Inflammatory bowel disease FAQs
(Crohn's disease and ulcerative colitis)

What are they?

Crohn's disease and ulcerative colitis are both types of inflammatory bowel disease (IBD).
Crohn's disease is an illness that can affect any part of the gut, though it usually involves the small intestine. The disease targets the wall, not just the lining, which becomes inflamed and swollen.
In ulcerative colitis the lining of the large bowel (colon) becomes inflamed and develops tiny ulcers which may bleed. It doesn't affect the small intestine and, if it affects only the rectum, it's called proctitis.

What are the main symptoms?

Crohn's disease

Abdominal pain
Diarrhoea accompanied by bleeding
Vomiting
Weight loss
Sometimes a fever
Anaemia (a low number of red blood cells) through the loss of blood

Secondary inflammatory symptoms include:

Arthritis
Inflammation of the joints in the spine and pelvis
Sore red eyes from inflammation of the eye muscle or iris
Painful red swellings on the legs and mouth ulcers

Ulcerative colitis

The more diseased the colon, the more severe the symptoms.

The mildest form is called proctitis (where "only" the rectum is affected)
The most severe is where the entire gut is inflamed

An attack of acute colitis causes:

Diarrhoea, usually containing blood, pus and mucus
Fever
Anaemia and tiredness

What's the risk?

Over 120,000 people in Britain have IBD and there are 8,000 new cases every year. It's slightly more common among women than men and it usually starts between the ages of 15 and 40. Six out of ten sufferers are under 30.

What causes them?

No-one knows, though there are plenty of theories:

IBD may run in families — about a fifth of people with Crohn's disease have a relative with some form of IBD.
Research at the Royal Free Hospital, London, has suggested the measles and mumps viruses, and the MMR (measles, mumps and rubella) vaccine may be linked to IBD, but recent studies have shown no connection.
Crohn's disease may be caused by Mycobacterium paratuberculosis, a bacterium related to the tuberculosis bug, transferred through food and water.

Neither emotional upset nor worry cause IBD although flare-ups may sometimes happen at times of personal stress. Colds, flu, antibiotics or pain-killing drugs can also trigger attacks.

Neither Crohn's disease nor ulcerative colitis are infectious, nor are they forms of cancer. However, if your colon has been diseased for many years you have a greater risk of developing bowel cancer.

How can I prevent them?

As no-one knows for certain what causes IBD, it is difficult to prevent it.

Should I see a doctor?

Yes. Your GP will give you a rectal examination and then refer you to a hospital specialist for further tests.

What are the main treatments?

IBD can't be cured, but drugs can control the symptoms.

For Crohn's disease you will be prescribed anti-inflammatory drugs, such as corticosteroids, that damp down the inflammation. The doctor may also prescribe drugs, such as anti-diarrhoeals and painkillers to help the symptoms, and antibiotics to control the growth of bacteria in the inflamed gut. There now a monoclonal antibody - infliximab (Remicade) - which can block inflammation of the gut in severe cases of Crohn's disease.
Treatment of ulcerative colitis depends on the severity of the disease. A mild attack may be treated with steroid suppositories to the rectum, plus drugs to control the symptoms. For severe attacks you may be admitted to hospital where steroids may be given directly into a vein along with fluids if you have become dehydrated.
If the IBD is severe, part of the gut may be removed and the cut end brought out on to the wall of the abdomen as a stoma, or permanent opening. You will be fitted with a small bag to contain the waste which would normally have gone into the colon. This sounds pretty nasty, but for many it is preferable to the symptoms of IBD.

How can I help myself?

Eat a healthy balanced diet and avoid foods such as milk, alcohol, hot spices and roughage that make your symptoms worse.
Try an exclusion diet to pinpoint any trigger foods (i.e. eliminate a suspected food for a few days to see if this affects your symptoms).
Large doses of vitamins will do you little good, but your doctor may recommend nutritional supplements.
Complementary therapies that ease stress, such as yoga, meditation, reflexology and hypnotherapy, may help.