Inflammatory bowel disease, or IBD, is an umbrella term used to describe disorders causing chronic inflammation of your digestive tract. It’s mainly aimed at ulcerative colitis and Crohn’s disease which are both long-term conditions.
Whilst anyone can get IBD, it’s usually diagnosed between the ages of 15 and 40. In this article, we delve a little deeper into the signs, symptoms and treatment options as well as a brief look at microscopic colitis.
What Causes Inflammatory Bowel Disease?
The exact cause of inflammatory bowel disease is still unknown although doctors initially thought diet and stress factors were responsible. However, they now know that these may aggravate IBD but not necessarily cause the condition. Many experts suggest it may be a combination of factors such as immune system malfunction and genetics.
When your immune system fights off a virus or bacterium, an abnormal immune response can result in the immune system attacking the cells in the digestive tract. Genetics also seems to play a part as IBD is more common in people who have family members with the disease. However, it’s not a general rule as most people with IBD don’t have a family history of the condition.
Ulcerative Colitis
Ulcerative colitis is a long-term condition where the colon and rectum become inflamed. A common occurrence is small ulcers developing on the lining of the colon which can bleed and produce pus. The severity of the associated symptoms varies and depends on how much of the rectum and colon are inflamed.
Ulcerative colitis can have a significant impact on your everyday life as many people experience bowel urgency and even bowel incontinence. It’s not all doom and gloom as most people who have ulcerative colitis lead full, happy, and productive lives.
Crohn’s Disease
Crohn’s disease is a lifelong condition where parts of the digestive system become inflamed and can be rather uncomfortable and sometimes debilitating. It affects people of all ages but the symptoms often start in childhood or early adulthood.
Living with Crohn’s disease can be difficult at times as there are unpredictable flare-ups and regular check-ups. This can easily disrupt school, work and even your social life but if you control the symptoms well, you can live a normal life. If you need help, there are care teams and organisations such as Crohn’s and Colitis UK.
What Are The Symptoms Of IBD?
The symptoms of IBD can vary depending on the severity of inflammation and where it occurs. Symptoms may be mild or severe and there could even be periods of active illness followed by periods of remission. Signs and symptoms common to Crohn’s disease and ulcerative colitis may include the following:
- Recurring diarrhoea or vomiting
- Extreme fatigue
- Abdominal pain, swelling and cramping
- Blood in your stool
- Reduced appetite
- Unintended weight loss
- High temperature
- Need to empty your bowels often (especially with Ulcerative colitis)
Some of the less likely symptoms are arthritis in the large joints of the arms and legs including elbows, wrists, knees and ankles painful red eyes (uveitis), painful red skin bumps (erythema nodosum) and jaundice. You should visit your doctor if your bowel movements change significantly or if you experience any of the other signs and symptoms of inflammatory bowel disease.
Risk Factors Of IBD (Ulcerative Colitis and Crohn’s Disease)
Whilst anyone can get IBD, most people are diagnosed before they are 30 years old. Some people don’t develop the disease until they are well into their 50s or 60s. Here are some of the most common risk factors:
- Although race or ethnicity can also play a part, it can happen to anyone.
- Family history is an important factor as you’re at higher risk if you have a close relative with the disease
- Smoking is the most important controllable risk factor for developing Crohn’s disease.
In terms of smoking, if you want to quit, here are some services that can help.
Is There A Cure For Inflammatory Bowel Disease?
If you have mild ulcerative colitis, you may require minimal or no treatment and remain well for a long time. Unfortunately, there is currently no known cure for ulcerative colitis or Crohn’s disease but there are things you can do to relieve symptoms and prevent them from returning.
A healthy, balanced diet will give people with IBD the nutrients that are important to stay well but does not and should not replace the medical treatments suggested by the patient’s IBD team.
Stress may also make the condition worse so regular exercise and meditation may help.
- Aminosalicylates or mesalazines (reduce inflammation in the gut)
- Immunosuppressants such as steroids or azathioprine can reduce the activity of the immune system
- Biological and biosimilar medicines (antibody-based treatments given by injection to target a specific part of the immune system)
Is IBD The Same As IBS?
This is a common misconception but IBD is categorically different from irritable bowel syndrome (IBS). IBS is a common disorder involving the gastrointestinal (GI) tract with symptoms such as bloating, stomach pain, constipation and diarrhoea.
As we’ve already established, Inflammatory Bowel Disease is the inflammation or destruction of the bowel wall. It’s far more serious and uncomfortable as it can lead to sores and narrowing of the intestines. And, while it’s not common, it is possible to have both IBD and IBS.
What Is Microscopic Colitis?
Microscopic Colitis is also an Inflammatory Bowel Disease that affects the large bowel (colon and rectum). The two main conditions under Microscopic Colitis are Lymphocytic Colitis and Collagenous Colitis. It’s not always as well-recognised as Crohn’s Disease or Ulcerative Colitis and diagnosis can take time.
With Microscopic Colitis, the inner walls (lining) of your bowel becomes inflamed but it can only be seen when the samples from the inner lining of the bowel (gut) wall are viewed under a microscope – hence the name microscopic colitis. Under normal circumstances, your large bowel absorbs 90% of the water from leftover digestion waste and creates solid stool.
However, when the colon is affected by Microscopic Colitis, it can’t absorb as much liquid which results in large volumes of non-bloody watery diarrhoea being produced.
Treatment For Microscopic Colitis
Before you get any treatment for Microscopic Colitis, your doctor will determine if any of your current medications are causing symptoms. Remember, some medicines can trigger the condition including ibuprofen, diclofenac, aspirin, depression medication (SSRIs) and heartburn medicine among others.
Here are some of the most common treatment options your doctor may recommend:
- Loperamide
- Bile Acid Sequestrants (colestyramine, colestipol or colesevelam)
- Budesonide
- Biologic Medicines (Infliximab and adalimumab)
- Immunosuppressants such as azathioprine and mercaptopurine
- Surgery is rare but it has helped people who don’t find relief from other treatments
Another great course of treatment is lifestyle changes whether it’s diet, exercise or stopping smoking. Cutting down your alcohol and caffeine consumption has proven to help reduce diarrhoea. You could also keep a food diary to record the reactions you might have to different types of food.
Microscopic Colitis And Coeliac Disease
Did you know that people with Microscopic Colitis are 50 times more likely to have coeliac disease? This is when you can’t digest a type of protein called gluten found in wheat, barley and rye. To find out if you need to avoid gluten, request a blood test from your doctor. If it’s positive, you may also have an upper gastrointestinal endoscopy to confirm the diagnosis.
Speaking of diets, if your diarrhoea gets worse after eating dairy, you could have problems digesting lactose. This is the type of sugar found mostly in milk, cheese and other dairy products. Sometimes a simple breath test can determine if you’re lactose intolerant. And, once again, keeping a food diary can help identify any foods you may be more susceptible to.
Support For Inflammatory Bowel Disease (IBD)
There are several support systems in place for those suffering from IBD, including the charity Crohn’s and Colitis UK. You can the helpline on 0300 222 5700 from Monday to Friday between 10 am and 5 pm or use the online contact form. Another British charity with useful information about support groups is The IBS Network.
VirtualOutcomes support community pharmacies and GP surgery teams with a wide range of online training courses. It covers topics such as the C19 Lateral Flow Device Distribution Service, vaccines, meningitis, cervical cancer screening and the Pharmacy Quality Scheme among many others. These practical online courses are free of charge to any community pharmacy.