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In his regular Gut Reaction column, Professor Nick Read, The Gut Trust's medical advisor sheds light on some of your personal questions about living with Irritable Bowel Syndrome and offers advice and support where possible to help you tackle your illness.

If you have a problem you can write to Professor Read.
About Nick Read

Professor Nick Read is a consultant gastroenterologist and analytical psychotherapist. He uses both of these disciplines in combination to investigate and treat patients with mind-body diseases, particularly those with functional gastrointestinal disorders.

So his expertise can reach a wider audience, Professor Read offers readers of Gut Reaction a sample of the letters he regularly receives and answers on behalf of The Gut Trust.

Constipation and Pain after a Holiday

My son has suffered severe abdominal pain and constipation since returning from holiday.


My 10 year old son has not yet been formally diagnosed with IBS but I suspect it might be the case (it seems to concur with much I have read).

He has had symptoms for a solid three weeks now during which time he has not been able to go to school - this is an additional worry.

Personality wise he is a kind, caring and confident boy, really good at sports and with lots of friends - so loves school and his soccer.

The main and by far the most distressing symptom for him (and for me) is constant cramping pain - coming in waves - cramps peaking every minute or so from shortly after waking to when we finally get him to sleep. The cramps get worse during the day and are worst from about 4 - 5 pm onwards. He has them all the time. The thought that this might continue is privately distressing me hugely as I do not know how he/we would cope with it seeing as he has no respite all day.

Once he is asleep he is calm and does not wake.

He is also constipated severely - shown on an xray - big backlog in the colon which we have worked to 'move' using Duphalac and Metamucil. On two days this week he went to the loo several times and did a lot of stool ending in diarrhoea (due to the laxatives). However the cramps were very bad before, during, and continued unabated afterwards giving no relief.

He has a great deal of wind as well.

Other tests done so far:

  • Standard X ray - normal except for the massive constipation
  • Ultrasound - all normal
  • Blood test - normal showing no inflammation but there was one slightly elevated marker indicating a possible allergy or parasite (my GP mentioned this and I should have paid more attention)
  • Normal iron
  • Coeliac screen - normal
  • Urine - normal
  • Liver function - normal
  • Test for giardia and travel panel for parasites - negative

He has never had any problem with constipation before - very regular and normal.

The onset occurred one week after returning from a holiday in Vanuatu - 2 points are relevant here:

Whilst we were there my son had gastroenteritis - mostly vomiting but some diarrhoea (this would have been about 2.5 weeks prior to the start of the current symptoms.

Another concern I have had is that we all took the anti malarial Lariam whilst away.

The first onset of my sons cramps occurred about 2 hours after the fourth weekly dose of this drug. The symptoms persisted for 2 days, went off for a day, came back after soccer, were bad the following day and then cleared for two days.

It can back again some hours after the fifth dose of Lariam. I wish to goodness I had never given it to him. I know this could be a coincidence but one of the Lariam S/Es I have read about is toxicity to nerves (no one seems to have reported s/e quite like ours but I wondered whether the drug could have damaged his brain - gut connection somehow.

No drugs we have tried so far make any difference to my son's cramps. Buscopan does not make any difference - paracetamol and neurofen do not make any difference to the pain.

Next week I am going to get a referral to a local gastroenterologist - but I would so appreciate your feedback and comments. We are feeling pretty desperate to help our boy.

Oh and I have also started on a very rigid rice based bland diet excluding milk from today.

Oh dear. Your son is really having a bad time, isn't he. It seems likely that the cramps and wind may related to constipation - the cramps occurring as an attempt to overcome the blockage and stimulated by distension of the bowel due to build up of faeces and gas and/or severe gut spasms causing constipation.

It seems clear there is some connection with your trip to Vanatu.

Larium can certainly cause neuromuscular side effects, but it seems very unlikely these would pick out the gut selectively.

Post gastroenteritis IBS can occur but usually this causes a persistence of diarrhoea.

Could the agent (virus?) that caused his gastroenteritis have damaged the enteric nervous system? That would be a long shot and very unlikely.

What seems more likely (on the balance of probabilities) is that the events around the trip to Vanatu caused a bowel disturbance but this has persisted because of psychological factors. Post gastroenteritis IBS is more common if the patient is anxious at the time of the original infection. The same applies to drug induced symptoms. This can easily develop into a vicious cycle whereupon the stress of having the disease keeps the symptoms going. He could of couse be picking up your worry. He is not going to school.

Yes, he needs to see a gastroenterologist to discuss any possibility neurolomuscular illness involving the gut. This will almost certainly mean more tests, but I would not wait for the results of the tests before exploring other avenues. Do think about the stress side of things. Try to talk to him about any worries. Try not to let your anxiety get to him. Treat the bowels with a gentle bulk laxative like fybogel - irritant laxatives tend to cause a lot of cramping. Find activities that distract him from the pain and calm him down. Consider an appointment with a child psychologist. It is important that he gets back to a normal life as soon as possible.