like stool. You sit on a toilet next to an x-ray machine. The health care professional will ask you to first pull in and squeeze muscles to keep stool in. Then, he or she will tell you to strain to have a bowel movement. The health care professional looks for problems as you push the paste out.

Magnetic resonance imaging (MRI)

MRI machines use radio waves and magnets to produce detailed pictures of your body’s internal organs and soft tissues without using x-rays.

Patients don’t need anesthesia, although a health care professional may give light sedation, taken by mouth, to children and people with a fear of small spaces. A health care professional may inject a special dye, called contrast medium, into your body. In most cases, you’ll lie on a table that slides into a tunnel-shaped device. The tunnel may be open ended or closed at one end. A radiologist reviews the images. A doctor can use the MRI images to diagnose health problems that may be causing your constipation.

Computerized tomography (CT) scan

CT scans use x-rays and computer technology to create images. A health care professional may give you a solution to drink and an injection of contrast medium. You’ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. Radiologists review the images. A doctor can use the MRI images to diagnose health problems that may be causing your constipation.

Patients don’t need anesthesia, although health care professionals may give children a sedative to help them fall asleep for the test.

Women of childbearing age should have a pregnancy test before having a CT scan. The radiation from CT scans can be harmful to a developing fetus.

Treatment

How do doctors treat constipation?

Treatment for constipation depends on

• what’s causing your constipation
• how bad your constipation is
• how long you’ve been constipated

Treatment for constipation may include the following:

Changes in eating, diet, and nutrition

Changes in your eating, diet, and nutrition can treat constipation. These changes include

• drinking liquids throughout the day. A health care professional can recommend how much and what kind of liquids you should drink.
• eating more fruits and vegetables.
• eating more fiber.

Read about what you should eat to help prevent and relieve constipation and foods to avoid if you are constipated.

Exercise and lifestyle changes

Exercising every day may help prevent and relieve constipation.

You can also try to have a bowel movement at the same time each day. Picking a specific time of day may help you have a bowel movement regularly. For example, some people find that trying to have a bowel movement 15 to 45 minutes after breakfast helps them have a bowel movement. Eating helps your colon move stool. Make sure you give yourself enough time to have a bowel movement. You should also use the bathroom as soon as you feel the urge to have a bowel movement.

Over-the-counter medicines

Your doctor may suggest using a laxative for a short time if you’re doing all the right things and are still constipated. Your doctor will tell you what type of laxative is best for you. Over-the-counter laxatives come in many forms, including liquid, tablet, capsule, powder, and granules.

If you’re taking an over-the-counter or prescription medicine or supplement that can cause constipation, your doctor may suggest you stop taking it or switch to a different one.

Bulk-forming agents. Bulk-forming agents absorb fluid in your intestines, making your stool bulkier. Bulkier stool helps trigger the bowel to contract and push stool out. Be sure to take bulk-forming agents with water or they can cause an obstruction or a blockage in your bowel. They can also cause bloating and pain in your abdomen. Brand names include

• Citrucel
• FiberCon
• Konsyl
• Metamucil
• Serutan

Osmotic agents. Osmotic agents help stool retain fluid. Stools with more fluid increase your number of bowel movements and soften stool. Older adults and people with heart or kidney failure should be careful when taking osmotic agents. They can cause dehydration or a mineral imbalance. Brand names include

• Cephulac
• Fleet Phospho-Soda
• Milk of Magnesia
• Miralax
• Sorbitol

Stool softeners. Stool softeners help mix fluid into stools to soften them. Doctors recommend stool softeners for people who should avoid straining while having a bowel movement. Doctors often recommend stool softeners after surgery or for women after childbirth. Brand names include

• Colace
• Docusate
• Surfak

Lubricants. Lubricants work by coating the surface of stool, which helps the stool hold in fluid and pass more easily. Lubricants are simple, inexpensive laxatives. Doctors may recommend lubricants for people with anorectal blockage. Brand names include

• Fleet
• Zymenol

If these laxatives don’t work for you, your doctor may recommend other types of laxatives, including

Stimulants. Stimulant laxatives cause the intestines to contract, which moves stool. You should only use stimulants if your constipation is severe or other treatments have not worked. Brand names include

• Correctol
• Dulcolax
• Purge
• Senokot

People should not use stimulant laxatives containing phenolphthalein. Phenolphthalein may increase your chances of cancer. Most laxatives sold in the United States do not contain phenolphthalein. Make sure to check the ingredients on the medicine’s package or bottle.

If you’ve been taking laxatives for a long time and can’t have a bowel movement without taking a laxative, talk with your doctor about how you can slowly stop using them. If you stop taking laxatives, over time, your colon should start moving stool normally.

Prescription medicines

If over-the-counter medicines do not relieve your symptoms, your doctor may prescribe one of the following medicines:

Chloride channel activator. If you have irritable bowel syndrome (IBS) with long-lasting or idiopathic—meaning the cause is not known—constipation, your doctor may prescribe lubiprostone (Amitiza). Lubiprostone is a chloride channel activator available with a prescription. Research has shown lubiprostone to be safe when used for 6 to 12 months. This type of medicine increases fluid in your GI tract, which helps to

• reduce pain or discomfort in your abdomen
• make your stool softer
• reduce your need to strain when having a bowel movement
• increase how often you have bowel movements

Guanylate cyclase-C agonist. If you have IBS with long-lasting or idiopathic constipation, your doctor may prescribe linaclotide (Linzess) to help make your bowel movements regular. Linaclotide is a guanylate cyclase-C agonist that eases pain in your abdomen and speeds up how often you have bowel movements.

Biofeedback

If you have problems with the muscles that control bowel movements, your doctor may recommend biofeedback to retrain your muscles. Biofeedback uses special sensors to measure bodily functions. A video monitor shows the measurements as line graphs, and sounds from the equipment tell you when you’re using the correct muscles. By watching the monitor and listening to the sounds, you learn how to change the muscle function. Practicing at home can improve muscle function. You may have to practice for 3 months before you get all the benefit from the training.

Surgery

You may need surgery to treat an anorectal blockage caused by rectal prolapse if other treatments don’t work. You may need surgery to remove your colon if your colon muscles don’t work correctly. Your doctor can tell you about the benefits and risks of surgery.

How do doctors treat complications of constipation?

Doctors can treat or tell you how to treat complications of constipation. Hemorrhoids, anal fissures, rectal prolapse, and fecal impaction all have different treatments.

Hemorrhoids

You can treat hemorrhoids at home by

• making dietary changes to prevent constipation
• taking warm tub baths
• applying over-the-counter hemorrhoid cream to the area or using suppositories—a medicine you insert into your rectum—before bedtime

Talk with your doctor about hemorrhoids that do not respond to at-home treatments.

Anal fissures

You can treat anal fissures at home by

• making changes in your diet to prevent constipation
• applying over-the-counter hemorrhoid cream to numb the area or relax your muscles
• using stool softeners
• taking warm tub baths

Your doctor may recommend surgery to treat anal fissures that don’t heal with at-home treatments.

Rectal prolapse

Your doctor may be able to treat your rectal prolapse in his or her office by manually pushing the rectum back through your anus. If you have a severe or chronic—long-lasting—rectal prolapse, you may need surgery. The surgery will strengthen and tighten your anal sphincter muscle and repair the prolapsed lining. You can help prevent rectal prolapse caused by constipation by not straining during a bowel movement.

Fecal impaction

You can soften a fecal impaction with mineral oil that you take by mouth or through an enema. After softening the impaction, a health care professional may break up and remove part of the hardened stool by inserting one or two gloved, lubricated fingers into your anus.

Eating, Diet, & Nutrition

How can my diet help prevent and relieve constipation?

You can drink water and other fluids, such as fruit and vegetable juices and clear soups, to help the fiber in your diet work better. This change should make your stools more normal and regular. Ask your doctor about how much you should drink each day based on your health and activity level and where you live.

Depending on their age and sex, adults should get 22 to 34 grams of fiber a day.³ Older adults sometimes don’t get enough fiber in their diets, because they may lose interest in food. If you are older and have lost interest in food, talk with your doctor if

• food doesn’t taste the same as it once did
• you don’t feel hungry as often
• you don’t want to cook
• you have problems chewing or swallowing

Talk with your doctor to plan a diet with the right amount of fiber for you. Be sure to add fiber to your diet a little at a time so that your body gets used to the change.

Use this table as a tool to help replace less healthy foods with foods that have fiber.

What should I avoid eating if I'm constipated?

If you’re constipated, try not to eat too many foods with little or no fiber, such as

• cheese
• chips
• fast food
• ice cream
• meat
• prepared foods, such as some frozen meals and snack foods
• processed foods, such as hot dogs or some microwavable dinners

References

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.?

Definition & Facts

What is constipation in children?

Constipation in children is a condition in which a child may have

• fewer than two bowel movements a week
• bowel movements with stools that are hard, dry, and small, making them painful or difficult to pass

In most cases, constipation in children lasts a short time and is not dangerous.

How common is constipation in children?

Almost 5 percent of visits to pediatricians are for constipation. About 25 percent of the children who visit gastroenterologists are constipated.¹

What are the complications of constipation in children?

Constipation can lead to health problems such as fecal impaction, anal fissures, or rectal prolapse.

Fecal impaction

Fecal impaction happens when hard stool packs a child’s intestine and rectum so tightly that the normal pushing action of the colon is not enough to push the stool out.

Anal fissures

Anal fissures are small tears in the anus that may cause itching, pain, or bleeding.

Rectal prolapse

Rectal prolapse happens when a child’s rectum slips so that it sticks out from his or her anus. Rectal prolapse in children is not common in developed countries.² Rectal prolapse can happen if a child strains during bowel movements, among other reasons. Rectal prolapse may cause mucus to leak from the child’s anus.

References

Symptoms & Causes

What are the symptoms of constipation in children?

If a child is constipated, he or she may have the following symptoms:

Posturing or changing positions

Posturing or changing positions can show that a child is trying to hold in stool or is constipated. When a child postures or changes position, he or she may

• stand on tiptoes and then rock back on his or her heels
• clench his or her buttocks muscles
• do unusual, dancelike movements

Parents or caretakers often mistake these postures as ways to try and have a bowel movement.

Abdominal pain and bloating

A child may feel pain or bloating in his or her abdomen.

Stool in a child’s underwear

If a child delays having a bowel movement, he or she may develop a large amount of stool in the rectum—something health care professionals call a fecal impaction. Some of this stool may leak and soil a child’s underwear. Parents or caretakers often mistake this soiling as a sign of diarrhea.

Urinary incontinence

Stool in a child’s colon can press against his or her bladder. This pressure may cause daytime or nighttime wetting called urinary incontinence.

When should a child with constipation see a doctor?

A child should see a doctor if his or her symptoms of constipation last for more than 2 weeks. You should take a child to see a doctor right away if he or she has one or more of the following symptoms:

• fever
• vomiting
• blood in his or her stool
• a swollen abdomen
• weight loss

What causes constipation in children?

Constipation happens when stool stays too long in a child’s colon. Causes of constipation in children may include the following:

Ignoring the urge to have a bowel movement

Children most often get constipated from holding in stool. When a child holds in stool, the colon absorbs too much fluid and his or her stool becomes hard, dry, and difficult to pass.

Children may hold in stool because they

• are feeling stressed about potty training
• are embarrassed to use a public bathroom
• do not want to interrupt playtime
• are worried about having a painful or an unpleasant bowel movement

Diets low in fiber

Another common cause of constipation in children is a diet with too little fiber. Fiber helps stool stay soft so that it moves smoothly through a child’s colon. Liquids such as water and juice help fiber work better.

Medicines

Some medicines that doctors prescribe to treat other health problems can cause constipation in children. Medicines that can cause constipation in children include

• antacids—used to neutralize stomach acid—that contain aluminum and calcium
• anticholinergics—used to treat muscle spasms in the intestines
• narcotics—used to treat severe pain
• some medicines used to treat depression

Certain health problems

Certain health problems can make stool move more slowly through a child’s colon, rectum, or anus, causing constipation:

• Hirschsprung disease—a birth defect in which the large intestine lacks some nerve cells. The signals that tell your muscles to push stool along are missing, so stool stays in the large intestine and causes blockage.
• obstructions that block part of the lower gastrointestinal (GI) tract
• tumors or narrowing of the GI tract

Functional GI disorders

Functional GI disorders happen when something changes the way a child’s GI tract works, yet doesn’t cause damage. Functional constipation happens when the muscles in a child’s colon or anus move stool more slowly, and it often happens during one of three times:

• when infants transition from breast milk to formula or when they start eating solid foods
• when parents or caretakers are potty training toddlers, and toddlers are learning how to control bowel movements
• when children start school and avoid using the bathroom at school for bowel movements

Irritable bowel syndrome (IBS) is also a functional GI disorder. Children with IBS can be constipated.

Diagnosis

How do doctors diagnose constipation in children?

To find out why a child is constipated, the child’s doctor will take a medical history and perform a physical exam, and may order tests.

Medical history

The medical history will include questions about the child’s constipation, such as

• what are the child’s bowel movement patterns, including how often the child has bowel movements
• when the first bowel movement after birth happened
• what are the child’s eating habits, including when and what the child most often eats and drinks
• what are the child’s social situations like, including
  • his or her day care attendance
  • his or her potty training
• whether the child has any health problems
• whether the child is taking medicine that can cause constipation
• what is the family’s history of constipation

Doctors primarily use a child’s medical history to diagnose functional constipation. The child’s history and symptoms may be different depending on his or her age.

Physical exam

During a physical exam, a doctor will listen for bowel sounds and feel the child’s abdomen for

• swelling
• tenderness
• masses, or lumps

The physical exam may include a rectal exam. After putting on a glove, a doctor will slide a lubricated finger into a child’s anus to check for tenderness, blockage, or blood.

Diagnostic tests

Since functional constipation is so common in children, doctors do not normally use diagnostic tests for children with constipation unless they do not respond to treatment or the doctor suspects a specific cause.

What tests do doctors use to diagnose constipation in children?

A doctor may use one or more of the following tests to diagnose constipation:

Blood test

A blood test might show an abnormality, such as anemia, indicating that a disease might be the cause of a child’s constipation.

X-ray

A doctor may order an x-ray of the child’s abdomen to look for problems causing the constipation. The child will lie on a table or stand during the x-ray. A health care professional positions the x-ray machine over the child’s abdomen. The child will hold his or her breath while the health care professional takes the x-ray so that the picture will not be blurry. The health care professional may ask the child to change position for more x-rays.

Treatment

How do doctors treat constipation in children?

Parents or caretakers can most often treat a child at home. However, if a child does not respond to treatment, call the child’s doctor. Treatment for constipation in children may include changes in eating, diet, and nutrition; behavioral changes; and enemas and laxatives:

Changes in eating, diet, and nutrition

Changes in a child’s eating, diet, and nutrition can treat constipation. These changes include

• drinking liquids throughout the day. A health care professional can recommend how much and what kind of liquids a child should drink.
• eating more fruits and vegetables.
• eating more fiber.

Read what a child should eat to help prevent and relieve constipation and foods to avoid if a child is constipated.

Behavioral changes

Changing a child’s patterns and behaviors about having bowel movements can help treat constipation. You can help the child by

• encouraging older children to use the toilet shortly after meals to build a routine
• using a reward system when children use the bathroom regularly
• taking a break from potty training until the constipation stops

Enemas and laxatives

Some children need to have an enema or take medicines to treat constipation. Most often, a doctor will first recommend using an enema. Cleansing a child’s bowel with an enema flushes water or a laxative into his or her anus using a special squirt bottle, which helps the child pass stool.

A doctor may prescribe a laxative for a child to take by mouth until his or her bowel movements are normal. Laxatives clean out the bowel and help a child have a bowel movement. Once a child has better eating and bowel habits, the doctor will recommend stopping the laxative. If you stop giving a child the laxative too soon then the child could become constipated again. You should not give a child laxatives unless told to do so by a doctor.

How do doctors treat complications of constipation in children?

Doctors can treat or recommend how to treat complications of constipation in children. Fecal impaction, anal fissures, and rectal prolapse all have different treatments.

Fecal impaction

Talk with the child’s doctor for how to treat fecal impaction in a child under 2 years old.

For a child who is 2 years old or older, you can soften his or her fecal impaction with mineral oil that he or she takes by mouth or through an enema. A health care professional may then recommend that you bring the child in to the doctor’s office. The health care professional can break up and remove part of the hardened stool by inserting one or two gloved, lubricated fingers into the child’s anus.

Anal fissures

You can treat a child’s anal fissures by

• making changes in his or her diet to prevent constipation
• applying over-the-counter anesthetic cream to numb the area or relax his or her muscles
• using stool softeners
• having him or her take warm tub baths to soothe the area

Rectal prolapse

A child’s doctor may be able to treat rectal prolapse during an office visit by manually pushing the rectum back through the child’s anus. Helping a child prevent constipation is the best way to prevent rectal prolapse.

Eating, Diet, & Nutrition

How can a child's diet help prevent or relieve constipation?

A child should drink water and other fluids, such as fruit and vegetable juices and clear soups, to help the fiber in his or her diet work better. This change should make the child’s stools more normal and regular. A doctor can help you plan a diet with the appropriate amount of fiber to help treat a child with constipation. A list of high-fiber foods appears below. Use this table as a tool to help replace less healthy foods with foods that have fiber.

Children ages 1 to 18, depending on their age and sex, should get 14 to 31 grams of fiber a day.³ Fiber guidelines are not available for infants less than 1 year old, who normally eat little to no solid food yet. Talk with the infant’s doctor about possibly breastfeeding the infant or what kind of foods he or she should eat.

What should my child avoid eating if he or she is constipated?

If a child is constipated, try not to give him or her too many foods with little or no fiber, such as

• ?cheese
• chips
• fast food
• ice cream
• meat
• prepared foods, such as some frozen meals and snack foods, such as saltine or animal crackers, angel food cake, and vanilla wafers
• processed foods, such as hot dogs or some microwavable dinners, such as pizza, Salisbury steak, and pot pie?

References

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many diseases and conditions.

What are clinical trials and what role do children play in research?

Clinical trials are research studies involving people of all ages. Clinical trials look at safe and effective new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving quality of life. Research involving children helps scientists

• identify care that is best for a child
• find the best dose of medicines
• find treatments for conditions that only affect children
• treat conditions that behave differently in children
• understand how treatment affects a growing child’s body

Find out more about clinical trials and children.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.??

Definition & Facts

What is Crohn’s disease?

Crohn’s disease is a chronic disease that causes inflammation and irritation in your digestive tract. Most commonly, Crohn’s affects your small intestine and the beginning of your large intestine. However, the disease can affect any part of your digestive tract, from your mouth to your anus. Learn more about your digestive system and how it works.

Crohn’s disease is an inflammatory bowel disease (IBD). Ulcerative colitis and microscopic colitis are other common types of IBD.

Crohn’s disease most often begins gradually and can become worse over time. You may have periods of remission that can last for weeks or years.

How common is Crohn’s disease?

Researchers estimate that more than half a million people in the United States have Crohn’s disease.¹ Studies show that, over time, Crohn’s disease has become more common in the United States and other parts of the world.^1,2 Experts do not know the reason for this increase.

Who is more likely to develop Crohn’s disease?

Crohn’s disease can develop in people of any age and is more likely to develop in people

• between the ages of 20 and 29²
• who have a family member, most often a sibling or parent, with IBD
• who smoke cigarettes

What are the complications of Crohn’s disease?

Complications of Crohn’s disease can include the following:

• Intestinal obstruction. Crohn’s disease can thicken the wall of your intestines. Over time, the thickened areas of your intestines can narrow, which can block your intestines. A partial or complete intestinal obstruction, also called a bowel blockage, can block the movement of food or stool through your intestines.
• Fistulas. In Crohn’s disease, inflammation can go through the wall of your intestines and create tunnels, or fistulas. Fistulas are abnormal passages between two organs, or between an organ and the outside of your body. Fistulas may become infected.
• Abscesses. Inflammation that goes through the wall of your intestines can also lead to abscesses. Abscesses are painful, swollen, pus-filled pockets of infection.
• Anal fissures. Anal fissures are small tears in your anus that may cause itching, pain, or bleeding.
• Ulcers. Inflammation anywhere along your digestive tract can lead to ulcers or open sores in your mouth, intestines, anus, or perineum.
• Malnutrition. Malnutrition develops when your body does not get the right amount of vitamins, minerals, and nutrients it needs to maintain healthy tissues and organ function.
• Inflammation in other areas of your body. You may have inflammation in your joints, eyes, and skin.

What other health problems do people with Crohn’s disease have?

If you have Crohn’s disease in your large intestine, you may be more likely to develop colon cancer. If you receive ongoing treatment for Crohn’s disease and stay in remission, you may reduce your chances of developing colon cancer.³

Talk with your doctor about how often you should get screened for colon cancer. Screening is testing for diseases when you have no symptoms. Screening for colon cancer can include colonoscopy with biopsies. Although screening does not reduce your chances of developing colon cancer, it may help to find cancer at an early stage and improve the chance of curing the cancer.

References

Symptoms & Causes

What are the symptoms of Crohn’s Disease?

The most common symptoms of Crohn’s disease are

• diarrhea
• cramping and pain in your abdomen
• weight loss

Other symptoms include

• anemia
• eye redness or pain
• feeling tired
• fever
• joint pain or soreness
• nausea or loss of appetite
• skin changes that involve red, tender bumps under the skin

Your symptoms may vary depending on the location and severity of your inflammation.

Some research suggests that stress, including the stress of living with Crohn’s disease, can make symptoms worse. Also, some people may find that certain foods can trigger or worsen their symptoms.

What causes Crohn’s disease?

Doctors aren’t sure what causes Crohn’s disease. Experts think the following factors may play a role in causing Crohn’s disease.

Autoimmune reaction

One cause of Crohn’s disease may be an autoimmune reaction—when your immune system attacks healthy cells in your body. Experts think bacteria in your digestive tract can mistakenly trigger your immune system. This immune system response causes inflammation, leading to symptoms of Crohn’s disease.

Genes

Crohn’s disease sometimes runs in families. Research has shown that if you have a parent or sibling with Crohn’s disease, you may be more likely to develop the disease. Experts continue to study the link between genes and Crohn’s disease.

Other factors

Some studies suggest that other factors may increase your chance of developing Crohn’s disease:

• Smoking may double your chance of developing Crohn’s disease.⁴
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen,⁵ antibiotics,⁶ and birth-control pills⁶ may slightly increase the chance of developing Crohn’s disease.
• A high-fat diet may also slightly increase your chance of getting Crohn’s disease.⁷

Stress and eating certain foods do not cause Crohn’s disease.

References

Diagnosis

How do doctors diagnose Crohn’s disease?

Doctors typically use a combination of tests to diagnose Crohn’s disease. Your doctor will also ask you about your medical history—including medicines you are taking—and your family history and will perform a physical exam.

Physical exam

During a physical exam, a doctor most often

• checks for bloating in your abdomen
• listens to sounds within your abdomen using a stethoscope
• taps on your abdomen to check for tenderness and pain and to see if your liver or spleen is abnormal or enlarged

Diagnostic tests

Your doctor may use the following tests to help diagnose Crohn’s disease:

• lab tests
• intestinal endoscopy
• upper gastrointestinal (GI) series
• computed tomography (CT) scan

Your doctor may also perform tests to rule out other diseases, such as ulcerative colitis, diverticular disease, or cancer, that cause symptoms similar to those of Crohn’s disease.

What tests do doctors use to diagnose Crohn’s disease?

Your doctor may perform the following tests to help diagnose Crohn’s disease.

Lab tests

Lab tests to help diagnose Crohn’s disease include:

Blood tests. A health care professional may take a blood sample from you and send the sample to a lab to test for changes in

• red blood cells. If your red blood cells are fewer or smaller than normal, you may have anemia.
• white blood cells. When your white blood cell count is higher than normal, you may have inflammation or infection somewhere in your body.

Stool tests. A stool test is the analysis of a sample of stool. Your doctor will give you a container for catching and storing the stool. You will receive instructions on where to send or take the kit for analysis. Doctors use stool tests to rule out other causes of digestive diseases.

Intestinal endoscopy

Intestinal endoscopies are the most accurate methods for diagnosing Crohn’s disease and ruling out other possible conditions, such as ulcerative colitis, diverticular disease, or cancer. Intestinal endoscopies include the following:

Colonoscopy. Colonoscopy is a procedure in which a doctor uses a long, flexible, narrow tube with a light and tiny camera on one end, called a colonoscope or endoscope, to look inside your rectum and colon. The doctor may also examine your ileum to look for signs of Crohn’s disease.

A trained specialist performs a colonoscopy in a hospital or an outpatient center. A health care professional will give you written bowel prep instructions to follow at home before the procedure. You will receive sedatives, anesthesia, or pain medicine during the procedure.

During a colonoscopy, you’ll be asked to lie on a table while the doctor inserts a colonoscope into your anus and slowly guides it through your rectum and colon and into the lower part of your ileum. If your doctor suspects that you have Crohn’s disease, the colonoscopy will include biopsies of your ileum, colon, and rectum. You won’t feel the biopsies.

Upper GI endoscopy and enteroscopy. In an upper GI endoscopy, your doctor uses an endoscope to see inside your upper digestive tract, also called your upper GI tract.

A trained specialist performs the procedure at a hospital or an outpatient center. You should not eat or drink before the procedure. A health care professional will tell you how to prepare for an upper GI endoscopy. You most often receive a liquid anesthetic to numb your throat and a light sedative to help you stay relaxed and comfortable during the procedure.

During the procedure, the doctor carefully feeds the endoscope down your esophagus and into your stomach and duodenum.

During an enteroscopy, a doctor examines your small intestine with a special, longer endoscope using one of the following procedures:

• push enteroscopy, which uses a long endoscope to examine the upper portion of your small intestine
• single- or double-balloon enteroscopy, which uses small balloons to help move the endoscope into your small intestine
• spiral enteroscopy, which uses a tube attached to an endoscope that acts as a corkscrew to move the instrument into your small intestine

Capsule endoscopy. In capsule endoscopy, you swallow a capsule containing a tiny camera that allows your doctor to see inside your digestive tract. You should not eat or drink before the procedure. A health care professional will tell you how to prepare for a capsule endoscopy. You don’t need anesthesia for this procedure.

The test begins in a doctor’s office, where you swallow the capsule. You can leave the doctor’s office during the test. As the capsule passes through your digestive tract, the camera will record and transmit images to a small receiver device that you wear. When the recording is done, your doctor downloads and reviews the images. The camera capsule leaves your body during a bowel movement, and you can safely flush it down the toilet.

Upper GI series

An upper GI series is a procedure in which a doctor uses x-rays, fluoroscopy, and a chalky liquid called barium to view your upper GI tract.

An x-ray technician and a radiologist perform this test at a hospital or an outpatient center. You should not eat or drink before the procedure. A health care professional will tell you how to prepare for an upper GI series. You don’t need anesthesia for this procedure.

For the procedure, you’ll be asked to stand or sit in front of an x-ray machine and drink barium. The barium will make your upper GI tract more visible on an x-ray. You will then lie on the x-ray table, and the radiologist will watch the barium move through your upper GI tract on the x-ray and fluoroscopy.

CT scan

A CT scan uses a combination of x-rays and computer technology to create images of your digestive tract.

For a CT scan, a health care professional may give you a solution to drink and an injection of a special dye, called contrast medium. Contrast medium makes the structures inside your body easier to see during the procedure. You’ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. CT scans can diagnose both Crohn’s disease and the complications of the disease.

Treatment

How do doctors treat Crohn’s disease?

Doctors treat Crohn’s disease with medicines, bowel rest, and surgery.

No single treatment works for everyone with Crohn’s disease. The goals of treatment are to decrease the inflammation in your intestines, to prevent flare-ups of your symptoms, and to keep you in remission.

Medicines

Many people with Crohn’s disease need medicines. Which medicines your doctor prescribes will depend on your symptoms.

Although no medicine cures Crohn’s disease, many can reduce symptoms.

Aminosalicylates. These medicines contain 5-aminosalicylic acid (5-ASA), which helps control inflammation. Doctors use aminosalicylates to treat people newly diagnosed with Crohn’s disease who have mild symptoms. Aminosalicylates include

• balsalazide
• mesalamine
• olsalazine
• sulfasalazine

Some of the common side effects of aminosalicylates include

• diarrhea
• headaches
• heartburn
• nausea and vomiting
• pain in your abdomen

Corticosteroids. Corticosteroids, also known as steroids, help reduce the activity of your immune system and decrease inflammation. Doctors prescribe corticosteroids for people with moderate to severe symptoms. Corticosteroids include

• budesonide
• hydrocortisone
• methylprednisolone
• prednisone

Side effects of corticosteroids include

• acne
• bone mass loss
• high blood glucose
• high blood pressure
• a higher chance of developing infections
• mood swings
• weight gain

In most cases, doctors do not prescribe corticosteroids for long-term use.

Immunomodulators. These medicines reduce immune system activity, resulting in less inflammation in your digestive tract. Immunomodulators can take several weeks to 3 months to start working. Immunomodulators include

• 6-mercaptopurine, or 6-MP
• azathioprine
• cyclosporine
• methotrexate

Doctors prescribe these medicines to help you go into remission or help you if you do not respond to other treatments. You may have the following side effects:

• a low white blood cell count, which can lead to a higher chance of infection
• feeling tired
• nausea and vomiting
• pancreatitis

Doctors most often prescribe cyclosporine only if you have severe Crohn’s disease because of the medicine’s serious side effects. Talk with your doctor about the risks and benefits of cyclosporine.

Biologic therapies. These medicines target proteins made by the immune system. Neutralizing these proteins decreases inflammation in the intestines. Biologic therapies work to help you go into remission, especially if you do not respond to other medicines. Biologic therapies include

• anti-tumor necrosis factor-alpha therapies, such as adalimumab, certolizumab, and infliximab
• anti-integrin therapies, such as natalizumab and vedolizumab
• anti-interleukin-12 and interleukin-23 therapy, such as ustekinumab

Doctors most often give patients infliximab every 6 to 8 weeks at a hospital or an outpatient center. Side effects may include a toxic reaction to the medicine and a higher chance of developing infections, particularly tuberculosis.

Other medicines. Other medicines doctors prescribe for symptoms or complications may include

• acetaminophen for mild pain. You should avoid using ibuprofen, naproxen, and aspirin because these medicines can make your symptoms worse.
• antibiotics to prevent or treat complications that involve infection, such as abscesses and fistulas.
• loperamide to help slow or stop severe diarrhea. In most cases, people only take this medicine for short periods of time because it can increase the chance of developing megacolon.

Bowel rest

If your Crohn’s disease symptoms are severe, you may need to rest your bowel for a few days to several weeks. Bowel rest involves drinking only certain liquids or not eating or drinking anything. During bowel rest, your doctor may

• ask you to drink a liquid that contains nutrients
• give you a liquid that contains nutrients through a feeding tube inserted into your stomach or small intestine
• give you intravenous (IV) nutrition through a special tube inserted into a vein in your arm

You may stay in the hospital, or you may be able to receive the treatment at home. In most cases, your intestines will heal during bowel rest.

Surgery

Even with medicines, many people will need surgery to treat their Crohn’s disease. One study found that nearly 60 percent of people had surgery within 20 years of having Crohn’s disease.⁸ Although surgery will not cure Crohn’s disease, it can treat complications and improve symptoms. Doctors most often recommend surgery to treat

• fistulas
• bleeding that is life threatening
• intestinal obstructions
• side effects from medicines when they threaten your health
• symptoms when medicines do not improve your condition

A surgeon can perform different types of operations to treat Crohn’s disease.

For any surgery, you will receive general anesthesia. You will most likely stay in the hospital for 3 to 7 days following the surgery. Full recovery may take 4 to 6 weeks.

Small bowel resection. Small bowel resection is surgery to remove part of your small intestine. When you have an intestinal obstruction or severe Crohn’s disease in your small intestine, a surgeon may need to remove that section of your intestine. The two types of small bowel resection are

• laparoscopic—when a surgeon makes several small, half-inch incisions in your abdomen. The surgeon inserts a laparoscope—a thin tube with a tiny light and video camera on the end—through the small incisions. The camera sends a magnified image from inside your body to a video monitor, giving the surgeon a close-up view of your small intestine. While watching the monitor, the surgeon inserts tools through the small incisions and removes the diseased or blocked section of small intestine. The surgeon will reconnect the ends of your intestine.
• open surgery—when a surgeon makes one incision about 6 inches long in your abdomen. The surgeon will locate the diseased or blocked section of small intestine and remove or repair that section. The surgeon will reconnect the ends of your intestine.

Subtotal colectomy. A subtotal colectomy, also called a large bowel resection, is surgery to remove part of your large intestine. When you have an intestinal obstruction, a fistula, or severe Crohn’s disease in your large intestine, a surgeon may need to remove that section of intestine. A surgeon can perform a subtotal colectomy by

• laparoscopic colectomy—when a surgeon makes several small, half-inch incisions in your abdomen. While watching the monitor, the surgeon removes the diseased or blocked section of your large intestine. The surgeon will reconnect the ends of your intestine.
• open surgery—when a surgeon makes one incision about 6 to 8 inches long in your abdomen. The surgeon will locate the diseased or blocked section of large intestine and remove that section. The surgeon will reconnect the ends of your intestine.

Proctocolectomy and ileostomy. A proctocolectomy is surgery to remove your entire colon and rectum. An ileostomy is a stoma, or opening in your abdomen, that a surgeon creates from a part of your ileum. The surgeon brings the end of your ileum through an opening in your abdomen and attaches it to your skin, creating an opening outside your body. The stoma is about three-quarters of an inch to a little less than 2 inches wide and is most often located in the lower part of your abdomen, just below the beltline.

A removable external collection pouch, called an ostomy pouch or ostomy appliance, connects to the stoma and collects stool outside your body. Stool passes through the stoma instead of passing through your anus. The stoma has no muscle, so it cannot control the flow of stool, and the flow occurs whenever occurs.

If you have this type of surgery, you will have the ileostomy for the rest of your life.

How do doctors treat the complications of Crohn’s disease?

Your doctor may recommend treatments for the following complications of Crohn’s disease:

• Intestinal obstruction. A complete intestinal obstruction is life threatening. If you have a complete obstruction, you will need medical attention right away. Doctors often treat complete intestinal obstruction with surgery.
• Fistulas. How your doctor treats fistulas will depend on what type of fistulas you have and how severe they are. For some people, fistulas heal with medicine and diet changes, whereas other people will need to have surgery.
• Abscesses. Doctors prescribe antibiotics and drain abscesses. A doctor may drain an abscess with a needle inserted through your skin or with surgery.
• Anal fissures. Most anal fissures heal with medical treatment, including ointments, warm baths, and diet changes.
• Ulcers. In most cases, the treatment for Crohn’s disease will also treat your ulcers.
• Malnutrition. You may need IV fluids or feeding tubes to replace lost nutrients and fluids.
• Inflammation in other areas of your body. Your doctor can treat inflammation by changing your medicines or prescribing new medicines.

References

Eating, Diet, & Nutrition

How can my diet help the symptoms of Crohn’s disease?

Changing your diet can help reduce symptoms. Your doctor may recommend that you make changes to your diet such as

• avoiding carbonated, or “fizzy,” drinks
• avoiding popcorn, vegetable skins, nuts, and other high-fiber foods
• drinking more liquids
• eating smaller meals more often
• keeping a food diary to help identify foods that cause problems

Depending on your symptoms or medicines, your doctor may recommend a specific diet, such as a diet that is

• high calorie
• lactose free
• low fat
• low fiber
• low salt

Talk with your doctor about specific dietary recommendations and changes.

Your doctor may recommend nutritional supplements and vitamins if you do not absorb enough nutrients. For safety reasons, talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.?