Bowel Function in Eating Disorders

Adolescents with bulimia—the binge-purge syndrome—frequently abuse laxatives to provoke diarrhea and purge unwanted calories. Constipation, by contrast, is a recognized complication of anorexia. Apart from a diet that is woefully deficient in nutrients and bulk, an anorexic teenager has weakening of the intestinal muscles and an overall slowing of body metabolism, both of which are directly due to starvation.

In addition, adolescents with this serious eating disorder typically drink very little for fear of becoming bloated. The weight of stool retained in the intestines can make it difficult to judge whether treatment is progressing. Finally, constipation may be worsened by medications used to treat anorexia.

Specialists treating adolescents with anorexia manage constipation through a diet that includes adequate fiber and fluids. They also encourage moderate exercise and may recommend stool softeners and other medications if necessary.


Appendicitis in Children and Teens

​​Appendicitis is an infection of an organ called the appendix, a narrow pouch connected to the colon. When it is infected, the appendix can swell. This causes pain in the abdomen and other symptoms

Appendicitis happens in 7% of all people in America at some time in their life. It happens most often when we are children or teens. The appendix has no known important function. If appendicitis develops, your child may become very sick.

Symptoms of appendicitis

One of the most common signs of appendicitis in children is abdominal pain. Your child may say it hurts in the middle of the abdomen near the belly button or along their right side. The pain will continue and become worse over time. The pain may feel worse with movement, like walking or riding in the car. Your child may not want to eat and may feel sick to his/her stomach or throw up. Your child may also have a fever.

How is appendicitis diagnosed?

Your child will have their blood pressure, heart rate and temperature checked. The doctor will see your child and perform an exam. The doctor will ask you and your child about the pain and other symptoms. If the doctor thinks that your child may have appendicitis, more tests may be needed. These tests may include:

  • Blood test—to look for signs of infection
  • Urine test—to see if there is a urine infection
  • X-ray test—to look at the intestines
  • Ultrasound test—to look at the appendix
  • CT (“Cat” scan) or MRI test—to look at the appendix

What is the treatment for appendicitis?

  • Medicines. The doctor or nurse may insert an IV in their vein to give your child fluids and medications. IV fluids will help hydrate your child. This is important because they will not give your child anything to eat or drink if they think that they may have appendicitis.

If the tests show appendicitis, they will give your child antibiotics into the IV. Antibiotics are important to treat the infection of the appendix.

Your child may also be given medicine for pain to help them feel better.

  • Surgery. If your child has appendicitis, a surgeon will see them. The surgeon will tell you if they think that your child needs surgery to remove the appendix, and also talk about when to do the operation.

Which is better: medicines or surgery?

Your doctor will give your child antibiotics to treat appendicitis. This is important to treat the infection of the appendix. Usually, antibiotics are given before the surgery to start treating the infection of the appendix before it is removed. Surgery to remove the infected appendix is considered the best way to treat appendicitis.

Sometimes, antibiotics can be enough to treat appendicitis. Your doctor will discuss with you if your child’s appendicitis can be treated safely with only antibiotics. For most children, however, surgery is required to remove the appendix.


If you think your child may have appendicitis, call your pediatrician or seek emergency care right away. The earlier appendicitis is diagnosed and treated with medications or surgery, the better your child’s recovery will be. If the infection gets severe enough to cause the appendix to leak or burst, which can spread the infection.


Abdominal Pains in Infants

Colic usually occurs in infants between the ages of ten days and three months of age. While no one knows exactly what causes it, colic seems to produce rapid and severe contractions of the intestine that probably are responsible for the baby’s pain. The discomfort often is more severe in the late afternoon and early evening, and may be accompanied by inconsolable crying, pulling up of the legs, frequent passage of gas, and general irritability. You can try a variety of approaches to colic, which might include rocking your baby, walking with her in a baby carrier, swaddling her in a blanket, or giving her a pacifier.

Intussusception is a rare condition that may cause abdominal pain in young infants (usually between eight months and fourteen months of age). This problem occurs when one part of the intestine slides inside another portion of the intestine, creating a blockage that causes severe pain. The child will intermittently and abruptly cry and pull her legs toward her stomach. This will be followed by periods without stomach pain and often without any distress. These children also may vomit and have dark, mucousy, bloody stools that often look like blackberry jelly.

It is important to recognize this cause of abdominal pain and to talk to your pediatrician immediately. She will want to see your child and perhaps order an X-ray called an air or barium enema. Sometimes doing this test not only enables the diagnosis but also unblocks the intestine. If the enema does not unblock the intestine, an emergency operation may be necessary to correct the problem.

Viral or bacterial infections of the intestine (gastroenteritis) are usually associated with diarrhea and/or vomiting. On and off abdominal pain is often also present. Most cases are viral, require no treatment, and will resolve on their own over a week or so; the pain itself generally lasts one or two days and then disappears. One exception is an infection caused by the Giardia lamblia parasite. This infestation may produce periodic recurrent pain not localized to any one part of the abdomen. The pain may persist for a week or more and can lead to a marked loss of appetite and weight. Treatment with appropriate medication can cure this infestation and the abdominal pain that accompanies it.


Abdominal Pain in Children

Constipation often is blamed for abdominal pain, and while it’s rarely a problem in younger infants, it’s a common cause of pain in older children, especially in the lower part of the abdomen. When a child’s diet lacks plenty of fluids, fresh fruits and vegetables, and fiber rich in whole grains, bowel problems are more likely to occur. For more information, talk to your pediatrician.

Urinary tract infections (UTI) are much more common in one- to five-year-old girls than in younger children. UTIs produce discomfort in the abdomen and the bladder area, as well as some pain and burning when urinating. These children also may urinate more frequently and possibly wet the bed. However, the infection usually does not produce a fever. If your child complains of these symptoms, take her to the pediatrician, who will examine her and check her urine. If an infection is present, an antibiotic will be prescribed, which will eliminate both the infection and the abdominal pain.

Strep throat is a throat infection caused by bacteria called streptococci. It occurs frequently in children over three years of age. The symptoms and signs include a sore throat, fever, and abdominal pain. There may be some vomiting and headache as well. Your pediatrician will want to examine your child and swab her throat to check for strep bacteria. If the results are positive for strep, your child will need to be treated with an antibiotic.

Appendicitis is very rare in children under age three and uncommon under the age of five. When it does occur, the first sign is often a complaint of constant stomachache in the center of the abdomen, and later the pain moves down and over to the right side.

Lead poisoning most often occurs in toddlers living in an older house where lead-based paint has been used. Children in this age group may eat small chips of paint off the walls and woodwork. The lead is then stored in their bodies and can create many serious health problems. Parents also should be aware of toys or other products with unacceptable lead content. Symptoms of lead poisoning include not only abdominal pain, but also constipation, irritability (the child is fussy, crying, difficult to satisfy), lethargy (she is sleepy, doesn’t want to play, has a poor appetite), and convulsions. If your child is exposed to lead paint, has eaten paint chips or been exposed to toys with cracking, peeling, or chipping paint and has any of the above symptoms, call your pediatrician. She can order a blood test for lead and advise you as to what else needs to be done.

Milk allergy is a reaction to the protein in milk, and can produce cramping abdominal pain, often accompanied by vomiting, diarrhea, and skin rash.

Emotional upset in school-age children sometimes causes recurrent abdominal pain that has no other obvious cause. Although this pain rarely occurs before age five, it can happen to a younger child who is under unusual stress. The first clue is pain that tends to come and go over a period of more than a week, often associated with activity that is stressful or unpleasant. In addition, there are no other associated findings or complaints (fever, vomiting, diarrhea, coughing, lethargy or weakness, urinary tract symptoms, sore throat, or flulike symptoms). There also may be a family history of this type of illness. Finally, your child probably will act either quieter or noisier than usual and have trouble expressing her thoughts or feelings. If this type of behavior occurs with your child, find out if there’s something troubling her at home or school or with siblings, relatives, or friends. Has she recently lost a close friend or a pet? Has there been a death of a family member, or the divorce or separation of her parents?

Your pediatrician can suggest ways to help your child talk about her troubles. For example, he may advise you to use toys or games to help the child act out her problems. If you need additional assistance, the pediatrician may refer you to a child therapist, psychologist, or psychiatrist.