What is inflammatory bowel disease?
Inflammatory bowel disease (IBD) involves chronic inflammation of all or part of your digestive tract. IBD primarily includes ulcerative colitis and Crohn’s disease. Both usually involve severe diarrhea, pain, fatigue and weight loss. IBD can be debilitating and sometimes leads to life-threatening complications.
Ulcerative colitis is an inflammatory bowel disease that causes long-lasting inflammation and sores (ulcers) in the innermost lining of your large intestine (colon) and rectum.
Crohn’s disease is an IBD that cause inflammation of the lining of your digestive tract. In Crohn’s disease, inflammation often spreads deep into affected tissues. The inflammation can involve different areas of the digestive tract — the large intestine, small intestine or both.
Collagenous colitis and lymphocytic colitis also are considered inflammatory bowel diseases but are usually regarded separately from classic inflammatory bowel disease.
How common is inflammatory bowel disease?
People of any age can get IBD, but it’s usually diagnosed between the ages of 15 and 40. Please discuss with your doctor for further information.
What are the symptoms of inflammatory bowel disease?
The common symptoms of inflammatory bowel disease are:
- Diarrhea, which occurs when affected parts of the bowel can’t reabsorb water
- Bleeding ulcers, which may cause blood to show up in the stool (hematochezia)
- Stomach pain, cramping, and bloating due to bowel obstruction
- Weight loss and anemia, which can cause delayed growth or development in children
People with Crohn’s disease may get canker sores in their mouths. Sometimes ulcers and fissures also appear around the genital area or anus.
IBD can also be associated with problems outside of the digestive system, such as:
- Eye inflammation
- Skin disorders
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my 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.
What causes inflammatory bowel disease?
The exact cause of inflammatory bowel disease remains unknown. Previously, diet and stress were suspected, but now doctors know that these factors may aggravate but don’t cause IBD.
One possible cause is an immune system malfunction. When your immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too. Heredity also seems to play a role in that IBD is more common in people who have family members with the disease. However, most people with IBD don’t have this family history.
What increases my risk for inflammatory bowel disease?
There are many risk factors for inflammatory bowel disease, such as:
- Most people who develop IBD are diagnosed before they’re 30 years old. But some people don’t develop the disease until their 50s or 60s.
- Race or ethnicity. Although whites have the highest risk of the disease, it can occur in any race. 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.
- Cigarette smoking. Cigarette smoking is the most important controllable risk factor for developing Crohn’s disease. However, smoking may provide some protection against ulcerative colitis. The overall health benefits of not smoking make it important to try to quit.
- Isotretinoin use. Isotretinoin (Amnesteem, Claravis, Sotret; formerly Accutane) is a medication sometimes used to treat scarring cystic acne or acne. Some studies suggest it may be a risk factor for IBD, but a clear association between IBD and isotretinoin has not been established.
- Nonsteroidal anti-inflammatory medications. These include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, Anaprox), diclofenac sodium (Voltaren, Solaraze) and others. These medications may increase the risk of developing IBD or worsen disease in people who have IBD.
- Where you live. If you live in an urban area or in an industrialized country, you’re more likely to develop IBD. Therefore, it may be that environmental factors, including a diet high in fat or refined foods, play a role. People living in northern climates also seem to be at greater risk.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is inflammatory bowel disease diagnosed?
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. He or she will use a combination of tests. To help confirm a diagnosis of IBD, you may have one or more of the following tests and procedures:
- Tests for anemia or infection. Your doctor may suggest blood tests to check for anemia — a condition in which there aren’t enough red blood cells to carry adequate oxygen to your tissues — or to check for signs of infection from bacteria or viruses.
- Fecal occult blood test. You may need to provide a stool sample so that your doctor can test for hidden blood in your stool.
- This test allows your doctor to view 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, which may help confirm a diagnosis. Clusters of inflammatory cells called granulomas, if present, help confirm a diagnosis of Crohn’s disease.
- Flexible sigmoidoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the last section of your colon (sigmoid).
- Upper endoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the esophagus, stomach and first part of the small intestine (duodenum). While it is rare for these areas to be involved with Crohn’s disease, this test may be recommended if you are having nausea and vomiting, difficulty eating or upper abdominal pain.
- Capsule endoscopy. This test is used to help diagnose Crohn’s disease. You swallow a capsule that has a camera in it. The images are transmitted to a computer you wear on your belt, after which the camera exits your body painlessly in your stool. You may still need endoscopy with biopsy to confirm a diagnosis of Crohn’s disease.
- 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 exact diagnosis is still in question.
- X-ray. If you have severe symptoms, your doctor may use a standard X-ray of your abdominal area to rule out serious complications, such as a perforated colon.
- Computerized tomography (CT) scan. You may have a CT scan — a special X-ray technique that provides more detail than a standard X-ray does. This test looks at the entire bowel as well as at tissues outside the bowel. CT enterography is a special CT scan that provides better images of the small bowel. This test has replaced barium X-rays in many medical centers.
- Magnetic resonance imaging (MRI). An MRI scanner uses a magnetic field and radio waves to create detailed images of organs and tissues. MRI is particularly useful for evaluating a fistula around the anal area (pelvic MRI) or the small intestine (MR enterography). Unlike CT, there is no radiation exposure with MRI.
- Small bowel imaging. This test looks at the part of the small bowel that can’t be seen by colonoscopy. After you drink a liquid containing barium, doctors take an X-ray of your small intestine. While this technique may still be used, it has largely been replaced by CT or MRI enterography.
How is inflammatory bowel disease treated?
There are a number of different treatments for IBD.
- Anti-inflammatory drugs are the first step in IBD treatment. These drugs decrease inflammation of the digestive tract. However, they have many side effects. Anti-inflammatory drugs used for IBD include sulfasalazine and its byproducts as well as corticosteroids.
- Immune suppressants (or immunomodulators) prevent the immune system from attacking the bowel and causing inflammation. This group includes drugs that block TNF. TNF is a chemical produced by the immune system that causes inflammation. Excess TNF in the blood is normally blocked, but in people with IBD, higher levels of TNF can lead to more inflammation. Immune suppressants can have many side effects, including rashes and infections.
- Antibiotics are used to kill bacteria that may trigger or aggravate IBD symptoms.
- Antidiarrheal drugs and laxatives can also be used to treat IBD symptoms.
- Lifestyle choices are important when you have IBD. Drinking plenty of fluids helps to compensate for those lost in your stool. Avoiding dairy products and stressful situations also improves symptoms. Exercising and quitting smoking can further improve your health.
- Vitamin and mineral supplements can help with nutritional deficiencies. For example, iron supplements can treat anemia.
Surgery can sometimes be necessary for people with IBD. Some IBD surgeries include:
- Strictureplasty to widen a narrowed bowel
- Closure or removal of fistulas
- Removal of affected portions of the intestines, for people with crohn’s disease
- Removal of the entire colon and rectum, for severe cases of ulcerative colitis
- Routine colonoscopy is used to monitor for colon cancer, since those with IBD are at a higher risk for developing it.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage inflammatory bowel disease?
The following lifestyles and home remedies might help you cope with inflammatory bowel disease:
There’s no firm evidence that what you eat actually causes inflammatory bowel disease. But certain foods and beverages can aggravate your signs and symptoms, especially during a flare-up.
It can be helpful to keep a food diary to keep track of what you’re eating, as well as how you feel. If you discover some foods are causing your symptoms to flare, you can try eliminating those foods. Here are some suggestions that may help:
- Limit dairy products. Many people with inflammatory bowel disease find that problems such as diarrhea, abdominal pain and gas improve when they limit or cut out dairy products. You may be lactose intolerant — that is, your body can’t digest the milk sugar (lactose) in dairy foods. Using an enzyme product such as Lactaid may help as well.
- Try low-fat foods. If you have Crohn’s disease of the small intestine, you may not be able to digest or absorb fat normally. Instead, fat passes through your intestine, making your diarrhea worse. Try avoiding butter, margarine, cream sauces and fried foods.
- Take care with fiber. If you have inflammatory bowel disease, high-fiber foods, such as fresh fruits and vegetables and whole grains, may make your symptoms worse, especially if you have narrowing in the bowel. If raw fruits and vegetables bother you, try steaming, baking or stewing them.In general, you may have more problems with foods in the cabbage family, such as broccoli and cauliflower, nuts, seeds, corn, and popcorn. You may be told to limit fiber or go on a low-residue diet if you have a narrowing of your bowel (stricture).
- Avoid other problem foods. Spicy foods, alcohol and caffeine may make your signs and symptoms worse.
Other dietary measures
- Eat small meals. You may find you feel better eating five or six small meals a day rather than two or three larger ones.
- Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.
- Consider multivitamins. Because Crohn’s disease can interfere with your ability to absorb nutrients and because your diet may be limited, multivitamin and mineral supplements are often helpful. Check with your doctor before taking any vitamins or supplements.
- 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 it worse. People with Crohn’s disease who smoke are more likely to have relapses and need medications and repeat surgeries.
Smoking may help prevent ulcerative colitis. However, its harm to overall health outweighs any benefit, and quitting smoking can improve the general health of your digestive tract, as well as provide many other health benefits. Nicotine patches have been used to treat ulcerative colitis, but the results have been disappointing.
The association of stress with Crohn’s disease is controversial, but many people who have the disease report symptom flares during high-stress periods. If you have trouble managing stress, try one of these strategies:
- 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.
- This stress-reduction technique may train you to reduce muscle tension and slow your heart rate with the help of a feedback machine. The goal is to help you enter a relaxed state so that you can cope more easily with stress.
- Regular relaxation and breathing exercises. One way to cope with stress is to regularly relax and use techniques such as deep, slow breathing to calm down. You can take classes in yoga and meditation or use books, CDs or DVDs at home.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Inflammatory bowel disease (IBD). http://www.mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/basics/definition/con-20034908. Accessed July 19, 2017.
Inflammatory bowel disease. http://www.nhs.uk/conditions/inflammatory-bowel-disease/Pages/Introduction.aspx#Help-and-support. Accessed July 19, 2017.
Inflammatory Bowel Disease. http://www.healthline.com/health/inflammatory-bowel-disease#overview1. Accessed July 19, 2017.
Review Date: July 20, 2017 | Last Modified: September 13, 2019