Heading to the Doctor? Here is a Doctor Visit Prep Sheet for IBD.

Inflammatory Bowel Disease (IBD) affects approximately 1.6 million people across the United States, with up to 70,000 new cases diagnosed each year. (1) If you or someone you love is suffering from this condition, you know it can greatly diminish one’s quality of life. Because I have worked with hundreds of patients with IBD, I am passionate about supporting IBD research and improving the lives of my patients as much as possible.

In this post I want to discuss Inflammatory Bowel Disease in depth so you can have a greater understanding of the disease, how it affects the body, what you can do to treat it and how to best work with your doctor to find healing and support.

What Is Inflammatory Bowel Disease (IBD)?

Inflammatory Bowel Disease describes two conditions: Ulcerative Colitis and Crohn’s Disease. Both are chronic inflammatory conditions of the gastrointestinal (GI) tract. These conditions may occur together or separately. As of today, these are chronic conditions that do not have a cure. There are many treatment options that can improve or even eliminate some symptoms, but not entirely rid one of the disease.

Ulcerative Colitis

Ulcerative Colitis occurs only in the large intestine and the rectum. It happens when chronic inflammation causes damage to the first inner layer of the colon or rectum lining.

Crohn’s Disease

Crohn’s disease can happen anywhere in the GI tract (from mouth to rectum). It happens when chronic inflammation damages multiple layers of the lining of the GI tract. Crohn’s Disease generally begins in the small intestine and spreads to other areas from there.

Symptoms of IBD

  • Persistent diarrhea
  • Constipation
  • Urgent need to go to the bathroom
  • Abdominal pain
  • Unexplained Weight Loss
  • Small appetite
  • Chronic fatigue
Symptoms Unique to Crohn’s Disease
  • Mouth sores between gums and lower lip, or bottom of tongue
  • Anal tears, ulcers, infections or narrowing
Symptoms More Common With Ulcerative Colitis
  • Rectal bleeding
  • Anemia

Complications of Ulcerative Colitis

When IBD goes untreated for long enough it can lead to some painful complications that require urgent medical attention.

Perforated bowel – when damage becomes so severe it creates a hole in the intestinal wall.

Toxic megacolon – when severe inflammation causes rapid enlargement of the colon.

Frequent diarrhea, bleeding and abdominal pain – when left untreated the damage becomes worse and symptoms become more severe.

Perforated bowel – when damage becomes so severe it creates a hole in the intestinal wall.

Complications of Crohn’s Disease

Malabsorption/Malnutrition – damage to the intestinal tract makes it difficult to digest and absorb nutrients properly.

Fistula – ulcers on the intestinal wall develop and create a tunnel to other parts of the intestine or even other organs.

Stricture – intestinal narrowing/blockage due to scaring.

Abscess – pus in the abdomen or anus.

Blood Clots – deep vein thrombosis or pulmonary embolism. IBD patients have a three times greater risk of experiencing these types of blood clots than those without IBD. (13)

Colorectal Cancer – cancer in the colon. Those with Crohn’s Disease are more likely to develop colorectal cancer, and the risk increases the longer one has had the disease. Statistics say as many as 18% of people who have Crohn’s Disease for 30+ years will have developed colorectal cancer. (12)

Other IBD Symptoms Outside The GI Tract

  • Red, painful, itchy eyes
  • Sores in the mouth
  • Swollen, painful joints
  • Ulcerations, sores or rashes on the skin
  • Osteoporosis
  • Kidney stones
  • Liver problems (rare)

IBD vs IBS

IBD and IBS (Irritable Bowel Syndrome) are different conditions and should not be confused. Although some symptoms may be similar (diarrhea, constipation, abdominal cramps) IBS does not cause severe damage to the GI tract as does IBD. IBS is much less severe than IBD and can often be improved with simple lifestyle changes.

Who Is At Risk For IBD?

The exact cause for IBD is currently unknown, although there are many factors which seem to contribute to its development. These include a genetic disposition for IBD, a poorly functioning immune system, and/or certain environmental triggers.

Genetics

Studies have found that 5-20% of people who develop IBD have a close relative who also has the disease. (2) This means children of parents with IBD have a higher risk than those with parents who don’t have IBD. (3) Research has also found that if both parents have IBD, children have a 36% chance of developing the disease as well. (4)

Certain genetic mutations have been linked to IBD, although having them does not mean you will develop IBD for sure. A certain geneic mutation, the NOD2/CARD15 gene, for example, exists in approximately 20% of Crohn’s Disease patients. (5)

Environmental Triggers

There are some environmental/lifestyle triggers that have been linked to an increased risk for IBD.

Smoking

People who smoke tobacco regularly are twice as likely to develop Crohn’s Disease than those who do not smoke. (6)

Heavy Antibiotic Use

Some studies suggest that mothers who frequently use antibiotics, which results in changes to the microbiome in the gut, may cause an increased risk of IBD in their children. When a mother gives birth, her microbiome is passed in part to her baby. If her microbiome is weak or imbalanced it may lead to an increased risk for health issues in the baby later on in life. (7)

Frequent Nonsteoidal Anti-inflammatory Drug Use (i.e. ibuprofen, naproxen)

Research has found that frequent use of NSAIDs may irritate the gut and lead to an increased risk for Crohn’s Disease and Ulcerative Colitis. (8)

Appendectomy 

Some studies have found that the risk for developing IBD increases in individuals who have had their appendix removed. The risk is highest in the first 6 months after removal and slowly declines over the next 20 years. Women have a slightly higher risk then men. (9, 10)

Poor Diet

Diet alone is not thought to cause IBD, but certain foods can aggravate the condition. These include:

  • Fatty, fried foods
  • Spicy foods
  • Meats
  • High-fiber fruits and vegetables
  • Caffeine
  • Sweets, high sugar beverages and snacks
  • Alcohol

Am I At Risk?

Here are some statistics for different demographics:

Location: More cases of IBD are found in developed countries than non-developed. There are more people with IBD in urban areas. Northern climates have higher rates than southern. Another interesting statistic; people who immigrate to America from underdeveloped nations have a higher chance of developing IBD after coming here.

Age: People are more likely to be diagnosed with IBD between the ages of 15 and 35.

Gender: Men and women are equally at risk for both ulcerative colitis and Crohn’s disease.

Race: IBD does not seem to affect any particular race or ethnicity more than another.

How To Treat Inflammatory Bowel Disease

Although science has yet to find a cure for IBD, there are many treatment options to alleviate symptoms and improve overall quality of life. There is no one-size-fits-all regimen, and doctors approach treatment on a case-by-case basis. The first step is obtaining a proper diagnosis.

How IBD Is Diagnosed

Step one: patient history and physical exam.

When you initially go to the doctors office, you will give your complete health history and tell the doctor about your symptoms. If you want help with this first doctor’s visit, use our Inflammatory Bowel Disease Doctor’s Checklist. This will help you remember all your symptoms and questions so that your visit can be as productive as possible.

You will also want to discuss your family history. Does anyone in your family have or had Crohn’s Disease or Ulcerative Colitis?

Your doctor may also perform a basic exam, including a rectal exam.

Step two: diagnostic testing. 

The following are the most common diagnostic procedures for IBD: (11)

  • Blood tests. Blood will be taken from a vein in your arm or through a finger prick. Blood testing alone cannot diagnose IBD, but can indicate inflammation levels in the body. Chronic inflammation is a marker for IBD. Blood tests can also determine liver and kidney function, detect anemia and check for infection.
  • Stool samples. Proteins found in your stool can help to detect inflammation in the body. Other biomarkers in the stool may be used to detect IBD activity. A stool sample can also help to rule out other gastrointestinal conditions that may present similar symptoms as IBD.
  • Endoscopy. During this procedure, a tiny camera is used to see inside your body. This procedure allows the doctor to see the inside of your intestine and check for damage and signs of IBD.
  • Biopsy. During an endoscopic procedure, many doctors will also take biopsy samples of your intestinal lining to evaluate for inflammation and infection.
  • Colonoscopy. This is the most common type of endoscopy used to diagnose IBD, as the colon tends to be a major place for symptoms to occur. There are a few steps to having this done:
    • You will receive restrictive diet instructions
    • You will be asked to drink a “bowel preparation” drink which will help to eliminate any fecal matter from your digestive tract that would otherwise block the endoscope.
    • You will be sedated for the procedure to minimize discomfort.
    • A trained professional will insert the colonoscope through your rectum and entire colon.
  • Radiology Scans. There are two-thirds of the small intestine that are not visible using a colonoscopy or endoscopy. These will be viewed using diagnostic imaging like CT scans, MRI, ultrasounds and x-rays.

Conventional Treatments for IBD

There are five different categories of medications used to treat IBD, as well as surgery for more difficult cases. Your doctor will create a plan that fits your unique situation and symptoms most effectively.

Aminosalicylates: Anti-inflammatory drugs given orally or rectally. Most effective for ulcerative colitis.

Corticosteroids: Support the body’s natural inflammatory process and offer short-term control of flareups by keeping the immune system from overreacting.

Immunomodulators: Prevent the immune system from causing chronic inflammation.

Antibiotics: Used to prevent infections (such as abscesses) that may develop from damage in the intestinal tract.

Biologic Therapies: Block white blood cells from entering inflamed tissue in the intestinal wall as well as neutralize inflammatory proteins.

Vaccinations: Staying up-to-date on vaccinations is recommended for IBD patients to prevent unnecessary and potentially dangerous infections.

Surgery: For some people with IBD, symptoms will not subside with medications or lifestyle changes alone. Those who have been suffering from IBD for several decades, damage will slowly build up over time and medications will become less and less effective. In cases like these, surgery may be required to remove some of the severely damaged colon or intestine.

Approximately 33%  of people with ulcerative colitis will require surgery after 30 years with the disease. About 70% of people with Crohn’s Disease end up needing surgery at one point or another.

Lifestyle Treatments for IBD

These lifestyle changes can help you to manage your IBD symptoms. Because every case is different, work with a medical professional to personalize these to your needs.

#1 Stop Smoking

As mentioned above, those who smoke tobacco regularly are twice as likely to develop Crohn’s Disease than those who do not smoke. (6)

#2 Eat Smaller, More Frequent Meals

Eating smaller meals tends to be easier on digestion in people with IBD. So instead of large meals 2-3 times a day, eat 4-6 small meals throughout the day.

#3 Eat The Right Kind Of Fiber

People with IBD generally have a difficult time digesting high amounts of fiber. However, fiber is still important in one’s diet. Try sticking to soluble fibers like oatmeal, flax-seed, beans, berries, apples, oranges, dried peas, cucumber, carrots and celery. Avoid insoluble fibers.

#4 Start Walking

Exercise can be a challenge for those with IBD, often because of painful symptoms or the need to be near a bathroom. But many patients with IBD report improvement of symptoms when they walk a little every day. Exercise benefits the whole body, including the digestive system. Start with just a few minutes a day and slowly build up.

#5 Avoid Trigger Foods

Pay close attention to your diet and how each meal affects your symptoms. Avoid foods that aggravate your IBD. These may include:

  • dairy
  • chocolate
  • cruciferous vegetables
  • wheat
  • broccoli
  • beans
  • alcohol
  • tap water
  • emulsifiers
  • fatty foods
  • caffeine

If you are not sure what foods make your symptoms worse, or everything you eat makes them worse, your doctor may recommend a temporary liquid diet. This gives your digestive system a chance to rest and heal. After a short period of time you will begin to reintroduce regular food; very slowly so that you can pay attention to how each piece affects your system.

Only do a liquid diet under the direction of your physician.

#6 Find Support

Connecting with people who understand what you are going through can be tremendously helpful.  Look for support groups on social media as well as in your community.

#7 Test for Nutritional Deficiencies

Ask your doctor to perform a test for nutritional deficiencies. This makes it easy to see what you are not absorbing well so you can supplement as needed. Use vitamins and minerals from brands recommended by your doctor as the supplement market is not carefully regulated. You may also want to work with a dietitian to fine-tune your diet.

#8 Use Turmeric and Probiotics

Curcumin, the active ingredient in turmeric, has been studied extensively for its anti-inflammatory properties. Research has found that it may be beneficial for those with IBD. (13) I also recommend my patients try a high-quality probiotic. Though the benefits have not been proven for IBD specifically, I find many people experience better digestion/absorption when they take them daily.

Heading to the Doctor? Here is a Doctor Checklist for IBD.

Frequently Asked Questions about IBD

Q. Can inflammatory bowel disease kill you?

A. Crohn’s Disease and Ulcerative Colitis are not considered fatal conditions. There are rare cases where patients have died from IBD-related causes.

Q. Can inflammatory bowel disease cause cancer?

A. People with IBD are more likely to develop colorectal cancer than those without IBD. This risk increases the longer one has had the disease.

Q. Can inflammatory bowel disease be cured?

A. At this time there is no cure for inflammatory bowel disease. There are however many medications and treatments that can reduce symptoms and improve quality of life.

Q. What is idiopathic inflammatory bowel disease?

A. When IBD has an unknown cause.

Conclusion

If you think you might have IBD, I suggest scheduling an appointment with your healthcare professional. Here is a Doctor Visit Checklist to help you have the most productive visit possible.

I believe strongly that we all should be our own #HealthHero. This means that we are committed to our wellbeing and will do what it takes to live a life of health and vitality. When you feel your best, you can make the most impact in the lives of those you love and in the community you live in.

Did you find the information in the post useful? What other conditions would you be interested in learning about on our blog? Comment below.

References

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  7. https://nyulangone.org/press-releases/changes-in-bacterial-mix-linked-to-antibiotics-increase-risk-for-inflammatory-bowel-disease
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3369539/
  9. https://www.ncbi.nlm.nih.gov/pubmed/9247453
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2000241/
  11. http://www.crohnscolitisfoundation.org/assets/pdfs/diagnosing-and-managing-ibd.pdf
  12. Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer
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  13. Nguyen GC, Sam J. Rising prevalence of venous thromboembolism
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  14. https://www.ncbi.nlm.nih.gov/pubmed/21649456