By Jeffrey Lazarus, MD, FAAP on May 18, 2020
Author, Controlling Your Gut Feelings Blog
Overview
Let’s face it, life for teenagers isn’t as easy going as it was 50 or 60 years ago. Put yourself in the shoes of a teenage girl, and the stress really piles on. Between rigorous schedules, the demands of school, social lives, and family problems, the life of a teenage girl can get pretty grueling. Add in a dash of social media, a pinch of drama, and a heaping helping of hormones, and you have a recipe for a teenage girl with digestive problems.
On average 95% of teens aged 13 to 17 in the U.S. have their own smartphones and they are constantly on them. Social stress and anxiety have now become portable and are unable to be left behind at the end of the school day.
According to a Stress Management and Teens Survey by AACDP some of the most common sources of stress for teenagers include:
- School demands and frustrations
- Negative thoughts or feelings about themselves
- Changes in their bodies
- Problems with friends and/or peers at school
- Unsafe living environment/neighborhood
- Separation or divorce of parents
- Chronic illness or severe problems in the family
- Death of a loved one
- Moving or changing schools
- Taking on too many activities or having too high expectations
- Family financial problems
Emotional turmoil in teens can manifest as abdominal pain, digestive issues and other gastrointestinal symptoms. It can also make an existing gastrointestinal disorder worse. The sensory nerves in the gastrointestinal system are connected to sensory nerves in the brain.
Common Digestive Issues In Teenage Girls
Historically, traditional medicine has divided gastrointestinal problems into 2 main categories:
- Functional disorders
- Organic diseases
Organic GI Diseases are those for which a specific diagnosis can be proven by an abnormal physical examination, lab test, or biopsy result. Examples of these include ulcerative colitis, Crohn’s disease, and other inflammatory bowel diseases.
In Functional GI Disorders, the exam and all lab results are basically normal, but the symptoms are still quite real. These symptoms can include: nausea, vomiting, pain, constipation, and/or diarrhea.
Functional Gastrointestinal Disorders
Functional Abdominal Pain (FAP)
Functional Abdominal Pain (FAP) was previously called Recurrent Abdominal Pain (RAP). The diagnosis is made when the following occur at least once a week for at least 2 months:
- Episodic or continuous pain
- All diagnostic tests are negative.
All diagnostic tests are negative, including blood tests, ultrasound, and endoscopy. In addition, all radiographic studies are negative, including CT scans and x-ray studies such as upper GI series (barium swallow) and lower GI series (in which a barium enema is given). Additional tests may be ordered and these, too, will turn out to have normal results.
And, it is important to realize that even though the test results are negative, the pain is still quite real. Hypnosis is a very powerful tool for pain.
One of the most commonly used medications for Irritable Bowel Syndrome and FAP is amitriptyline, an antidepressant. Studies have shown repeatedly that this medication is no more effective than placebo for this problem.
Irritable Bowel Syndrome (IBS)
It is estimated that between 6 and 14% of all teenagers suffer from some form of IBS. It affects females more than males. Symptoms of IBS can include bloating, gas, belly pain, and either diarrhea, constipation, or both.
Irritable Bowel Syndrome (IBS) is characterized by chronic abdominal pain and altered bowel habits. There may be vomiting, constipation, and/or diarrhea. The pain is sometimes made worse by eating or stress. It is often better after a bowel movement.
All diagnostic tests are negative, including blood tests, ultrasound, and endoscopy. In addition, all radiographic studies are negative, including CT scans and x-ray studies such as upper GI series (barium swallow) and lower GI series (in which a barium enema is given). Additional tests may be ordered and these, too, will turn out to have normal results.
And, it is important to realize that even though the test results are negative, the pain is still quite real. Hypnosis is a very powerful tool for pain.
Functional Dyspepsia (FD)
Functional Dyspepsia (FD) is characterized by all of the following at least once a week for two months:
- Persistent/recurrent pain in the upper abdomen.
- Not relieved with a bowel movement.
- Not associated with change in stool frequency or form.
- All diagnostic tests are negative.
All diagnostic tests are negative, including blood tests, ultrasound, and endoscopy. In addition, all radiographic studies are negative, including CT scans and x-ray studies such as upper GI series (barium swallow) and lower GI series (in which a barium enema is given). Additional tests may be ordered and these, too, will turn out to have normal results.
One of the most commonly used medications for Irritable Bowel Syndrome, Functional Abdominal Pain, and FD is amitriptyline, an antidepressant. Studies have shown repeatedly that this medication is no more effective than placebo for this problem.
And, it is important to realize that even though the test results are negative, the pain is still quite real. Hypnosis is a very powerful tool for pain.
Cyclic Vomiting Syndrome
Cyclic Vomiting Syndrome (CVS) is a condition in which patients:
- Have 3 or more episodes per year.
- Are completely normal between episodes.
- Experience vomiting for hours or days.
- All diagnostic tests are negative.
When I see patients with CVS, they invariably act as if they are having an abdominal migraine. For example, patients with abdominal migraine or migraine headaches usually experience an “aura.” This is a sensation, a warning sign of some sort, that in 10 to 30 minutes, the abdominal migraine or migraine headache will occur.
The timeline for CVS is virtually the same as a migraine headache. Patients who learn self-hypnosis can use the aura or beginning of the episode to use this technique to prevent the episode from occurring and there is typically significant improvement after only 2 to 3 visits.
Hypnotherapy is an effective treatment for Cyclic Vomiting Syndrome.
Abdominal Migraine
Abdominal Migraine is a type of migraine that causes a dull or achy pain around the stomach, rather than in the head and is seen mainly in children ages 5 to 10 years old’s. Abdominal Migraine is composed mostly of abdominal pain, nausea and also vomiting.
It’s recognized as an episodic syndrome because children who get abdominal migraines are symptom-free between episodes. The episodes typically last between 2-72 hours.The condition can be tricky to diagnose because symptoms are similar to other common causes of stomach aches.
The cause of Abdominal Migraines is still not fully understood, but Hypnotherapy is an effective treatment for Abdominal Migraine.
Other Disorders That Are Not Functional GI Disorders
Gastroesophageal Reflux Disease (GERD)
Nearly 10% of teens and pre-teens in the U.S. have GERD. GERD is when the esophageal sphincter relaxes or does not close properly, allowing stomach contents to splash back up into the esophagus (acid reflux). The esophageal sphincter is only supposed to open to let food go down toward the stomach. Symptoms include:
- Burning pain in the top of the stomach and up into the esophagus (heartburn).
- Sour, bitter taste in the mouth and throat.
- Swallowing difficulty – raw, sore throat or feeling that food is getting stuck in the throat.
- Breathing problems – coughing, wheezing or worsening asthma.
Gastritis
Gastritis or inflammation of the stomach lining can be caused by stress. Symptoms include stomach pain, nausea, vomiting blood, dark-colored stools, bloating, hiccups, loss of appetite, and hunger pangs at night and between meals. Other causes of gastritis include taking too much over the counter anti-inflammatory medication, chronic vomiting, excessive alcohol consumption, and bacterial and viral infections.
Gastroparesis
Gastroparesis means “paralyzed stomach,” and it is a diagnosis that has been on the rise in teenage girls and women in their twenties. The issue is every time they eat, they feel sick, so then they don’t want to eat. The number of gastroparesis patients has increased year over year for the past 20 years, and there is no explanation for it.
If the stomach isn’t working correctly, the food sits in the stomach too long and comes back up via vomiting. If the food isn’t being ground up properly in the stomach, then nutrients are not being absorbed. Symptoms include nausea, vomiting, feeling full, bloating, and abdominal pain. Gastroparesis appears to be more common in type 1 diabetic patients; however, there is still a large number of non-diabetic patients.
A Final Word
There are many causes of digestive issues; however, because the digestive system and the brain are so interlinked, there is a strong correlation between anxiety and stress with the gastrointestinal tract (gi tract).
For Functional GI Disorders, doctors are using alternative treatment methods that are more functional in nature, such as Self-Hypnosis and are having great success with patients.
