Input: What causes Ulcerative Colitis ?

Output:
The exact cause of ulcerative colitis is unknown. Researchers believe the following factors may play a role in causing ulcerative colitis:

- overactive intestinal immune system  - genes  - environment

Overactive intestinal immune system. Scientists believe one cause of ulcerative colitis may be an abnormal immune reaction in the intestine. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. Researchers believe bacteria or viruses can mistakenly trigger the immune system to attack the inner lining of the large intestine. This immune system response causes the inflammation, leading to symptoms.

Genes. Ulcerative colitis sometimes runs in families. Research studies have shown that certain abnormal genes may appear in people with ulcerative colitis. However, researchers have not been able to show a clear link between the abnormal genes and ulcerative colitis.

Environment. Some studies suggest that certain things in the environment may increase the chance of a person getting ulcerative colitis, although the overall chance is low. Nonsteroidal anti-inflammatory drugs,1 antibiotics,1 and oral contraceptives2 may slightly increase the chance of developing ulcerative colitis. A high-fat diet may also slightly increase the chance of getting ulcerative colitis.3

Some people believe eating certain foods, stress, or emotional distress can cause ulcerative colitis. Emotional distress does not seem to cause ulcerative colitis. A few studies suggest that stress may increase a person's chance of having a flare-up of ulcerative colitis. Also, some people may find that certain foods can trigger or worsen symptoms. </s>


Input: What are the symptoms of Ulcerative Colitis ?

Output:
The most common signs and symptoms of ulcerative colitis are diarrhea with blood or pus and abdominal discomfort. Other signs and symptoms include

- an urgent need to have a bowel movement  - feeling tired  - nausea or loss of appetite  - weight loss  - fever  - anemiaa condition in which the body has fewer red blood cells than normal

Less common symptoms include

- joint pain or soreness  - eye irritation  - certain rashes

The symptoms a person experiences can vary depending on the severity of the inflammation and where it occurs in the intestine. When symptoms first appear,

- most people with ulcerative colitis have mild to moderate symptoms  - about 10 percent of people can have severe symptoms, such as frequent, bloody bowel movements; fevers; and severe abdominal cramping1 </s>


Input: How to diagnose Ulcerative Colitis ?

Output:
A health care provider diagnoses ulcerative colitis with the following:

- medical and family history  - physical exam  - lab tests  - endoscopies of the large intestine

The health care provider may perform a series of medical tests to rule out other bowel disorders, such as irritable bowel syndrome, Crohn's disease, or celiac disease, that may cause symptoms similar to those of ulcerative colitis. Read more about these conditions on the Digestive Disease A-Z list.

Medical and Family History

Taking a medical and family history can help the health care provider diagnose ulcerative colitis and understand a patient's symptoms. The health care provider will also ask the patient about current and past medical conditions and medications.

Physical Exam

A physical exam may help diagnose ulcerative colitis. During a physical exam, the health care provider most often

- checks for abdominal distension, or swelling  - listens to sounds within the abdomen using a stethoscope  - taps on the abdomen to check for tenderness and pain

Lab Tests

A health care provider may order lab tests to help diagnose ulcerative colitis, including blood and stool tests.

Blood tests. A blood test involves drawing blood at a health care provider's office or a lab. A lab technologist will analyze the blood sample. A health care provider may use blood tests to look for

- anemia  - inflammation or infection somewhere in the body  - markers that show ongoing inflammation  - low albumin, or proteincommon in patients with severe ulcerative colitis

Stool tests. A stool test is the analysis of a sample of stool. A health care provider will give the patient a container for catching and storing the stool at home. The patient returns the sample to the health care provider or to a lab. A lab technologist will analyze the stool sample. Health care providers commonly order stool tests to rule out other causes of GI diseases, such as infection.

Endoscopies of the Large Intestine

Endoscopies of the large intestine are the most accurate methods for diagnosing ulcerative colitis and ruling out other possible conditions, such as Crohn's disease, diverticular disease, or cancer. Endoscopies of the large intestine include

- colonoscopy  - flexible sigmoidoscopy

Colonoscopy. Colonoscopy is a test that uses a long, flexible, narrow tube with a light and tiny camera on one end, called a colonoscope or scope, to look inside the rectum and entire colon. In most cases, light anesthesia and pain medication help patients relax for the test. The medical staff will monitor a patient's vital signs and try to make him or her as comfortable as possible. A nurse or technician places an intravenous (IV) needle in a vein in the patient's arm or hand to give anesthesia.

For the test, the patient will lie on a table or stretcher while the gastroenterologist inserts a colonoscope into the patient's anus and slowly guides it through the rectum and into the colon. The scope inflates the large intestine with air to give the gastroenterologist a better view. The camera sends a video image of the intestinal lining to a monitor, allowing the gastroenterologist to carefully examine the tissues lining the colon and rectum. The gastroenterologist may move the patient several times and adjust the scope for better viewing. Once the scope has reached the opening to the small intestine, the gastroenterologist slowly withdraws it and examines the lining of the colon and rectum again.

A colonoscopy can show irritated and swollen tissue, ulcers, and abnormal growths such as polypsextra pieces of tissue that grow on the inner lining of the intestine. If the gastroenterologist suspects ulcerative colitis, he or she will biopsy the patient's colon and rectum. A biopsy is a procedure that involves taking small pieces of tissue for examination with a microscope.

A health care provider will give patients written bowel prep instructions to follow at home before the test. The health care provider will also give patients information about how to care for themselves following the procedure.

Flexible sigmoidoscopy. Flexible sigmoidoscopy is a test that uses a flexible, narrow tube with a light and tiny camera on one end, called a sigmoidoscope or scope, to look inside the rectum, the sigmoid colon, and sometimes the descending colon. In most cases, a patient does not need anesthesia.

For the test, the patient will lie on a table or stretcher while the health care provider inserts the sigmoidoscope into the patient's anus and slowly guides it through the rectum, the sigmoid colon, and sometimes the descending colon. The scope inflates the large intestine with air to give the health care provider a better view. The camera sends a video image of the intestinal lining to a monitor, allowing the health care provider to examine the tissues lining the sigmoid colon and rectum. The health care provider may ask the patient to move several times and adjust the scope for better viewing. Once the scope reaches the end of the sigmoid colon, the health care provider slowly withdraws it while examining the lining of the colon and rectum again.

The health care provider will look for signs of bowel diseases and conditions such as irritated and swollen tissue, ulcers, and polyps.

If the health care provider suspects ulcerative colitis, he or she will biopsy the patient's colon and rectum.

A health care provider will give patients written bowel prep instructions to follow at home before the test. The health care provider will also give patients information about how to care for themselves following the procedure. </s>


Input: What are the treatments for Ulcerative Colitis ?

Output:
A health care provider treats ulcerative colitis with

- medications  - surgery

Which treatment a person needs depends on the severity of the disease and the symptoms. Each person experiences ulcerative colitis differently, so health care providers adjust treatments to improve the person's symptoms and induce, or bring about, remission.

Medications

While no medication cures ulcerative colitis, many can reduce symptoms. The goals of medication therapy are

- inducing and maintaining remission  - improving the person's quality of life

Many people with ulcerative colitis require medication therapy indefinitely, unless they have their colon and rectum surgically removed.

Health care providers will prescribe the medications that best treat a person's symptoms:

- aminosalicylates  - corticosteroids  - immunomodulators  - biologics, also called anti-TNF therapies  - other medications

Depending on the location of the symptoms in the colon, health care providers may recommend a person take medications by

- enema, which involves flushing liquid medication into the rectum using a special wash bottle. The medication directly treats inflammation of the large intestine.  - rectal foama foamy substance the person puts into the rectum like an enema. The medication directly treats inflammation of the large intestine.  - suppositorya solid medication the person inserts into the rectum to dissolve. The intestinal lining absorbs the medication.  - mouth.  - IV.

Aminosalicylates are medications that contain 5-aminosalicyclic acid (5-ASA), which helps control inflammation. Health care providers typically use aminosalicylates to treat people with mild or moderate symptoms or help people stay in remission. Aminosalicylates can be prescribed as an oral medication or a topical medicationby enema or suppository. Combination therapyoral and rectalis most effective, even in people with extensive ulcerative colitis.5 Aminosalicylates are generally well tolerated.

Aminosalicylates include

- balsalazide  - mesalamine  - olsalazine  - sulfasalazinea combination of sulfapyridine and 5-ASA

Some of the common side effects of aminosalicylates include

- abdominal pain  - diarrhea  - headaches  - nausea

Health care providers may order routine blood tests for kidney function, as aminosalicylates can cause a rare allergic reaction in the kidneys.

Corticosteroids, also known as steroids, help reduce the activity of the immune system and decrease inflammation. Health care providers prescribe corticosteroids for people with more severe symptoms and people who do not respond to aminosalicylates. Health care providers do not typically prescribe corticosteroids for long-term use.

Corticosteroids are effective in bringing on remission; however, studies have not shown that the medications help maintain long-term remission. Corticosteroids include

- budesonide  - hydrocortisone  - methylprednisone  - prednisone

Side effects of corticosteroids include

- acne  - a higher chance of developing infections  - bone mass loss  - death of bone tissue  - high blood glucose  - high blood pressure  - mood swings  - weight gain

People who take budesonide may have fewer side effects than with other steroids.

Immunomodulators reduce immune system activity, resulting in less inflammation in the colon. These medications can take several weeks to 3 months to start working. Immunomodulators include

- azathioprine  - 6-mercaptopurine, or 6-MP

Health care providers prescribe these medications for people who do not respond to 5-ASAs. People taking these medications may have the following side effects:

- abnormal liver tests  - feeling tired  - infection  - low white blood cell count, which can lead to a higher chance of infection  - nausea and vomiting  - pancreatitis  - slightly increased chance of lymphoma  - slightly increased chance of nonmelanoma skin cancers

Health care providers routinely test blood counts and liver function of people taking immunomodulators. People taking these medications should also have yearly skin cancer exams.

People should talk with their health care provider about the risks and benefits of immunomodulators.

Biologicsincluding adalimumab, golimumab, infliximab, and vedolizumabare medications that target a protein made by the immune system called tumor necrosis factor (TNF). These medications decrease inflammation in the large intestine by neutralizing TNF. Anti-TNF therapies work quickly to bring on remission, especially in people who do not respond to other medications. Infliximab and vedolizumab are given through an IV; adalimumab and golimumab are given by injection.

Health care providers will screen patients for tuberculosis and hepatitis B before starting treatment with anti-TNF medications.

Side effects of anti-TNF medications may include

- a higher chance of developing infectionsespecially tuberculosis or fungal infection  - skin cancermelanoma  - psoriasis

Other medications to treat symptoms or complications may include

- acetaminophen for mild pain. People with ulcerative colitis should avoid using ibuprofen, naproxen, and aspirin since these medications can make symptoms worse.  - antibiotics to prevent or treat infections.  - loperamide to help slow or stop diarrhea. In most cases, people only take this medication for short periods of time since it can increase the chance of developing megacolon. People should check with a health care provider before taking loperamide, because those with significantly active ulcerative colitis should not take this medication.6  - cyclosporinehealth care providers prescribe this medication only for people with severe ulcerative colitis because of the side effects. People should talk with their health care provider about the risks and benefits of cyclosporine.

Surgery

Some people will need surgery to treat their ulcerative colitis when they have

- colon cancer  - dysplasia, or precancerous cells in the colon  - complications that are life threatening, such as megacolon or bleeding  - no improvement in symptoms or condition despite treatment  - continued dependency on steroids  - side effects from medications that threaten their health

Removal of the entire colon, including the rectum, "cures" ulcerative colitis. A surgeon performs the procedure at a hospital. A surgeon can perform two different types of surgery to remove a patient's colon and treat ulcerative colitis:

- proctocolectomy and ileostomy  - proctocolectomy and ileoanal reservoir

Full recovery from both operations may take 4 to 6 weeks.

Proctocolectomy and ileostomy. A proctocolectomy is surgery to remove a patient's entire colon and rectum. An ileostomy is a stoma, or opening in the abdomen, that a surgeon creates from a part of the ileumthe last section of the small intestine. The surgeon brings the end of the ileum through an opening in the patient's abdomen and attaches it to the skin, creating an opening outside of the patient's body. The stoma most often is located in the lower part of the patient's abdomen, just below the beltline.

A removable external collection pouch, called an ostomy pouch or ostomy appliance, connects to the stoma and collects intestinal contents outside the patient's body. Intestinal contents pass through the stoma instead of passing through the anus. The stoma has no muscle, so it cannot control the flow of intestinal contents, and the flow occurs whenever peristalsis occurs. Peristalsis is the movement of the organ walls that propels food and liquid through the GI tract.

People who have this type of surgery will have the ileostomy for the rest of their lives.

Proctocolectomy and ileoanal reservoir. An ileoanal reservior is an internal pouch made from the patient's ileum. This surgery is a common alternative to an ileostomy and does not have a permanent stoma. Ileoanal reservoir is also known as a J-pouch, a pelvic pouch, or an ileoanal pouch anastamosis. The ileoanal reservior connects the ileum to the anus. The surgeon preserves the outer muscles of the patient's rectum during the proctocolectomy. Next, the surgeon creates the ileal pouch and attaches it to the end of the rectum. Waste is stored in the pouch and passes through the anus.

After surgery, bowel movements may be more frequent and watery than before the procedure. People may have fecal incontinencethe accidental passing of solid or liquid stool or mucus from the rectum. Medications can be used to control pouch function. Women may be infertile following the surgery.

Many people develop pouchitis in the ileoanal reservoir. Pouchitis is an irritation or inflammation of the lining of the ileoanal reservoir. A health care provider treats pouchitis with antibiotics. Rarely, pouchitis can become chronic and require long-term antibiotics or other medications.

The surgeon will recommend one of the operations based on a person's symptoms, severity of disease, expectations, age, and lifestyle. Before making a decision, the person should get as much information as possible by talking with

- health care providers  - enterostomal therapists, nurses who work with colon-surgery patients  - people who have had one of the surgeries

Patient-advocacy organizations can provide information about support groups and other resources.

More information is provided in the NIDDK health topic, ostomy surgery. </s>


Input: What to do for Ulcerative Colitis ?

Output:
Researchers have not found that eating, diet, and nutrition play a role in causing ulcerative colitis symptoms. Good nutrition is important in the management of ulcerative colitis, however. Dietary changes can help reduce symptoms. A health care provider may recommend dietary changes such as

- avoiding carbonated drinks  - avoiding popcorn, vegetable skins, nuts, and other high-fiber foods while a person has symptoms  - drinking more liquids  - eating smaller meals more often  - keeping a food diary to help identify troublesome foods

Health care providers may recommend nutritional supplements and vitamins for people who do not absorb enough nutrients.

To help ensure coordinated and safe care, people should discuss their use of complementary and alternative medical practices, including their use of dietary supplements and probiotics, with their health care provider. Read more at www.nccam.nih.gov/health/probiotics.

Depending on a person's symptoms or medications, a health care provider may recommend a specific diet, such as a

- high-calorie diet  - lactose-free diet  - low-fat diet  - low-fiber diet  - low-salt diet

People should speak with a health care provider about specific dietary recommendations and changes. </s>


Input: What are the complications of Ulcerative Colitis ?

Output:
Complications of ulcerative colitis can include

- rectal bleedingwhen ulcers in the intestinal lining open and bleed. Rectal bleeding can cause anemia, which health care providers can treat with diet changes and iron supplements. People who have a large amount of bleeding in the intestine over a short period of time may require surgery to stop the bleeding. Severe bleeding is a rare complication of ulcerative colitis.  - dehydration and malabsorbtion, which occur when the large intestine is unable to absorb fluids and nutrients because of diarrhea and inflammation. Some people may need IV fluids to replace lost nutrients and fluids.  - changes in bones. Some corticosteroid medications taken to treat ulcerative colitis symptoms can cause      - osteoporosisthe loss of bone    - osteopenialow bone density

Health care providers will monitor people for bone loss and can recommend calcium and vitamin D supplements and medications to help prevent or slow bone loss.

- inflammation in other areas of the body. The immune system can trigger inflammation in the      - joints    - eyes    - skin    - liver

Health care providers can treat inflammation by adjusting medications or prescribing new medications.

- megacolona serious complication that occurs when inflammation spreads to the deep tissue layers of the large intestine. The large intestine swells and stops working. Megacolon can be a life-threatening complication and most often requires surgery. Megacolon is a rare complication of ulcerative colitis.

Ulcerative Colitis and Colon Cancer   People with ulcerative colitis may be more likely to develop colon cancer when   - ulcerative colitis affects the entire colon   - a person has ulcerative colitis for at least 8 years   - inflammation is ongoing   - people also have primary sclerosing cholangitis, a condition that affects the liver   - a person is male    People who receive ongoing treatment and remain in remission may reduce their chances of developing colon cancer.   People with ulcerative colitis should talk with their health care provider about how often they should get screened for colon cancer. Screening can include colonoscopy with biopsies or a special dye spray called chromoendoscopy.   Health care providers may recommend colonoscopy every 1 to 3 years for people with ulcerative colitis who have   - the disease in one-third or more or of their colon   - had ulcerative colitis for 8 years    Such screening does not reduce a person's chances of developing colon cancer. Instead, screening can help diagnose cancer early and improve chances for recovery.   Surgery to remove the entire colon eliminates the risk of colon cancer. </s>


Input: What to do for Ulcerative Colitis ?

Output: - Ulcerative colitis is a chronic, or long lasting, disease that causes inflammationirritation or swellingand sores called ulcers on the inner lining of the large intestine.  - The exact cause of ulcerative colitis is unknown. Researchers believe that factors such as an overactive intestinal immune system, genes, and environment may play a role in causing ulcerative colitis.  - Ulcerative colitis can occur in people of any age. However, it is more likely to develop in people      - between the ages of 15 and 30    - older than 60    - who have a family member with inflammatory bowel disease (IBD)    - of Jewish descent    - The most common signs and symptoms of ulcerative colitis are diarrhea with blood or pus and abdominal discomfort.  - A health care provider diagnoses ulcerative colitis with the following:      - medical and family history    - physical exam    - lab tests    - endoscopies of the large intestine    - Which treatment a person needs depends on the severity of the disease and symptoms.  - Good nutrition is important in the management of ulcerative colitis. A health care provider may recommend that a person make dietary changes.  - People with ulcerative colitis should talk with their health care provider about how often they should get screened for colon cancer. </s>


Input: What is (are) Short Bowel Syndrome ?

Output:
Short bowel syndrome is a group of problems related to poor absorption of nutrients. Short bowel syndrome typically occurs in people who have

- had at least half of their small intestine removed and sometimes all or part of their large intestine removed  - significant damage of the small intestine  - poor motility, or movement, inside the intestines

Short bowel syndrome may be mild, moderate, or severe, depending on how well the small intestine is working.

People with short bowel syndrome cannot absorb enough water, vitamins, minerals, protein, fat, calories, and other nutrients from food. What nutrients the small intestine has trouble absorbing depends on which section of the small intestine has been damaged or removed. </s>


Input: What is (are) Short Bowel Syndrome ?

Output:
The small intestine is the tube-shaped organ between the stomach and large intestine. Most food digestion and nutrient absorption take place in the small intestine. The small intestine is about 20 feet long and includes the duodenum, jejunum, and ileum:

duodenumthe first part of the small intestine, where iron and other minerals are absorbed

jejunumthe middle section of the small intestine, where carbohydrates, proteins, fat, and most vitamins are absorbed

ileumthe lower end of the small intestine, where bile acids and vitamin B12 are absorbed </s>


Input: What is (are) Short Bowel Syndrome ?

Output: The large intestine is about 5 feet long in adults and absorbs water and any remaining nutrients from partially digested food passed from the small intestine. The large intestine then changes waste from liquid to a solid matter called stool. </s>


Input: What causes Short Bowel Syndrome ?

Output:
The main cause of short bowel syndrome is surgery to remove a portion of the small intestine. This surgery can treat intestinal diseases, injuries, or birth defects.

Some children are born with an abnormally short small intestine or with part of their bowel missing, which can cause short bowel syndrome. In infants, short bowel syndrome most commonly occurs following surgery to treat necrotizing enterocolitis, a condition in which part of the tissue in the intestines is destroyed.1

Short bowel syndrome may also occur following surgery to treat conditions such as

- cancer and damage to the intestines caused by cancer treatment  - Crohn's disease, a disorder that causes inflammation, or swelling, and irritation of any part of the digestive tract  - gastroschisis, which occurs when the intestines stick out of the body through one side of the umbilical cord  - internal hernia, which occurs when the small intestine is displaced into pockets in the abdominal lining  - intestinal atresia, which occurs when a part of the intestines doesn't form completely  - intestinal injury from loss of blood flow due to a blocked blood vessel  - intestinal injury from trauma  - intussusception, in which one section of either the large or small intestine folds into itself, much like a collapsible telescope  - meconium ileus, which occurs when the meconium, a newborn's first stool, is thicker and stickier than normal and blocks the ileum  - midgut volvulus, which occurs when blood supply to the middle of the small intestine is completely cut off  - omphalocele, which occurs when the intestines, liver, or other organs stick out through the navel, or belly button

Even if a person does not have surgery, disease or injury can damage the small intestine. </s>


Input: How many people are affected by Short Bowel Syndrome ?

Output: Short bowel syndrome is a rare condition. Each year, short bowel syndrome affects about three out of every million people.1 </s>


Input: What are the symptoms of Short Bowel Syndrome ?

Output:
The main symptom of short bowel syndrome is diarrhealoose, watery stools. Diarrhea can lead to dehydration, malnutrition, and weight loss. Dehydration means the body lacks enough fluid and electrolyteschemicals in salts, including sodium, potassium, and chlorideto work properly. Malnutrition is a condition that develops when the body does not get the right amount of vitamins, minerals, and nutrients it needs to maintain healthy tissues and organ function. Loose stools contain more fluid and electrolytes than solid stools. These problems can be severe and can be life threatening without proper treatment.

Other signs and symptoms may include

- bloating  - cramping  - fatigue, or feeling tired  - foul-smelling stool  - heartburn  - too much gas  - vomiting  - weakness

People with short bowel syndrome are also more likely to develop food allergies and sensitivities, such as lactose intolerance. Lactose intolerance is a condition in which people have digestive symptomssuch as bloating, diarrhea, and gasafter eating or drinking milk or milk products.

More information is provided in the NIDDK health topic, Lactose Intolerance. </s>


Input: What are the complications of Short Bowel Syndrome ?

Output:
The complications of short bowel syndrome may include

- malnutrition  - peptic ulcerssores on the lining of the stomach or duodenum caused by too much gastric acid  - kidney stonessolid pieces of material that form in the kidneys  - small intestinal bacterial overgrowtha condition in which abnormally large numbers of bacteria grow in the small intestine

Seek Help for Signs or Symptoms of Severe Dehydration   People who have any signs or symptoms of severe dehydration should call or see a health care provider right away:   - excessive thirst   - dark-colored urine   - infrequent urination   - lethargy, dizziness, or faintness   - dry skin    Infants and children are most likely to become dehydrated. Parents or caretakers should watch for the following signs and symptoms of dehydration:   - dry mouth and tongue   - lack of tears when crying   - infants with no wet diapers for 3 hours or more   - infants with a sunken soft spot   - unusually cranky or drowsy behavior   - sunken eyes or cheeks   - fever    If left untreated, severe dehydration can cause serious health problems:   - organ damage   - shockwhen low blood pressure prevents blood and oxygen from getting to organs   - comaa sleeplike state in which a person is not conscious </s>


Input: What are the symptoms of Short Bowel Syndrome ?

Output:
People who have any signs or symptoms of severe dehydration should call or see a health care provider right away:

- excessive thirst  - dark-colored urine  - infrequent urination  - lethargy, dizziness, or faintness  - dry skin

Infants and children are most likely to become dehydrated. Parents or caretakers should watch for the following signs and symptoms of dehydration:

- dry mouth and tongue  - lack of tears when crying  - infants with no wet diapers for 3 hours or more  - infants with a sunken soft spot  - unusually cranky or drowsy behavior  - sunken eyes or cheeks  - fever

If left untreated, severe dehydration can cause serious health problems:

- organ damage  - shockwhen low blood pressure prevents blood and oxygen from getting to organs  - comaa sleeplike state in which a person is not conscious </s>


Input: How to diagnose Short Bowel Syndrome ?

Output:
A health care provider diagnoses short bowel syndrome based on

- a medical and family history  - a physical exam  - blood tests  - fecal fat tests  - an x-ray of the small and large intestines  - upper gastrointestinal (GI) series  - computerized tomography (CT) scan

Medical and Family History

Taking a medical and family history may help a health care provider diagnose short bowel syndrome. He or she will ask the patient about symptoms and may request a history of past operations.

Physical Exam

A physical exam may help diagnose short bowel syndrome. During a physical exam, a health care provider usually

- examines a patient's body, looking for muscle wasting or weight loss and signs of vitamin and mineral deficiencies  - uses a stethoscope to listen to sounds in the abdomen  - taps on specific areas of the patient's body

Blood Tests

A blood test involves drawing a patient's blood at a health care provider's office or a commercial facility and sending the sample to a lab for analysis. Blood tests can show mineral and vitamin levels and measure complete blood count.

Fecal Fat Tests

A fecal fat test measures the body's ability to break down and absorb fat. For this test, a patient provides a stool sample at a health care provider's office. The patient may also use a take-home test kit. The patient collects stool in plastic wrap that he or she lays over the toilet seat and places a sample into a container. A patient can also use a special tissue provided by the health care provider's office to collect the sample and place the tissue into the container. For children wearing diapers, the parent or caretaker can line the diaper with plastic to collect the stool. The health care provider will send the sample to a lab for analysis. A fecal fat test can show how well the small intestine is working.

X-ray

An x-ray is a picture created by using radiation and recorded on film or on a computer. The amount of radiation used is small. An x-ray technician performs the x-ray at a hospital or an outpatient center, and a radiologista doctor who specializes in medical imaginginterprets the images. An x-ray of the small intestine can show that the last segment of the large intestine is narrower than normal. Blocked stool causes the part of the intestine just before this narrow segment to stretch and bulge.

Upper Gastrointestinal Series

Upper GI series, also called a barium swallow, uses x rays and fluoroscopy to help diagnose problems of the upper GI tract. Fluoroscopy is a form of x ray that makes it possible to see the internal organs and their motion on a video monitor. An x-ray technician performs this test at a hospital or an outpatient center, and a radiologist interprets the images.

During the procedure, the patient will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the esophagus, stomach, and small intestine so the radiologist and a health care provider can see the shape of these organs more clearly on x-rays.

A patient may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract causes white or light-colored stools. A health care provider will give the patient specific instructions about eating and drinking after the test. Upper GI series can show narrowing and widening of the small and large intestines.

More information is provided in the NIDDK health topic, Upper GI Series.

Computerized Tomography Scan

Computerized tomography scans use a combination of x-rays and computer technology to create images. For a CT scan, a health care provider may give the patient a solution to drink and an injection of a special dye, called a contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device that takes x-rays.

An x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. The patient does not need anesthesia. CT scans can show bowel obstruction and changes in the intestines. </s>


Input: What are the treatments for Short Bowel Syndrome ?

Output:
A health care provider will recommend treatment for short bowel syndrome based on a patient's nutritional needs. Treatment may include

- nutritional support  - medications  - surgery  - intestinal transplant

Nutritional Support

The main treatment for short bowel syndrome is nutritional support, which may include the following:

- Oral rehydration. Adults should drink water, sports drinks, sodas without caffeine, and salty broths. Children should drink oral rehydration solutionsspecial drinks that contain salts and minerals to prevent dehydrationsuch as Pedialyte, Naturalyte, Infalyte, and CeraLyte, which are sold in most grocery stores and drugstores.  - Parenteral nutrition. This treatment delivers fluids, electrolytes, and liquid vitamins and minerals into the bloodstream through an intravenous (IV) tubea tube placed into a vein. Health care providers give parenteral nutrition to people who cannot or should not get their nutrition or enough fluids through eating.  - Enteral nutrition. This treatment delivers liquid food to the stomach or small intestine through a feeding tubea small, soft, plastic tube placed through the nose or mouth into the stomach. Gallstonessmall, pebblelike substances that develop in the gallbladderare a complication of enteral nutrition. More information is provided in the NIDDK health topic, Gallstones.  - Vitamin and mineral supplements. A person may need to take vitamin and mineral supplements during or after parenteral or enteral nutrition.  - Special diet. A health care provider can recommend a specific diet plan for the patient that may include      - small, frequent feedings    - avoiding foods that can cause diarrhea, such as foods high in sugar, protein, and fiber    - avoiding high-fat foods

Medications

A health care provider may prescribe medications to treat short bowel syndrome, including

- antibiotics to prevent bacterial overgrowth  - H2 blockers to treat too much gastric acid secretion  - proton pump inhibitors to treat too much gastric acid secretion  - choleretic agents to improve bile flow and prevent liver disease  - bile-salt binders to decrease diarrhea  - anti-secretin agents to reduce gastric acid in the intestine  - hypomotility agents to increase the time it takes food to travel through the intestines, leading to increased nutrient absorption  - growth hormones to improve intestinal absorption  - teduglutide to improve intestinal absorption

Surgery

The goal of surgery is to increase the small intestine's ability to absorb nutrients. Approximately half of the patients with short bowel syndrome need surgery.2 Surgery used to treat short bowel syndrome includes procedures that

- prevent blockage and preserve the length of the small intestine  - narrow any dilated segment of the small intestine  - slow the time it takes for food to travel through the small intestine  - lengthen the small intestine

Long-term treatment and recovery, which for some may take years, depend in part on

- what sections of the small intestine were removed  - how much of the intestine is damaged  - how well the muscles of the intestine work  - how well the remaining small intestine adapts over time

Intestinal Transplant

An intestinal transplant is surgery to remove a diseased or an injured small intestine and replace it with a healthy small intestine from a person who has just died, called a donor. Sometimes a living donor can provide a segment of his or her small intestine.

Transplant surgeonsdoctors who specialize in performing transplant surgeryperform the surgery on patients for whom other treatments have failed and who have lifethreatening complications from long-term parenteral nutrition. An intestinal-transplant team performs the surgery in a hospital. The patient will need anesthesia. Complications of intestinal transplantation include infections and rejection of the transplanted organ.

A successful intestinal transplant can be a life-saving treatment for people with intestinal failure caused by short bowel syndrome. By 2008, transplant surgeons had performed almost 2,000 intestinal transplantations in the United Statesapproximately 75 percent of which were in patients younger than 18 years of age.3

A health care provider will tailor treatment to the severity of the patient's disease:   - Treatment for mild short bowel syndrome involves eating small, frequent meals; drinking fluid; taking nutritional supplements; and using medications to treat diarrhea.   - Treatment for moderate short bowel syndrome is similar to that for mild short bowel syndrome, with the addition of parenteral nutrition as needed.   - Treatment for severe short bowel syndrome involves use of parenteral nutrition and oral rehydration solutions. Patients may receive enteral nutrition or continue normal eating, even though most of the nutrients are not absorbed. Both enteral nutrition and normal eating stimulate the remaining intestine to work better and may allow patients to discontinue parenteral nutrition. Some patients with severe short bowel syndrome require parenteral nutrition indefinitely or surgery. </s>


Input: How to prevent Short Bowel Syndrome ?

Output: People can ask their health care providers about surgical techniques that minimize scar tissue. Scientists have not yet found a way to prevent short bowel syndrome that is present at birth, as its cause is unknown. </s>


Input: What is (are) Short Bowel Syndrome ?

Output: Intestinal adaptation is a process that usually occurs in children after removal of a large portion of their small intestine. The remaining small intestine goes through a period of adaptation and grows to increase its ability to absorb nutrients. Intestinal adaptation can take up to 2 years to occur, and during this time a person may be heavily dependent on parenteral or enteral nutrition.1 </s>


Input: What to do for Short Bowel Syndrome ?

Output: Researchers have not found that eating, diet, and nutrition play a role in causing or preventing short bowel syndrome. </s>


Input: What to do for Short Bowel Syndrome ?

Output: - Short bowel syndrome is a group of problems related to poor absorption of nutrients.  - People with short bowel syndrome cannot absorb enough water, vitamins, minerals, protein, fat, calories, and other nutrients from food.  - The main symptom of short bowel syndrome is diarrhealoose, watery stools. Diarrhea can lead to dehydration, malnutrition, and weight loss.  - A health care provider will recommend treatment for short bowel syndrome based on a patient's nutritional needs. Treatment may include      - nutritional support    - medications    - surgery    - intestinal transplant </s>


Input: What is (are) Your Guide to Diabetes: Type 1 and Type 2 ?

Output:
Diabetes is when your blood glucose, also called blood sugar, is too high. Blood glucose is the main type of sugar found in your blood and your main source of energy. Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries glucose to all of your bodys cells to use for energy.

Your pancreasan organ, located between your stomach and spine, that helps with digestionreleases a hormone it makes, called insulin, into your blood. Insulin helps your blood carry glucose to all your bodys cells. Sometimes your body doesnt make enough insulin or the insulin doesnt work the way it should. Glucose then stays in your blood and doesnt reach your cells. Your blood glucose levels get too high and can cause diabetes or prediabetes.

Over time, having too much glucose in your blood can cause health problems.

*See the Pronunciation Guide for tips on how to say the the words in bold type. </s>


Input: What is (are) Your Guide to Diabetes: Type 1 and Type 2 ?

Output: Prediabetes is when the amount of glucose in your blood is above normal yet not high enough to be called diabetes. With prediabetes, your chances of getting type 2 diabetes, heart disease, and stroke are higher. With some weight loss and moderate physical activity, you can delay or prevent type 2 diabetes. You can even return to normal glucose levels, possibly without taking any medicines. </s>


Input: What are the symptoms of Your Guide to Diabetes: Type 1 and Type 2 ?

Output:
The signs and symptoms of diabetes are

- being very thirsty  - urinating often  - feeling very hungry  - feeling very tired  - losing weight without trying  - sores that heal slowly  - dry, itchy skin  - feelings of pins and needles in your feet  - losing feeling in your feet  - blurry eyesight

Some people with diabetes dont have any of these signs or symptoms. The only way to know if you have diabetes is to have your doctor do a blood test. </s>


Input: What is (are) Hashimoto's Disease ?

Output:
Hashimotos disease, also called chronic lymphocytic thyroiditis or autoimmune thyroiditis, is an autoimmune disease. An autoimmune disease is a disorder in which the bodys immune system attacks the bodys own cells and organs. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances.

In Hashimotos disease, the immune system attacks the thyroid gland, causing inflammation and interfering with its ability to produce thyroid hormones. Large numbers of white blood cells called lymphocytes accumulate in the thyroid. Lymphocytes make the antibodies that start the autoimmune process.

Hashimotos disease often leads to reduced thyroid function, or hypothyroidism. Hypothyroidism is a disorder that occurs when the thyroid doesnt make enough thyroid hormone for the bodys needs. Thyroid hormones regulate metabolismthe way the body uses energyand affect nearly every organ in the body. Without enough thyroid hormone, many of the bodys functions slow down. Hashimotos disease is the most common cause of hypothyroidism in the United States.1

More information is provided in the NIDDK health topic, Hypothyroidism. </s>


Input: What is (are) Hashimoto's Disease ?

Output:
The thyroid is a 2-inch-long, butterfly-shaped gland weighing less than 1 ounce. Located in the front of the neck below the larynx, or voice box, it has two lobes, one on either side of the windpipe.

The thyroid is one of the glands that make up the endocrine system. The glands of the endocrine system produce and store hormones and release them into the bloodstream. The hormones then travel through the body and direct the activity of the bodys cells.

The thyroid makes two thyroid hormones, triiodothyronine (T3) and thyroxine (T4). T3 is the active hormone and is made from T4. Thyroid hormones affect metabolism, brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, and cholesterol levels.

Thyroid-stimulating hormone (TSH), which is made by the pituitary gland in the brain, regulates thyroid hormone production. When thyroid hormone levels in the blood are low, the pituitary releases more TSH. When thyroid hormone levels are high, the pituitary decreases TSH production. </s>


Input: What are the symptoms of Hashimoto's Disease ?

Output:
Many people with Hashimotos disease have no symptoms at first. As the disease slowly progresses, the thyroid usually enlarges and may cause the front of the neck to look swollen. The enlarged thyroid, called a goiter, may create a feeling of fullness in the throat, though it is usually not painful. After many years, or even decades, damage to the thyroid causes it to shrink and the goiter to disappear.

Not everyone with Hashimotos disease develops hypothyroidism. For those who do, the hypothyroidism may be subclinicalmild and without symptoms, especially early in its course. With progression to hypothyroidism, people may have one or more of the following symptoms:

- fatigue  - weight gain  - cold intolerance  - joint and muscle pain  - constipation, or fewer than three bowel movements a week  - dry, thinning hair  - heavy or irregular menstrual periods and problems becoming pregnant  - depression  - memory problems  - a slowed heart rate </s>


Input: How to diagnose Hashimoto's Disease ?

Output:
Diagnosis begins with a physical exam and medical history. A goiter, nodules, or growths may be found during a physical exam, and symptoms may suggest hypothyroidism. Health care providers will then perform blood tests to confirm the diagnosis. A blood test involves drawing blood at a health care providers office or a commercial facility and sending the sample to a lab for analysis. Diagnostic blood tests may include the

- TSH test. The ultrasensitive TSH test is usually the first test performed. This test detects even tiny amounts of TSH in the blood and is the most accurate measure of thyroid activity available. Generally, a TSH reading above normal means a person has hypothyroidism.  - T4 test. The T4 test measures the actual amount of thyroid hormone circulating in the blood. In hypothyroidism, the level of T4 in the blood is lower than normal.  - antithyroid antibody test. This test looks for the presence of thyroid autoantibodies, or molecules produced by a persons body that mistakenly attack the bodys own tissues. Two principal types of antithyroid antibodies are      - anti-TG antibodies, which attack a protein in the thyroid called thyroglobulin    - anti-thyroperoxidase (TPO) antibodies, which attack an enzyme called thyroperoxidase in thyroid cells that helps convert T4 to T3. Having TPO autoantibodies in the blood means the bodys immune system attacked the thyroid tissue in the past. Most people with Hashimotos disease have these antibodies, although people whose hypothyroidism is caused by other conditions do not.

A health care provider may also order imaging tests, including an ultrasound or a computerized tomography (CT) scan.

- Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician performs the procedure in a health care providers office, an outpatient center, or a hospital, and a radiologista doctor who specializes in medical imaginginterprets the images; a patient does not need anesthesia.

- The images can show the size and texture of the thyroid, as well as a pattern of typical autoimmune inflammation, helping the health care provider confirm Hashimotos disease. The images can also show nodules or growths within the gland that suggest a malignant tumor.

- CT scan. CT scans use a combination of x rays and computer technology to create images. For a CT scan, a health care provider may give the patient a solution to drink and an injection of a special dye, called contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device where the x rays are taken. An x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. The patient does not need anesthesia. In some cases of Hashimotos disease, a CT scan is used to examine the placement and extent of a large goiter, and to show a goiters effect on nearby structures.

More information is provided in the NIDDK health topic, Thyroid Tests. </s>


Input: What are the treatments for Hashimoto's Disease ?

Output:
Treatment generally depends on whether the thyroid is damaged enough to cause hypothyroidism. In the absence of hypothyroidism, some health care providers treat Hashimotos disease to reduce the size of the goiter. Others choose not to treat the disease and simply monitor their patients for disease progression.

Hashimotos disease, with or without hypothyroidism, is treated with synthetic thyroxine, which is man-made T4. Health care providers prefer to use synthetic T4, such as Synthroid, rather than synthetic T3, because T4 stays in the body longer, ensuring a steady supply of thyroid hormone throughout the day. The thyroid preparations made with animal thyroid are not considered as consistent as synthetic thyroid (Levothyroxine) and rarely prescribed today.

Health care providers routinely test the blood of patients taking synthetic thyroid hormone and adjust the dose as necessary, typically based on the result of the TSH test. Hypothyroidism can almost always be completely controlled with synthetic thyroxine, as long as the recommended dose is taken every day as instructed. </s>


Input: What to do for Hashimoto's Disease ?

Output:
Iodine is an essential mineral for the thyroid. However, people with Hashimotos disease may be sensitive to harmful side effects from iodine. Taking iodine drops or eating foods containing large amounts of iodinesuch as seaweed, dulse, or kelpmay cause or worsen hypothyroidism. Read more in Iodine in diet at www.nlm.nih.gov/medlineplus/ency/article/002421.htm.

Women need more iodine when they are pregnantabout 220 micrograms a daybecause the baby gets iodine from the mothers diet. Women who are breastfeeding need about 290 micrograms a day. In the United States, about 7 percent of pregnant women may not get enough iodine in their diet or through prenatal vitamins.3 Pregnant women should choose iodized saltsalt supplemented with iodineover plain salt and take prenatal vitamins containing iodine to ensure this need is met.

To help ensure coordinated and safe care, people should discuss their use of complementary and alternative medical practices, including their use of dietary supplements such as iodine, with their health care provider. Tips for talking with health care providers are available through the National Center for Complementary and Integrative Health. </s>


Input: What to do for Hashimoto's Disease ?

Output: - Hashimotos disease, also called chronic lymphocytic thyroiditis or autoimmune thyroiditis, is an autoimmune disease.  - Hashimotos disease often leads to reduced thyroid function, or hypothyroidism. Hypothyroidism is a disorder that occurs when the thyroid doesnt make enough thyroid hormone for the bodys needs.  - Hashimotos disease is the most common cause of hypothyroidism in the United States. Many people with Hashimotos disease have no symptoms at first. As the disease slowly progresses, the thyroid usually enlarges and may cause the front of the neck to look swollen. The enlarged thyroid, called a goiter, may create a feeling of fullness in the throat, though it is usually not painful.  - Not everyone with Hashimotos disease develops hypothyroidism. For those who do, the hypothyroidism may be subclinicalmild and without symptoms, especially early in its course.  - Hashimotos disease is much more common in women than men. Although the disease often occurs in adolescent or young women, it more commonly appears between 30 and 50 years of age.  - Hashimotos disease, with or without hypothyroidism, is treated with synthetic thyroxine, which is man-made T4.  - Women with Hashimotos disease should discuss their condition with their health care provider before becoming pregnant.  - Pregnant women should choose iodized saltsalt supplemented with iodineover plain salt and take prenatal vitamins containing iodine.  - People should discuss their use of dietary supplements, such as iodine, with their health care provider. </s>


Input: What is (are) Urinary Incontinence in Children ?

Output:
Urinary incontinence is the loss of bladder control, which results in the accidental loss of urine. A child with UI may not stay dry during the day or night. Some UI is caused by a health problem such as

- a urinary tract infection (UTI)  - diabetes, a condition where blood glucose, also called blood sugar, is too high  - kidney problems  - nerve problems  - constipation, a condition in which a child has fewer than two bowel movements a week and stools can be hard, dry, small, and difficult to pass  - obstructive sleep apnea (OSA), a condition in which breathing is interrupted during sleep, often because of inflamed or enlarged tonsils  - a structural problem in the urinary tract

Most of the time, the exact cause of UI is not known, but it is often the result of more than one factor.

Although UI affects many children, it usually disappears naturally over time. UI after age 3the age when most children achieve daytime drynessmay cause great distress and embarrassment. Many children experience occasional UI, and treatment is available for most children who have a hard time controlling their bladder. Thus, caregivers of children who wet the bed or have accidents during the day should approach this problem with understanding and patience.

The age at which children achieve dryness varies. Wetting in younger children is common and not considered UI, so daytime UI is not usually diagnosed until age 5 or 6, and nighttime UI is not usually diagnosed until age 7.

Enuresis   Urinary incontinence is also called enuresis. Types of enuresis include the following:   - Primary enuresis is wetting in a child who has never been consistently dry.   - Secondary enuresis is wetting that begins after at least 6 months of dryness.   - Nocturnal enuresis is wetting that usually occurs during sleep, also called nighttime UI.   - Diurnal enuresis is wetting when awake, also called daytime UI. </s>


Input: How many people are affected by Urinary Incontinence in Children ?

Output: By 5 years of age, more than 90 percent of children can control urination during the day. Nighttime wetting is more common than daytime wetting in children, affecting 30 percent of 4-year-olds. The condition resolves itself in about 15 percent of children each year; about 10 percent of 7-year-olds, 3 percent of 12-year-olds, and 1 percent of 18-year-olds continue to experience nighttime wetting.1 </s>


Input: What causes Urinary Incontinence in Children ?

Output:
The exact cause of most cases of nighttime UI is not known. Though a few cases are caused by structural problems in the urinary tract, most cases probably result from a mix of factors including slower physical development, an overproduction of urine at night, and the inability to recognize bladder filling when asleep. Nighttime UI has also been associated with attention deficit hyperactivity disorder (ADHD), OSA, and anxiety. Children also may inherit genes from one or both parents that make them more likely to have nighttime UI.

Slower Physical Development

Between the ages of 5 and 10, bedwetting may be the result of a small bladder capacity, long sleeping periods, and underdevelopment of the bodys alarms that signal a full or emptying bladder. This form of UI fades away as the bladder grows and the natural alarms become operational.

Overproduction of Urine at Night

The body produces antidiuretic hormone (ADH), a natural chemical that slows down the production of urine. More ADH is produced at night so the need to urinate lessens. If the body does not produce enough ADH at night, the production of urine may not slow down, leading to bladder overfilling. If a child does not sense the bladder filling and awaken to urinate, wetting will occur.

Structural Problems

A small number of UI cases are caused by physical problems in the urinary tract. Rarely, a blocked bladder or urethra may cause the bladder to overfill and leak. Nerve damage associated with the birth defect spina bifida can cause UI. In these cases, UI can appear as a constant dribbling of urine.

Attention Deficit Hyperactivity Disorder

Children with ADHD are three times more likely to have nighttime UI than children without ADHD.2 The connection between ADHD and bedwetting has not been explained, but some experts theorize that both conditions are related to delays in central nervous system development.

Obstructive Sleep Apnea

Nighttime UI may be one sign of OSA. Other symptoms of OSA include snoring, mouth breathing, frequent ear and sinus infections, sore throat, choking, and daytime drowsiness. Experts believe that when the airway in people with OSA closes, a chemical may be released in the body that increases water production and inhibits the systems that regulate fluid volume. Successful treatment of OSA often resolves the associated nighttime UI.

Anxiety

Anxiety-causing events that occur between 2 and 4 years of agebefore total bladder control is achievedmight lead to primary enuresis. Anxiety experienced after age 4 might lead to secondary enuresis in children who have been dry for at least 6 months. Events that cause anxiety in children include physical or sexual abuse; unfamiliar social situations, such as moving or starting at a new school; and major family events such as the birth of a sibling, a death, or divorce.

UI itself is an anxiety-causing event. Strong bladder contractions resulting in daytime leakage can cause embarrassment and anxiety that lead to nighttime wetting.

Genetics

Certain genes have been found to contribute to UI. Children have a 30 percent chance of having nighttime UI if one parent was affected as a child. If both parents were affected, there is a 70 percent chance of bedwetting.1 </s>


Input: What causes Urinary Incontinence in Children ?

Output:
Daytime UI can be caused by a UTI or structural problems in the urinary tract. Daytime UI that is not associated with UTI or structural problems is less common and tends to disappear much earlier than nighttime UI. Overactive bladder and infrequent or incomplete voiding, or urination, are common causes of daytime UI.

Overactive Bladder

Overactive bladder is a condition in which a child experiences at least two of the following conditions:

- urinary urgencyinability to delay urination  - urge urinary incontinenceurinary leakage when the bladder contracts unexpectedly  - urinary frequencyurination eight or more times a day or more than twice at night

Infrequent or Incomplete Voiding

Infrequent voiding is when children voluntarily hold urine for prolonged periods of time. For example, children may not want to use the toilets at school or may not want to interrupt enjoyable activities, so they ignore the bodys signal of a full bladder. In these cases, the bladder can overfill and leak urine. In addition, these children often develop UTIs, leading to an irritated or overactive bladder.

Factors that may combine with infrequent voiding to produce daytime UI include

- small bladder capacity  - structural problems  - anxiety-causing events  - pressure from constipation  - drinks or foods that contain caffeine

Sometimes, overly demanding toilet training may make children unable to relax the sphincters enough to completely empty the bladder. Incomplete voiding may also lead to UTIs. </s>


Input: What are the treatments for Urinary Incontinence in Children ?

Output:
Most UI fades away naturally as a child grows and develops and does not require treatment. When treatment is needed, options include bladder training and related strategies, moisture alarms, and medications.

Growth and Development

As children mature

- bladder capacity increases  - natural body alarms become activated  - an overactive bladder settles down  - production of ADH becomes normal  - response to the bodys signal that it is time to void improves

Bladder Training and Related Strategies

Bladder training consists of exercises to strengthen the bladder muscles to better control urination. Gradually lengthening the time between trips to the bathroom can also help by stretching the bladder so it can hold more urine. Additional techniques that may help control daytime UI include

- urinating on a scheduletimed voidingsuch as every 2 hours  - avoiding food or drinks with caffeine  - following suggestions for healthy urination, such as relaxing muscles and taking enough time to allow the bladder to empty completely

Waking children up to urinate can help decrease nighttime UI. Ensuring children drink enough fluids throughout the day so they do not drink a lot of fluids close to bedtime may also help. A health care provider can give guidance about how much a child needs to drink each day, as the amount depends on a childs age, physical activity, and other factors.

Moisture Alarms

At night, moisture alarms can wake children when they begin to urinate. These devices use a water-sensitive pad connected to an alarm that sounds when moisture is first detected. A small pad can clip to the pajamas, or a larger pad can be placed on the bed. For the alarm to be effective, children must awaken as soon as the alarm goes off, stop the urine stream, and go to the bathroom. Children using moisture alarms may need to have someone sleep in the same room to help wake them up.

Medications

Nighttime UI may be treated by increasing ADH levels. The hormone can be boosted by a synthetic version known as desmopressin (DDAVP), which is available in pill form, nasal spray, and nose drops. DDAVP is approved for use in children. Another medication, called imipramine (Tofranil), is also used to treat nighttime UI, though the way this medication prevents bedwetting is not known. Although both of these medications may help children achieve short-term success, relapse is common once the medication is withdrawn.

UI resulting from an overactive bladder may be treated with oxybutynin (Ditropan), a medication that helps calm the bladder muscle and control muscle spasms. </s>


Input: What to do for Urinary Incontinence in Children ?

Output: Eating, diet, and nutrition have not been shown to play a role in causing or preventing UI in children, though ensuring sufficient fluid intake throughout the day and avoiding caffeine intake may be helpful. </s>


Input: What to do for Urinary Incontinence in Children ?

Output: - Urinary incontinence (UI) is the loss of bladder control, which results in the accidental loss of urine. A child with UI may not stay dry during the day or night. Although UI affects many children, it usually disappears naturally over time.  - By 5 years of age, more than 98 percent of children can control urination during the day. Nighttime wetting is more common than daytime wetting in children, affecting 30 percent of 4-year-olds.  - The exact cause of most cases of nighttime UI is not known. Though a few cases are caused by structural problems in the urinary tract, most cases result from more than one factor including slower physical development, an overproduction of urine at night, and the inability to recognize bladder filling when asleep.  - Nighttime UI has also been associated with attention deficit hyperactivity disorder (ADHD), obstructive sleep apnea (OSA), and anxiety. Certain genes have been found to contribute to UI.  - Daytime UI that is not associated with urinary tract infection (UTI) or structural problems in the urinary tract may be due to an overactive bladder or infrequent or incomplete voiding problems.  - Most UI fades away naturally as a child grows and develops and does not require treatment. When treatment is needed, options include bladder training and related strategies, moisture alarms, and medications. </s>


Input: What is (are) Chronic Diarrhea in Children ?

Output:
Diarrhea is loose, watery stools. Chronic, or long lasting, diarrhea typically lasts for more than 4 weeks. Children with chronic diarrhea may have loose, watery stools continually, or diarrhea may come and go. Chronic diarrhea may go away without treatment, or it may be a symptom of a chronic disease or disorder. Treating the disease or disorder can relieve chronic diarrhea.

Chronic diarrhea can affect children of any age:

- infantsages 0 to 12 months  - toddlersages 1 to 3 years  - preschool-age childrenages 3 to 5 years  - grade school-age childrenages 5 to 12 years  - adolescentsages 12 to 18 years

Diarrhea that lasts only a short time is called acute diarrhea. Acute diarrhea, a common problem, usually lasts a few days and goes away on its own. More information about acute diarrhea is provided in the NIDDK health topics:

- Diarrhea  - What I need to know about Diarrhea </s>


Input: What causes Chronic Diarrhea in Children ?

Output:
Many diseases and disorders can cause chronic diarrhea in children. Common causes include

- infections  - functional gastrointestinal (GI) disorders  - food allergies and intolerances  - inflammatory bowel disease (IBD)

Infections, food allergies and intolerances, and IBD may cause chronic diarrhea along with malabsorption, meaning the small intestine does not absorb nutrients from food. If children do not absorb enough nutrients from the food they eat, they may become malnourished. Functional GI disorders do not cause malabsorption.

Infections

Infections from viruses, bacteria, or parasites sometimes lead to chronic diarrhea. After an infection, some children have problems digesting carbohydrates, such as lactose, or proteins, such as milk or soy proteins. These problems can cause prolonged diarrheaoften for up to 6 weeksafter an infection. Also, some bacteria and parasite infections that cause diarrhea do not go away quickly without treatment.

More information about infections that cause diarrhea is provided in the NIDDK health topics:

- Viral Gastroenteritis  - Foodborne Illnesses

Small intestinal bacterial overgrowth may also cause chronic diarrhea. Normally, few bacteria live in the small intestine, and many bacteria live in the large intestine. Small intestinal bacterial overgrowth is an increase in the number of bacteria or a change in the type of bacteria in the small intestine. These bacteria can cause diarrhea, gas, cramping, and weight loss. Small intestinal bacterial overgrowth is often related to diseases or disorders that damage the digestive system or affect how it works, such as Crohns disease or diabetes. Small intestinal bacterial overgrowth is also more common in people who have had abdominal surgery or who have slow-moving intestines.

Functional Gastrointestinal Disorders

In functional GI disorders, symptoms are caused by changes in how the GI tract works. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anusthe opening through which stool leaves the body. The GI tract digests, or breaks down, food and processes solid waste.

Children with a functional GI disorder have frequent symptoms, yet the GI 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 toddlers diarrhea and irritable bowel syndrome (IBS).

Toddlers diarrhea. Toddlers diarrheaalso called functional diarrhea or chronic nonspecific diarrhea of childhoodis a common cause of chronic diarrhea in toddlers and preschool-age children. Children with this disorder pass three or more loose stools a day and do not have any other symptoms. They typically are growing well and gaining weight, and are healthy.

Toddlers 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 a diet with too much sugarsuch as the sugar found in fruit juicerelative to the amount of fat and fiber may cause toddlers diarrhea.

IBS. The most common symptoms of IBS are abdominal pain or discomfort, often reported as cramping, along with changes in bowel habits, such as diarrhea. 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.

Possible causes include problems with nerves in the intestines, problems with nerve signals between the brain and the intestines, changes in how food moves through the intestines, and hypersensitivity to pain. Psychological problems, such as anxiety and depression, or food sensitivity may also play a role.

IBS is a common cause of chronic diarrhea in grade school-age children and adolescents. Health care providers rarely diagnose IBS in younger children because younger children are not able to report symptoms of pain or discomfort. More information is provided in the NIDDK health topics:

- Irritable Bowel Syndrome  - Irritable Bowel Syndrome in Children

Food Allergies and Intolerances

Food allergies, celiac disease, lactose intolerance, and dietary fructose intolerance are common causes of chronic diarrhea.

Food allergies. A food allergy is a reaction by the immune system, the bodys natural defense system, to one or more proteins in certain foods. The immune system normally protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances that can cause illness. In food allergies, however, the immune system responds abnormally to certain foods.

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

Symptoms of food allergies may include diarrhea, vomiting, and weight loss or poor weight gain. Some children have mild symptoms, while others have severe or life-threatening symptoms. For example, some children have severe vomiting and diarrhea that lead to dehydration, which means the body lacks enough fluid and electrolytesminerals in salts, including sodium, potassium, and chlorideto function properly.

Celiac disease. Celiac disease is an autoimmune disease in which people cannot tolerate gluten. A chronic reaction to gluten damages the lining of their small intestine and prevents absorption of nutrients. Gluten is a protein found in wheat, rye, and barley and in vitamin and nutrient supplements, lip balms, communion wafers, and certain medications.

Children of any age can experience digestive symptoms of celiac disease or have symptoms in other parts of the body. Digestive symptoms can include

- chronic diarrhea  - abdominal bloating  - stomach pain  - gas  - vomiting  - constipation  - pale, foul-smelling, or fatty stool

Malabsorption of nutrients during the years when nutrition is critical to a childs normal growth and development can result in other health problems. These problems may include

- failure to thrive in infants  - slowed growth and short stature  - weight loss  - irritability or mood changes  - delayed puberty  - dental enamel defects of the permanent teeth  - anemia, a condition in which red blood cells are fewer or smaller than normal, which prevents the bodys cells from getting enough oxygen  - low levels of important nutrients such as iron and calcium

More information is provided in the NIDDK health topics:

- Celiac Disease  - What I need to know about Celiac Disease

Lactose intolerance. Lactose intolerance is a condition in which people have digestive symptomssuch as bloating, gas, and diarrheaafter consuming milk or milk products. Lactose is a sugar found in milk or milk products. Lactase, an enzyme produced by the small intestine, breaks down lactose into two simpler forms of sugar: glucose and galactose. The bloodstream then absorbs these simpler sugars.

Some children have a lactase deficiency, meaning the small intestine produces low levels of lactase and cannot digest much lactose. Lactase deficiency may cause lactose malabsorption. In children with lactose malabsorption, undigested lactose passes to the colon, where bacteria break down the lactose and create fluid and gas.

Not all children with lactase deficiency and lactose malabsorption have digestive symptoms. Experts use the term lactose intolerance when lactase deficiency and lactose malabsorption cause digestive symptoms.

The most common type of lactase deficiency develops over time, beginning after about age 2, when the body begins to produce less lactase. Children who have lactase deficiency may not experience symptoms of lactose intolerance until late adolescence or adulthood.

Infants rarely have lactose intolerance at birth. People sometimes mistake cows milk allergy, which can cause diarrhea in infants, for lactose intolerance. Congenital lactase deficiencyan extremely rare inherited genetic disorder in which the small intestine produces little or no lactase enzyme at birthcan cause lactose intolerance in infants. Premature infants may experience lactose intolerance for a short time after birth. Children of any age may develop temporary lactose intolerance after a viral diarrheal episode or other infection.

More information is provided in the NIDDK health topics:

- Lactose Intolerance  - What I need to know about Lactose Intolerance

Dietary fructose intolerance. Dietary fructose intolerance is a condition in which people have digestive symptomssuch as bloating, gas, and diarrheaafter consuming foods that contain fructose. Fructose is a sugar found in fruits, fruit juices, and honey. Fructose is also added to many foods and soft drinks as a sweetener called high fructose corn syrup.

Fructose malabsorption causes dietary fructose intolerance. The small intestine absorbs fructose, and, when a person consumes more fructose than the small intestine can absorb, fructose malabsorption results. Unabsorbed fructose passes to the colon, where bacteria break down the fructose and create fluid and gas.

The amount of fructose that a childs small intestine can absorb varies. The capacity of the small intestine to absorb fructose increases with age. Some children may be able to tolerate more fructose as they get older.

Another type of fructose intolerance, hereditary fructose intolerance, is not related to fructose malabsorption. Hereditary fructose intolerance is an extremely rare inherited genetic disorder. Children with this disorder lack an enzyme needed to break down fructose. Symptoms of hereditary fructose intolerance may include abdominal pain, vomiting, and diarrhea. This disorder can also damage the liver and kidneys.

Inflammatory Bowel Disease

Inflammatory bowel disease causes irritation and inflammation in the intestines. The two main types of IBD are ulcerative colitis and Crohns disease. These disorders can affect children at any age; however, they commonly begin in the grade school years or in adolescence. The causes of IBD are unknown. Researchers believe they result from an abnormal immune system reaction.

Ulcerative colitis. Ulcerative colitis is a disease that causes inflammation, or swelling, and ulcers in the inner lining of the large intestine. The large intestine includes the colon and the rectumthe lower end of the large intestine leading to the anus. Normally, the large intestine absorbs water from stool and changes it from a liquid to a solid. In ulcerative colitis, the inflammation causes loss of the lining of the large intestine, leading to bleeding, production of pus, diarrhea, and abdominal discomfort.

More information is provided in the NIDDK health topic, Ulcerative Colitis.

Crohns disease. Crohns disease is a disease that causes inflammation and irritation of any part of the GI tract. The end part of the small intestine, called the ileum, is most commonly affected. In Crohns disease, inflammation can extend through the entire wall of the GI tract, leading to possible complications. Swelling can cause pain and can make the intestine empty frequently, resulting in diarrhea.

More information is provided in the NIDDK health topics:

- Crohns Disease  - What I need to know about Crohns Disease </s>


Input: What are the symptoms of Chronic Diarrhea in Children ?

Output:
Symptoms that accompany chronic diarrhea in children depend on the cause of the diarrhea. Symptoms can include

- cramping  - abdominal pain  - nausea or vomiting  - fever  - chills  - bloody stools

Children with chronic diarrhea who have malabsorption can experience

- bloating and swelling, also called distention, of the abdomen  - changes in appetite  - weight loss or poor weight gain

Consult a Health Care Provider   A childs parent or caretaker should consult a health care provider if the child   - has diarrhea for more than 24 hours   - is younger than 6 months old   - has received treatment and the diarrhea persists    Children with any of the following symptoms should see a health care provider right away:   - signs of malabsorptionbloating and swelling of the abdomen, changes in appetite, and weight loss or poor weight gain   - severe abdominal or rectal pain   - a fever of 102 degrees or higher   - stools containing blood or pus    More information is provided in the NIDDK health topics:   - Diarrhea   - What I need to know about Diarrhea </s>


Input: What causes Chronic Diarrhea in Children ?

Output:
To determine the cause of chronic diarrhea in children, the health care provider will take a complete medical and family history and conduct a physical exam, and may perform tests.

Medical and family history. Taking a medical and family history is one of the first things a health care provider may do to help determine the cause of chronic diarrhea. He or she will ask for information about symptoms, such as

- how long the child has had diarrhea  - the amount of stool passed  - the frequency of diarrhea  - the appearance of the stool  - the presence of other symptoms that accompany diarrhea

The health care provider will ask about the childs diet and may recommend keeping a diary of the childs diet and bowel habits. If the health care provider suspects a food allergy or intolerance, he or she may recommend changing the childs diet to see if symptoms improve.

The health care provider may also ask about family medical history. Some of the conditions that cause chronic diarrhea, such as celiac disease and lactose intolerance, run in families.

Physical exam. After taking a medical history, a health care provider will perform a physical exam, which may help determine the cause of chronic diarrhea. During a physical exam, a health care provider usually

- examines a childs body  - uses a stethoscope to listen to bodily sounds  - taps on specific areas of the childs body

Tests. The health care provider may perform one or more of the following tests:

- Stool test. A stool test is the analysis of a sample of stool. The health care provider will give the parent or caretaker a container for catching and storing the stool. The parent or caretaker returns the sample to the health care provider or a commercial facility that will send the sample to a lab for analysis. Stool tests can show the presence of blood, bacteria, or parasites or signs of diseases and disorders. The health care provider may also do a rectal exam, sometimes during the physical exam. For a rectal exam, the health care provider inserts a gloved, lubricated finger into the rectum to check for blood in the stool.    - Blood test. A blood test involves drawing blood at a health care providers office or a commercial facility and sending the sample to a lab for analysis. The blood test can show signs of certain diseases and disorders that can cause chronic diarrhea in children, including      - high levels of white blood cells, which may be a sign of inflammation or infection somewhere in the body    - anemia, which may be a sign of bleeding in the GI tract or of malabsorption    - the presence of certain antibodiesproteins that react against the bodys own cells or tissueswhich may be a sign of celiac disease      - Hydrogen breath test. This test measures the amount of hydrogen in a childs breath. Normally, only a small amount of hydrogen is detectable in the breath. However, bacteria break down sugarssuch as lactose and fructosethat are not digested by the small intestine and produce high levels of hydrogen. In small intestinal bacterial overgrowth, bacteria break down sugars in the small intestine and produce hydrogen.  For this test, the child breathes into a balloonlike container that measures hydrogen. Then, the child drinks a lactose-loaded beverage, and the childs breath is analyzed at regular intervals to measure the amount of hydrogen. In most cases, a health care provider performs this test at a hospital, on an outpatient basis. A health care provider may use a hydrogen breath test to check for signs of lactose intolerance, fructose intolerance, or small intestinal bacterial overgrowth.    - Upper GI endoscopy. This procedure involves using an endoscopea small, flexible tube with a lightto see the upper GI tract, which includes the esophagus, stomach, and duodenum, the first part of the small intestine. A gastroenterologista doctor who specializes in digestive diseasesperforms the test at a hospital or an outpatient center. The endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A child may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. A health care provider will place an intravenous (IV) needle in a vein in the arm if general anesthesia is given.  The health care provider may use instruments passed through the endoscope to perform a biopsy or collect fluid. A biopsy is a procedure that involves taking a piece of tissue for examination with a microscope. A pathologista doctor who specializes in diagnosing diseasesexamines the tissues in a lab. This test can show problems in the upper GI tract that may cause chronic diarrhea. For example, a biopsy of the small intestine can show signs of celiac disease. A health care provider may use a fluid sample from the small intestine to check for bacteria to diagnose small intestinal bacterial overgrowth.    - Flexible sigmoidoscopy or colonoscopy. While these tests are similar, a health care provider uses a colonoscopy to view the rectum and entire colon and a flexible sigmoidoscopy to view just the rectum and lower colon. A gastroenterologist performs these tests at a hospital or an outpatient center. For both tests, the health care provider will give written bowel prep instructions for the child to follow at home. The health care provider may ask that the child follow a clear liquid diet the day before either test. The child may require a laxative for 4 days before either test or only the day before either test. The child may require an enema the day before either test. These medications cause diarrhea, so the child should stay close to a bathroom during the bowel prep.  In most cases, light anesthesia, and possibly pain medication, helps the child relax. For either test, the child will lie on a table while the gastroenterologist inserts a flexible tube into the anus. A small camera on the tube sends a video image of the intestinal lining to a computer screen. The gastroenterologist may also perform a biopsy by taking a small piece of tissue from the intestinal lining. The child will not feel the biopsy. These tests can show problems in the rectum or colon, such as signs of IBD.  Cramping or bloating may occur during the first hour after these tests. The child should recover fully by the next day and be able to return to a normal diet. </s>


Input: What are the treatments for Chronic Diarrhea in Children ?

Output:
The treatment for chronic diarrhea will depend on the cause. Some common causes of chronic diarrhea are treated as follows:

- Infections. If a child has prolonged problems digesting certain carbohydrates or proteins after an acute infection, a health care provider may recommend changes in diet. A child may need antibiotics or medications that target parasites to treat infections that do not go away on their own. A health care provider may also prescribe antibiotics to treat small intestinal bacterial overgrowth.    - Functional GI disorders. For toddlers diarrhea, treatment is usually not needed. Most children outgrow toddlers diarrhea by the time they start school. In many children, limiting fruit juice intake and increasing the amount of fiber and fat in the diet may improve symptoms of toddlers diarrhea.  A health care provider may treat IBS with      - changes in diet.    - medication.    - probioticslive microorganisms, usually bacteria, that are similar to microorganisms normally found in the GI tract. Studies have found that probiotics, specifically Bifidobacteria and certain probiotic combinations, improve symptoms of IBS when taken in large enough amounts. However, researchers are still studying the use of probiotics to treat IBS.    - psychological therapy.

To help ensure coordinated and safe care, people should discuss their use of complementary and alternative medical practices, including their use of dietary supplements and probiotics, with their health care provider. Read more at www.nccam.nih.gov/health/probiotics.

- Food allergies and intolerances. A health care provider will recommend changes in diet to manage symptoms of food allergies and intolerances. To treat food allergies, the childs parent or caretaker should remove the food that triggers the allergy from the childs diet.  For children with celiac disease, following a gluten-free diet will stop symptoms, heal existing intestinal damage, and prevent further damage.  The childs parent or caretaker can manage the symptoms of lactose intolerance with changes in the childs diet and by using products that contain the lactase enzyme. Most children with lactose intolerance can tolerate some amount of lactose in their diet. The amount of change needed in the diet depends on how much lactose a child can consume without symptoms.  For children with dietary fructose intolerance, reducing the amount of fructose in the diet can relieve symptoms.    - IBD. A health care provider may use medications, surgery, and changes in diet to treat IBD. </s>


Input: What to do for Chronic Diarrhea in Children ?

Output: A health care provider may recommend changing a childs diet to treat the cause of chronic diarrhea. Making sure that children receive proper nutrition is important for growth and development. A childs parent or caretaker should talk with a health care provider about changing the childs diet to treat chronic diarrhea. </s>


Input: What to do for Chronic Diarrhea in Children ?

Output: - Diarrhea is loose, watery stools. Chronic, or long lasting, diarrhea typically lasts for more than 4 weeks.  - Many diseases and disorders can cause chronic diarrhea in children. Common causes include infections, functional gastrointestinal (GI) disorders, food allergies and intolerances, and inflammatory bowel disease (IBD).  - Symptoms that accompany chronic diarrhea in children depend on the cause of the diarrhea. Symptoms can include cramping, abdominal pain, nausea or vomiting, fever, chills, or bloody stools.  - Children with chronic diarrhea who have malabsorption can experience bloating and swelling of the abdomen, changes in appetite, or weight loss or poor weight gain.  - Children with any of the following symptoms should see a health care provider right away: signs of malabsorption, severe abdominal or rectal pain, a fever of 102 degrees or higher, or stools containing blood or pus.  - To determine the cause of chronic diarrhea, the health care provider will take a complete medical and family history and conduct a physical exam, and may perform tests.  - The treatment for chronic diarrhea will depend on the cause.  - A childs parent or caretaker should talk with a health care provider about changing the childs diet to treat chronic diarrhea. </s>


Input: What is (are) Irritable Bowel Syndrome in Children ?

Output:
Irritable bowel syndrome is a functional gastrointestinal (GI) disorder, meaning it is a problem caused by changes in how the GI tract works. Children with a functional GI disorder have frequent symptoms, but the GI tract does not become damaged. IBS is not a disease; it is a group of symptoms that occur together. The most common symptoms of IBS are abdominal pain or discomfort, often reported as cramping, along with diarrhea, constipation, or both. In the past, IBS was called colitis, mucous colitis, spastic colon, nervous colon, and spastic bowel. The name was changed to reflect the understanding that the disorder has both physical and mental causes and is not a product of a persons imagination.

IBS is diagnosed when a child who is growing as expected has abdominal pain or discomfort once per week for at least 2 months without other disease or injury that could explain the pain. The pain or discomfort of IBS may occur with a change in stool frequency or consistency or may be relieved by a bowel movement. </s>


Input: What is (are) Irritable Bowel Syndrome in Children ?

Output:
The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The movement of muscles in the GI tract, along with the release of hormones and enzymes, allows for the digestion of food. Organs that make up the GI tract are the mouth, esophagus, stomach, small intestine, large intestinewhich includes the appendix, cecum, colon, and rectumand anus. The intestines are sometimes called the bowel. The last part of the GI tractcalled the lower GI tractconsists of the large intestine and anus.

The large intestine absorbs water and any remaining nutrients from partially digested food passed from the small intestine. The large intestine then changes waste from liquid to a solid matter called stool. Stool passes from the colon to the rectum. The rectum is located between the last part of the coloncalled the sigmoid colonand the anus. The rectum stores stool prior to a bowel movement. During a bowel movement, stool moves from the rectum to the anus, the opening through which stool leaves the body. </s>


Input: How many people are affected by Irritable Bowel Syndrome in Children ?

Output: Limited information is available about the number of children with IBS. Older studies have reported prevalence rates for recurrent abdominal pain in children of 10 to 20 percent.1 However, these studies did not differentiate IBS from functional abdominal pain, indigestion, and abdominal migraine. One study of children in North America found that 14 percent of high school students and 6 percent of middle school students have IBS. The study also found that IBS affects boys and girls equally.2 </s>


Input: What are the symptoms of Irritable Bowel Syndrome in Children ?

Output:
The symptoms of IBS include abdominal pain or discomfort and changes in bowel habits. To meet the definition of IBS, the pain or discomfort should be associated with two of the following three symptoms:

- start with bowel movements that occur more or less often than usual  - start with stool that appears looser and more watery or harder and more lumpy than usual  - improve with a bowel movement

Other symptoms of IBS may include

- diarrheahaving loose, watery stools three or more times a day and feeling urgency to have a bowel movement  - constipationhaving hard, dry stools; two or fewer bowel movements in a week; or straining to have a bowel movement  - feeling that a bowel movement is incomplete  - passing mucus, a clear liquid made by the intestines that coats and protects tissues in the GI tract  - abdominal bloating

Symptoms may often occur after eating a meal. To meet the definition of IBS, symptoms must occur at least once per week for at least 2 months. </s>


Input: What causes Irritable Bowel Syndrome in Children ?

Output:
The causes of IBS are not well understood. Researchers believe a combination of physical and mental health problems can lead to IBS. The possible causes of IBS in children include the following:

- Brain-gut signal problems. Signals between the brain and nerves of the small and large intestines, also called the gut, control how the intestines work. Problems with brain-gut signals may cause IBS symptoms, such as changes in bowel habits and pain or discomfort.  - GI motor problems. Normal motility, or movement, may not be present in the colon of a child who has IBS. Slow motility can lead to constipation and fast motility can lead to diarrhea. Spasms, or sudden strong muscle contractions that come and go, can cause abdominal pain. Some children with IBS also experience hyperreactivity, which is an excessive increase in contractions of the bowel in response to stress or eating.  - Hypersensitivity. Children with IBS have greater sensitivity to abdominal pain than children without IBS. Affected children have been found to have different rectal tone and rectal motor response after eating a meal.  - Mental health problems. IBS has been linked to mental health, or psychological, problems such as anxiety and depression in children.  - Bacterial gastroenteritis. Some children who have bacterial gastroenteritisan infection or irritation of the stomach and intestines caused by bacteriadevelop IBS. Research has shown a connection between gastroenteritis and IBS in adults but not in children. But researchers believe postinfectious IBS does occur in children. Researchers do not know why gastroenteritis leads to IBS in some people and not others.  - Small intestinal bacterial overgrowth (SIBO). Normally, few bacteria live in the small intestine. SIBO is an increase in the number of bacteria or a change in the type of bacteria in the small intestine. These bacteria can produce excess gas and may also cause diarrhea and weight loss. Some researchers believe that SIBO may lead to IBS, and some studies have shown antibiotics to be effective in treating IBS. However, the studies were weak and more research is needed to show a link between SIBO and IBS.  - Genetics. Whether IBS has a genetic cause, meaning it runs in families, is unclear. Studies have shown that IBS is more common in people with family members who have a history of GI problems. However, the cause could be environmental or the result of heightened awareness of GI symptoms. </s>