Definition of Inflammatory bowel disease (IBD)
Inflammatory bowel disease (IBD) involves chronic inflammation of all or part of your digestive tract. IBD primarily includes ulcerative colitis and Crohn’s disease. IBD can be painful and debilitating, and sometimes leads to life-threatening complications.
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease that causes long-lasting inflammation in part of your digestive tract. Symptoms usually develop over time, rather than suddenly. Ulcerative colitis usually affects only the innermost lining of your large intestine (colon) and rectum. It occurs only through continuous stretches of your colon.
Crohn’s disease is an inflammatory bowel disease that causes inflammation anywhere along the lining of your digestive tract, and often spreads deep into affected tissues. This can lead to abdominal pain, severe diarrhea and even malnutrition. The inflammation caused by Crohn’s disease can involve different areas of the digestive tract in different people.
Collagenous colitis (kuh-LAJ-uh-nus) and lymphocytic colitis also are considered inflammatory bowel diseases, but are usually regarded separately from classic inflammatory bowel disease.
Symptoms of Inflammatory bowel disease (IBD)
Inflammatory bowel disease symptoms vary, depending on the severity of inflammation and where it occurs.
Ulcerative colitis symptoms
Ulcerative colitis is classified according to its signs and symptoms:
- Ulcerative proctitis. In this form of ulcerative colitis, inflammation is confined to the area closest to the anus (rectum), and for some people, rectal bleeding may be the only sign of the disease. Others may have rectal pain, a feeling of urgency or have frequent, small bowel movements. This form of ulcerative colitis tends to be the mildest.
- Proctosigmoiditis. This form involves the rectum and the lower end of the colon, known as the sigmoid colon. Bloody diarrhea, abdominal cramps and pain, and an inability to move the bowels in spite of the urge to do so (tenesmus) are common problems associated with this form of the disease.
- Left-sided colitis. As the name suggests, inflammation extends from the rectum up through the sigmoid and descending colon, which are located in the upper left part of the abdomen. Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and unintended weight loss.
- Pancolitis. Affecting more than the left colon and often the entire colon, pancolitis causes bouts of bloody diarrhea that may be severe, abdominal cramps and pain, fatigue, and significant weight loss.
- Fulminant colitis. This rare, life-threatening form of colitis affects the entire colon and causes severe pain, profuse diarrhea and, sometimes, dehydration and shock. People with fulminant colitis are at risk of serious complications, including colon rupture and toxic megacolon, a condition that causes the colon to rapidly expand.
The course of ulcerative colitis varies, with periods of acute illness often alternating with periods of remission. Most people with a milder condition, such as ulcerative proctitis, won’t go on to develop more-severe signs and symptoms.
Crohn’s disease symptoms
Inflammation of Crohn’s disease may involve different parts of the digestive tract in different people. The most common areas affected by Crohn’s disease are the last part of the small intestine called the ileum and the colon. Inflammation may be confined to the bowel wall, which can lead to scarring (stenosis), or inflammation may spread through the bowel wall (fistula).
Signs and symptoms of Crohn’s disease can range from mild to severe and may develop gradually or come on suddenly, without warning. Signs and symptoms may include:
- Diarrhea. The inflammation that occurs in Crohn’s disease causes cells in the affected areas of your intestine to secrete large amounts of water and salt. Because the colon can’t completely absorb this excess fluid, you develop diarrhea. Intensified intestinal cramping also can contribute to loose stools. Diarrhea is a common problem for people with Crohn’s.
- Abdominal pain and cramping. Inflammation and ulceration may cause the walls of portions of your bowel to swell and eventually thicken with scar tissue. This affects the normal movement of contents through your digestive tract and may lead to pain and cramping. Mild Crohn’s disease usually causes slight to moderate intestinal discomfort, but in more-serious cases, the pain may be severe and include nausea and vomiting.
- Blood in your stool. Food moving through your digestive tract may cause inflamed tissue to bleed, or your bowel may also bleed on its own. You might notice bright red blood in the toilet bowl or darker blood mixed with your stool. You can also have bleeding you don’t see (occult blood).
- Ulcers. Crohn’s disease and ulcerative colitis can cause small sores on the surface of the intestine that eventually become large ulcers that penetrate deep into — and sometimes through — the intestinal walls. You may also have ulcers elsewhere, including in your mouth similar to canker sores.
- Reduced appetite and weight loss. Abdominal pain and cramping and inflammation of your bowel wall can affect both your appetite and your ability to digest and absorb food.
People with severe Crohn’s disease may also experience:
- Eye inflammation
- Skin disorders
- Inflammation of the liver or bile ducts
- Delayed growth or sexual development, in children
When to see a doctor
See your doctor if you experience a persistent change in your bowel habits or if you have any of the signs and symptoms of inflammatory bowel disease. Although inflammatory bowel disease usually isn’t fatal, it’s a serious disease that, in some cases, may cause life-threatening complications.
No one is quite sure what triggers inflammatory bowel disease, but there’s a consensus as to what doesn’t. Researchers no longer believe that diet and stress are main causes, although stress can often aggravate symptoms. Instead, current thinking focuses on the:
- Immune system. Some scientists think a virus or bacterium may trigger IBD. The digestive tract becomes inflamed when your immune system tries to fight off the invading microorganism (pathogen). It’s also possible that inflammation may stem from an autoimmune reaction in which your body mounts an immune response even though no pathogen is present.
- Heredity. Because you’re more likely to develop IBD if you have a parent or sibling with the disease, scientists suspect that genetic makeup may play a role. However, most people who have IBD don’t have a family history of the disorder.
Inflammatory bowel disease affects about the same number of women and men. Risk factors may include:
- Age. Inflammatory bowel disease usually begins before the age of 30. But, it can occur at any age, and some people may not develop the disease until their 50s or 60s.
- Ethnicity. Although whites have the highest risk of the disease, it can occur in any ethnic group. If you’re of Ashkenazi Jewish descent, your risk is even higher.
- Family history. You’re at higher risk if you have a close relative, such as a parent, sibling or child, with the disease.
Isotretinoin use. Isotretinoin is a medication sometimes used to treat scarring cystic acne or acne that doesn’t respond to other treatments. It used to be sold under the brand name Accutane, but that brand has been discontinued, and it’s now sold under the brand names Amnesteem, Claravis and Sotret.
There is conflicting information as to whether isotretinoin use can increase the risk of inflammatory bowel disease. Some studies have suggested a possible link, while other studies have found no such evidence. The question of whether or not there is a link is further complicated by research that suggests a possible connection between the use of tetracycline class antibiotics and the development of IBD. Many people who have been treated with isotretinoin for acne also have received tetracyclines as part of their acne therapy. Studies that have examined the possible link between isotretinoin and IBD have not addressed the question of whether antibiotics used for acne may have played a role in increasing risk.
- Cigarette smoking. Cigarette smoking is the most important controllable risk factor for developing Crohn’s disease. It leads to more-severe symptoms and higher risk of complications. If you smoke, stop. Discuss this with your doctor and get help. There are many smoking cessation programs available if you are unable to quit on your own.
- Some pain relievers. These medications include ibuprofen (Advil, Motrin, others), naproxen (Aleve) and aspirin. These medications have been shown to cause gastrointestinal ulceration and may make existing IBD worse. Acetaminophen (Tylenol, others) does not have this effect. Discuss the use of any pain medication with your doctor.
- Where you live. If you live in an urban area or in an industrialized country, you’re more likely to develop IBD. Because Crohn’s disease occurs more often among people living in cities and industrial nations, it may be that environmental factors, including a diet high in fat or refined foods, play a role in IBD. People living in northern climates also seem to have a greater risk of the disease.
Complications of Inflammatory bowel disease (IBD)
Inflammatory bowel disease may lead to one or more of the following complications:
- Bowel obstruction. Crohn’s disease affects the entire thickness of the intestinal wall. Over time, parts of the bowel can thicken and narrow, which may block the flow of digestive contents through the affected part of your intestine. Some cases require surgery to remove the diseased portion of your bowel.
- Ulcers. Chronic inflammation can lead to open sores (ulcers) anywhere in your digestive tract, including your mouth and anus, and in the genital area (perineum) and anus. Bleeding may result.
- Fistulas. Sometimes ulcers can extend completely through the intestinal wall, creating a fistula. A fistula is an abnormal connection between different parts of your intestine, between your intestine and skin, or between your intestine and another organ, such as the bladder or vagina. When internal fistulas develop, food may bypass areas of the bowel that are necessary for absorption. An external fistula can cause continuous drainage of bowel contents to your skin, and in some cases, a fistula may become infected and form an abscess, a problem that can be life-threatening if left untreated. Fistulas around the anal area (perianal) are the most common kind of fistula.
- Anal fissure. This is a crack, or cleft, in the anus or in the skin around the anus where infections can occur. It’s often associated with painful bowel movements. This may lead to a perianal fistula.
- Malnutrition. Diarrhea, abdominal pain and cramping may make it difficult for you to eat or for your intestine to absorb enough nutrients to keep you nourished. Additionally, anemia is common in people with IBD.
- Colon cancer. Having IBD disease that affects your colon increases your risk of colon cancer.
- Other health problems. In addition to inflammation and ulcers in the digestive tract, IBD can cause problems in other parts of the body, such as arthritis, inflammation of the eyes or skin, clubbing of the fingernails, kidney stones, gallstones, and, occasionally, inflammation of the bile ducts. People with long-standing IBD also may develop osteoporosis, a condition that causes weak, brittle bones.
Preparing for your appointment
Symptoms of inflammatory bowel disease may first prompt a visit to your family doctor or general practitioner. However, you may then be referred to a doctor who specializes in treating digestive disorders (gastroenterologist).
Because appointments can be brief, and there’s often a lot of information to discuss, it’s a good idea to be well prepared. Here’s some information to help you get ready, and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there’s anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you made the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, as well as any vitamins or supplements, that you’re taking.
- Take a family member or friend along. Sometimes it can be difficult to remember everything during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Time with your doctor is limited, so preparing a list of questions beforehand may help you make the most of your visit. List your questions from most important to least important in case time runs out. For inflammatory bowel disease, some basic questions to ask your doctor include:
- What’s causing these symptoms?
- Are there other possible causes for my symptoms?
- What kinds of tests do I need? Do these tests require any special preparation?
- Is this condition temporary or long lasting?
- What treatments are available, and which do you recommend?
- Are there any medications that I should avoid?
- What types of side effects can I expect from treatment?
- What sort of follow-up care do I need? How often do I need a colonoscopy?
- Are there any alternatives to the primary approach that you’re suggesting?
- I have other health conditions. How can I best manage them together?
- Do I need to follow any dietary restrictions?
- Is there a generic alternative to the medicine you’re prescribing me?
- Are there brochures or other printed material that I can take with me? What websites do you recommend?
- Is there a risk to me or my child if I become pregnant?
- Is there a risk of complications to my partner’s pregnancy if I have IBD and father a child?
- What is the risk to my child of developing IBD if I have it?
- Are there support groups for people with IBD and their families?
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or intermittent?
- How severe are your symptoms?
- Do you have abdominal pain?
- Have you had diarrhea? How often?
- Have you lost weight unintentionally?
- Have you ever had liver problems, hepatitis or jaundice?
- Have you ever taken the acne medication isotretinoin?
- Have you had problems with your joints, eyes or skin — including rashes and sores — or had sores in your mouth?
- Do you have a family history of inflammatory bowel disease?
- Do your symptoms affect your ability to work or do other activities?
- Does anything seem to improve your symptoms?
- Is there anything that you’ve noticed that makes your symptoms worse?
- Do you smoke?
- Do you take NSAIDs, for example, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or diclofenac (Volteren, Solaraze)?
- Have you taken antibiotics recently?
Tests and diagnosis
Your doctor will likely diagnose inflammatory bowel disease only after ruling out other possible causes for your signs and symptoms, including ischemic colitis, infection, irritable bowel syndrome (IBS), diverticulitis and colon cancer. To help confirm a diagnosis of IBD, you may have one or more of the following tests and procedures:
- Blood tests. Your doctor may suggest blood tests to check for anemia or infection. Tests that look for the presence of certain antibodies can sometimes help diagnose which type of inflammatory bowel disease you have, but these tests can’t definitely make the diagnosis.
- Stool sample. The presence of white blood cells in your stool indicates an inflammatory disease, possibly IBD. A stool sample can also help rule out other disorders, such as those caused by bacteria, viruses and parasites. Your doctor can also check for a bowel infection, which is more likely to occur in people with IBD.
- Colonoscopy. This exam allows your doctor to view the inside of your entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis. Sometimes a tissue sample can help confirm a diagnosis.
- Flexible sigmoidoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the last portion of your colon (sigmoid colon). The test may miss problems higher up in your colon, and it doesn’t give a full picture of how much of the colon has been affected. But if your colon is severely inflamed, your doctor may perform this test instead of a full colonoscopy.
- Barium enema. This diagnostic test allows your doctor to evaluate your entire large intestine with an X-ray. Barium, a contrast solution, is placed into your bowel using an enema. Sometimes, air is added as well. The barium coats the bowel lining, creating a silhouette image of your rectum, colon and a portion of your small intestine. This test is rarely used anymore, and it can be dangerous because the pressure required to inflate and coat the colon can lead to rupture of the colon.
- X-ray. A standard X-ray of your abdominal area may be done to rule out toxic megacolon or a perforation of the colon if these conditions are suspected because of severe symptoms.
- Computerized tomography (CT) scan. A CT scan of your abdomen or pelvis may be performed if your doctor suspects a complication from ulcerative colitis or inflammation of the small intestine that might suggest Crohn’s disease. A CT scan may also reveal how much of the colon is inflamed.
- Magnetic resonance imaging (MRI). An MRI scanner uses a magnetic field and radio waves to create detailed images of organs and tissues. Most MRI machines are large, tube-shaped magnets. During the test, you lie on a movable table inside the MRI machine. This test is very helpful in diagnosing and managing Crohn’s disease. It’s biggest advantage is that there is no radiation exposure. It’s particularly useful for evaluating a fistula around the anal area (pelvic MRI) or the small intestine (MRI enterography).
- Capsule endoscopy. If you have signs and symptoms that suggest Crohn’s disease but other diagnostic tests are negative, your doctor may perform capsule endoscopy. For this test you swallow a capsule that has a tiny camera in it. The camera takes pictures as it moves through your digestive tract, and the images are transmitted to a computer that you wear on your belt. Your doctor later downloads the images, which are then displayed on a monitor and checked for signs of Crohn’s disease. Once it’s made the trip through your digestive system, the camera exits your body painlessly in your stool.
- Double-balloon endoscopy. For this test, a longer scope is used to look further into the small bowel where standard endoscopes don’t reach. This technique is useful when capsule endoscopy shows abnormalities but the diagnosis is still in question. It allows for biopsy of the abnormal area. It’s usually performed in specialized endoscopy centers.
- Small bowel imaging. This test looks at the part of the small bowel that can’t be seen by colonoscopy. You drink a solution containing barium, then X-ray, CT or MRI images are taken of your small intestine. The test can help locate areas of narrowing or inflammation in the small bowel that are seen in Crohn’s disease. The test can also help your doctor determine which type of inflammatory bowel disease you have.
Treatments and drugs
The goal of inflammatory bowel disease treatment is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission. IBD treatment usually involves either drug therapy or surgery.
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:
- Sulfasalazine (Azulfidine). Sulfasalazine can be effective in reducing symptoms of ulcerative colitis, but it has a number of side effects, including nausea, vomiting, diarrhea, heartburn and headache. Don’t take this medication if you’re allergic to sulfa medications.
- Mesalamine (Apriso, Asacol, Lialda, others), balsalazide (Colazal) and olsalazine (Dipentum). These medications are available in oral forms, and also in topical forms, such as enemas and suppositories. Which form you take depends on the area of your colon that’s affected. These medications tend to have fewer side effects than sulfasalazine, and are generally very well tolerated.
- Corticosteroids. Corticosteroids can help reduce inflammation, but they have numerous side effects, including weight gain, excessive facial hair, mood swings, high blood pressure, type 2 diabetes, osteoporosis, bone fractures, cataracts, glaucoma and an increased susceptibility to infections. Doctors generally use corticosteroids only if you have moderate to severe inflammatory bowel disease that doesn’t respond to other treatments. Corticosteroids aren’t for long-term use and the dose is usually tapered down over two to three months.
Immune system suppressors
These drugs also reduce inflammation, but they target your immune system rather than treating inflammation itself. Because immune suppressors can be effective in treating ulcerative colitis, scientists theorize that damage to digestive tissues is caused by your body’s immune response to an invading virus or bacterium or even to your own tissue. By suppressing this response, inflammation is also reduced. Immune system suppressors are associated with a small risk of developing cancer, such as lymphoma. Immunosuppressant drugs include:
- Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol). Because azathioprine and mercaptopurine act slowly — taking three months or longer to start working — they’re sometimes initially combined with a corticosteroid. With time, they seem to produce benefits on their own and the steroids may be tapered off.
- Cyclosporine (Gengraf, Neoral, Sandimmune). This potent drug is normally reserved for people who don’t respond well to other medications or who face possible surgery because of severe ulcerative colitis. In some cases, cyclosporine may be used to delay surgery until you’re strong enough to undergo the procedure. It may also be used to control signs and symptoms until less toxic drugs start working. Cyclosporine begins working in one to two weeks, but because it has the potential for severe side effects, including kidney damage, seizures and fatal infections, talk to your doctor about the risks and benefits of treatment. There’s also a small risk of cancer with these medications, so let your doctor know if you’ve previously had cancer.
- Infliximab (Remicade). This drug is specifically for those with moderate to severe ulcerative colitis who don’t respond to or can’t tolerate other treatments. It works quickly to bring on remission, especially for people who haven’t responded well to corticosteroids. It works by neutralizing a protein produced by your immune system known as tumor necrosis factor (TNF).
- Adalimumab (Humira).Adalimumab works similarly to infliximab by blocking TNF for people with moderate to severe Crohn’s disease. It can be used soon after you’re diagnosed if you have a fistula, or if you have more severe Crohn’s disease. It also may be used after other medications have failed to improve your symptoms. Adalimumab may be used instead of infliximab or certiluzimab, or it can be used if infliximab or certiluzimab stop working. Adalimumab may reduce the signs and symptoms of Crohn’s disease and may cause remission.
- Certolizumab pegol (Cimzia). Approved by the Food and Drug Administration for the treatment of Crohn’s disease, certolizumab pegol works by inhibiting TNF. Certolizumab pegol is prescribed for people with moderate to severe Crohn’s disease. Certolizumab pegol may be used instead of infliximab, or it can be used if infliximab or adalimumab stop working. Common side effects include headache, upper respiratory infections, abdominal pain, nausea and reactions at the injection site. Because this drug affects your immune system, you’re also at risk of becoming seriously ill with certain infections, such as tuberculosis. Your doctor will give you a skin test for tuberculosis, obtain a chest X-ray and test you for hepatitis before you begin certiluzimab pegol.
- Methotrexate (Rheumatrex)zThis drug, which is used to treat cancer, psoriasis and rheumatoid arthritis, is sometimes used for people with Crohn’s disease who don’t respond well to other medications. Short-term side effects include nausea, fatigue and diarrhea, and rarely, it can cause potentially life-threatening pneumonia. Long-term use can lead to scarring of the liver and sometimes to cancer. Avoid becoming pregnant while taking methotrexate. If you’re taking this medication, follow up closely with your doctor and have your blood checked regularly to look for side effects.
- Natalizumab (Tysabri). This drug works by inhibiting certain immune cell molecules — integrins — from binding to other cells in your intestinal lining. Natalizumab is approved for people with moderate to severe Crohn’s disease with evidence of inflammation and who aren’t responding well to other conventional Crohn’s disease therapies. Because the drug is associated with a rare, but serious, risk of multifocal leukoencephalopathy — a brain infection that usually leads to death or severe disability — you must be enrolled in a special program to use it.
Side effects can include allergic reactions, bone marrow suppression, infections, and inflammation of the liver and pancreas. There also is a small risk of development of cancer with these medications. If you’re taking either of these medications, you’ll need to follow up closely with your doctor and have your blood checked regularly to look for side effects. If you’ve had cancer, discuss this with your doctor before starting these medications.
Some people with heart failure, people with multiple sclerosis, and people with cancer or a history of cancer can’t take infliximab. The drug has been linked to an increased risk of infection, especially tuberculosis and reactivation of viral hepatitis, and may increase your risk of blood problems and cancer. You’ll need to have a skin test for tuberculosis, a chest X-ray and a test for hepatitis B before taking infliximab.
However, adalimumab, like infliximab, carries a small risk of complications, including tuberculosis and serious fungal infections. Your doctor will give you a skin test for tuberculosis, obtain a chest X-ray and test you for hepatitis before you begin adalimumab treatment. The most common side effects of adalimumab are skin irritation and pain at the injection site, nausea, runny nose and upper respiratory infection.
Antibiotics can reduce the amount of drainage and sometimes heal fistulas and abscesses in people with Crohn’s disease. Researchers also believe antibiotics help reduce harmful intestinal bacteria and suppress the intestine’s immune system, which can trigger symptoms. However, there’s no strong evidence that antibiotics are effective for Crohn’s disease. Frequently prescribed antibiotics include:
- Metronidazole (Flagyl). Once the most commonly used antibiotic for Crohn’s disease, metronidazole can cause serious side effects, including numbness and tingling in your hands and feet and, occasionally, muscle pain or weakness.
- Ciprofloxacin (Cipro). This drug, which improves symptoms in some people with Crohn’s disease, is now generally preferred to metronidazole. A rare, but possible side effect of this medication is tendon rupture.
In addition to controlling inflammation, some medications may help relieve your signs and symptoms. Depending on the severity of your inflammatory bowel disease, your doctor may recommend one or more of the following:
- Anti-diarrheals. A fiber supplement, such as psyllium powder (Metamucil) or methylcellulose (Citrucel), can help relieve mild to moderate diarrhea by adding bulk to your stool. For more severe diarrhea, loperamide (Imodium) may be effective.
- Laxatives. In some cases, swelling may cause your intestines to narrow, leading to constipation. Talk to your doctor before taking any laxatives, because even those sold over-the-counter may be too harsh for your system.
- Pain relievers.For mild pain, your doctor may recommend acetaminophen (Tylenol, others). Avoid ibuprofen (Advil, Motrin, others), naproxen (Aleve) and aspirin. These are likely to make your symptoms worse.
- Iron supplements. If you have chronic intestinal bleeding, you may develop iron deficiency anemia. Taking iron supplements may help restore your iron levels to normal and reduce this type of anemia once your bleeding has stopped or diminished.
- Nutrition. Your doctor may recommend a special diet given via a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat your Crohn’s disease. This can improve your overall nutrition and allow the bowel to rest. Bowel rest can reduce inflammation in the short term.
- B-12 shots.Vitamin B-12 helps prevent anemia, promotes normal growth and development, and is essential for proper nerve function. It’s absorbed in the terminal ileum, a part of the small intestine often affected by Crohn’s disease. If inflammation of your terminal ileum is interfering with your ability to absorb this vitamin, you may need monthly B-12 shots for life. You’ll also need lifelong B-12 injections if your terminal ileum has been removed during surgery.
- Calcium and vitamin D supplements. You may need to take a calcium supplement with added vitamin D. This is because Crohn’s disease and steroids used to treat it can increase your risk of osteoporosis. Ask your doctor if a calcium supplement is right for you.
If diet and lifestyle changes, drug therapy, or other treatments don’t relieve your IBD signs and symptoms, your doctor may recommend surgery.
- Surgery for ulcerative colitis. Surgery can often eliminate ulcerative colitis. But that usually means removing your entire colon and rectum (proctocolectomy). In the past, after this surgery you would wear a small bag over an opening in your abdomen (ileostomy) to collect stool. But a procedure called ileoanal anastomosis eliminates the need to wear a bag and is the preferred procedure for most people. Your surgeon constructs a pouch from the end of your small intestine. The pouch is then attached directly to your anus. This allows you to expel waste more normally.
- Surgery for Crohn’s disease. In Crohn’s disease, surgery can provide years of remission at best. At the least, it may provide a temporary improvement in your signs and symptoms. During surgery, your surgeon removes a damaged portion of your digestive tract and then reconnects the healthy sections. In addition, surgery may also be used to close fistulas and drain abscesses. A common procedure for Crohn’s is strictureplasty, which widens a segment of the intestine that has become too narrow.
People who have inflammatory bowel disease have an increased risk of colon cancer. Talk with your doctor about how often you should be screened.
Lifestyle and home remedies
Sometimes you may feel helpless when facing inflammatory bowel disease. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.
There’s no firm evidence that what you eat causes inflammatory bowel disease. But certain foods and beverages can aggravate your symptoms, especially during a flare-up. It’s a good idea to try eliminating from your diet anything that seems to make your signs and symptoms worse. Here are some suggestions:
- Limit dairy products. If milk or other dairy products aggravate your symptoms, you may be lactose intolerant — that is, your body can’t digest the milk sugar (lactose) in dairy foods. If so, you may want to try an enzyme product, such as Lactaid, to help break down lactose. In some cases, you may need to eliminate dairy foods completely. Keep in mind that with limiting your dairy intake, you’ll need to find other sources of calcium, such as supplements.
- Experiment with fiber. For most people, high-fiber foods, such as fresh fruits and vegetables and whole grains, are the foundation of a healthy diet. But if you have inflammatory bowel disease, fiber may make diarrhea, pain and gas worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them. Check with your doctor before adding significant amounts of fiber to your diet.
- Avoid problem foods. Eliminate any other foods that seem to make your symptoms worse. These may include “gassy” foods, such as beans, cabbage and broccoli, raw fruit juices and fruits, popcorn, caffeine, and carbonated beverages.
- Eat small meals. You may find that you feel better eating five or six small meals rather than two or three larger ones.
- Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.
- Consider multivitamins. Because inflammatory bowel disease can interfere with your ability to absorb nutrients and because your diet may be limited, vitamin and mineral supplements can play a key role in supplying missing nutrients. They don’t provide essential protein and calories, however, and shouldn’t be a substitute for meals.
- Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.
Smoking increases your risk of developing Crohn’s disease, and once you have it, smoking can make the condition worse. People with Crohn’s disease who smoke are more likely to have relapses, need medications and repeat surgeries. Quitting smoking can improve the overall health of your digestive tract, as well as provide many other health benefits.
Although stress doesn’t cause inflammatory bowel disease, it can make your signs and symptoms much worse and may trigger flare-ups. Stressful events can range from minor annoyances to a move, job loss or the death of a loved one.
When you’re stressed, your normal digestive process can change, causing your stomach to empty more slowly and secrete more acids. Stress can also speed or slow the passage of intestinal contents. It may also cause changes in intestinal tissue itself.
Although it’s not always possible to avoid stress, you can learn ways to help manage it. Some of these include:
- Exercise. Even mild exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your doctor about an exercise plan that’s right for you.
- Biofeedback. This stress-reduction technique helps you reduce muscle tension and slow your heart rate with the help of a feedback machine. You’re then taught how to produce these changes yourself. The goal is to help you enter a relaxed state so that you can cope more easily with stress. Biofeedback is usually taught in hospitals and medical centers.
- Regular relaxation and breathing exercises. An effective way to cope with stress is to perform relaxation and breathing exercises. You can take classes in yoga and meditation or practice at home using books, CDs or DVDs.
- Hypnosis. Hypnosis may reduce abdominal pain and bloating. A trained professional can teach you how to enter a relaxed state.
- Other techniques. Set aside time every day for any activity you find relaxing — listening to music, reading, playing computer games or just soaking in a warm bath.
Many people with inflammatory bowel disease have used some form of alternative or complementary therapy. Side effects and ineffectiveness of conventional therapies may be among the reasons for seeking alternative care.
These therapies generally aren’t regulated by the Food and Drug Administration. Manufacturers can claim that their therapies are safe and effective, but don’t need to prove it. Because even natural herbs can have side effects and cause dangerous interactions, talk to your doctor before trying any alternative or complementary therapies.
Currently, no alternative therapies have good evidence supporting their use in treating IBD, but some that may eventually prove beneficial include:
- Probiotics. Because bacteria in the gut have been implicated in ulcerative colitis, researchers suspect that adding more of the beneficial bacteria (probiotics) that are normally found in the gut might help combat the disease.
- Fish oil. Fish oil acts as an anti-inflammatory, but studies on its possible benefits for people with ulcerative colitis have had conflicting results.
- Aloe vera. Aloe vera juice has been purported to have an anti-inflammatory effect for people with ulcerative colitis, but there’s no strong evidence to back this claim. In addition, when ingested, aloe vera can have a laxative effect.
- Acupuncture. Several studies have found acupuncture to be of benefit to people with ulcerative colitis. The procedure involves the insertion of fine needles into the skin, which may stimulate the release of the body’s natural painkillers.
- Curcumin. This compound comes from the spice turmeric. Curcumin combined with standard ulcerative colitis therapies, such as corticosteroids or sulfasalazine, has helped improve symptoms and allowed smaller doses of the standard drugs to be used. However, this evidence comes from two small studies. More research is needed before this treatment can be recommended.
Coping and support
Inflammatory bowel disease doesn’t just affect you physically — it takes an emotional toll as well. If signs and symptoms are severe, your life may revolve around a constant need to run to the toilet. When you do, you might worry about an accident, and this anxiety only makes your symptoms worse.
One of the best ways to feel more in control is to find out as much as possible about inflammatory bowel disease. Organizations such as the Crohn’s and Colitis Foundation of America (CCFA) have chapters across the United States to provide information and access to support groups. Contact the organization directly at 888-MY-GUTPAIN (888-694-8872).
Some people find it helpful to consult a psychologist or psychiatrist who’s familiar with inflammatory bowel disease and the emotional difficulties it can cause. Ask your doctor for a referral if you think counseling might be helpful for you.
Although support groups aren’t for everyone, they can provide valuable information about your condition as well as emotional support. Group members frequently know about the latest medical treatments or integrative therapies. You may also find it reassuring to be among people who understand what you’re going through.