What is IBD?
'Inflammatory bowel disease', or
IBD, is a general term that includes both ulcerative colitis and Crohn's
disease. Both diseases cause inflammation (sores, swelling, bleeding and
pain) in the digestive system. Ulcerative colitis affects the inner
lining of the large intestine (colon and rectum), and Crohn's disease
can affect any part of the digestive tract from the mouth to the anus.
Both diseases are manageable, and with treatment most people are able to
carry on living normal lives.
IBD affects different people in different ways, and no two people with
IBD are alike. Here are some answers to some of the most common
questions about IBD, to help you understand how it might affect you and
how it is managed.
What are the symptoms?
most common IBD symptoms are abdominal pain, cramping, tiredness
(fatigue), diarrhoea and weight loss. Other symptoms may include
bloody diarrhoea, slight fever, anaemia (low levels of red blood
cells in the blood which can make you feel tired, faint or
breathless) and exhaustion (extreme tiredness).
Both diseases are ongoing (chronic) with times when symptoms get
worse (called flares, flare-ups, or attacks) and other times when
symptoms get better (remission). Although the symptoms can make you
feel unwell and may make your daily activities difficult, they can
usually be managed with a combination of care, medication,
hospitalisation and (sometimes) surgery. Many people find that in
well managed IBD, making some simple changes to their everyday lives
enables them to continue their normal activities.
Who gets IBD?
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IBD can start at any age. It first develops in many people
between the ages of 15 and 30. Both Crohn's disease and ulcerative
colitis are found worldwide, although they are more common in the
Western world. About 2.2 million people in Europe have IBD. Regional
differences range from 1/1000 to 1/500, with the highest numbers in
IBD affects men and women equally, although
ulcerative colitis is slightly more common in men and Crohn's
disease is slightly more common in women.
What causes IBD?
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Although the exact causes of IBD are unknown, they are believed
to be related to changes in the immune system brought about by an
environmental trigger in people who are genetically prone to the
disease. A combination of factors may play a role, including
bacteria, viruses, genetics, smoking and over-the-counter pain
medicines. Other factors, such as stress and diet, are not believed
to cause IBD, although they may be involved in worsening symptoms
for some people.
Is it contagious?
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Neither ulcerative colitis nor Crohn's disease is contagious,
meaning you cannot catch it from someone else or spread it to anyone
if you have it. This should not be confused with the fact that the
tendency to develop the disease may be hereditary (passed on through
the genes), since relatives of people with IBD are at a slightly
greater risk of developing the disease. However, other factors (such
as environmental triggers) are also believed to play a role in
developing the disease for these people.
What else could happen?
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Both ulcerative colitis and Crohn's disease can have
complications. With ulcerative colitis, for example, severe bleeding
may cause anaemia (low levels of red blood cells in the blood, which
can make you feel tired, faint or breathless).
disease, scarring and thickening of the intestine walls can create a
narrowing of the intestine wall, which is called a stricture,
leading to constipation, bloating and pain. Nutritional problems may
also occur if the body cannot absorb vitamins or minerals properly.
Although not everyone will have these problems, if they do arise,
they may also need specific treatment in addition to treating
ulcerative colitis or Crohn's disease.
Can it affect
other parts of the body too?
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Not everyone will have these problems, but for some people IBD may
also affect other parts of the body, such as the joints, eyes,
mouth, liver, gallbladder, skin or kidneys. Although some of these
problems may improve with the treatment and management of IBD,
specific treatment may also be needed.
How is IBD treated?
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For most people with IBD, especially with mild to moderate symptoms,
treatment with medicine is usually the first approach. The type of
treatment you will be given depends on several things
such as whether you have ulcerative colitis or Crohn's disease, the
extent of the disease, and the impact of your symptoms on your daily
For people with ulcerative colitis, the type of treatment depends on
the amount of the large bowel affected and the severity of the
inflammation. For example, disease in the lower part of the bowel
may be treated with drugs given directly into the rectum with an
enema or suppository. A medicine called mesalazine may be given by
mouth. Steroid tablets (such as prednisolone) may be given in more
severe cases or if more of the bowel is affected. Immunosuppressants
may also be used to help reduce the activity of the body's immune
system, which causes a lot of the damage to the bowel. After
symptoms are reduced, many people take medicine to keep symptoms
from returning; this is called maintenance therapy.
For Crohn's disease, there are generally the same options as those
used for ulcerative colitis. However, with Crohn's disease, drugs
that suppress the immune system (azathioprine, 6-mercaptopurine or
methotrexate) are used more often to help control the inflammation
and as maintenance therapy to help keep symptoms from coming back.
Active Crohn's disease is usually treated with steroid tablets (eg,
prednisolone) and sometimes antibiotics are also used. When other
drug therapy does not work well, an anti-TNF drug may be given by
infusion (drip) in the hospital or by injection at home.
With both diseases, surgery may be needed if medication does not
work well or if there are complications. If you have any questions
about the possibility of needing surgery, it is best to discuss your
situation with your doctor. In general, surgery is usually only used
in severe situations when other options are not possible or do not
more details on treatment options for ulcerative colitis and Crohn's
disease, please see
Treatment plan for ulcerative colitis
In severe ulcerative colitis, sudden, severe dilation of the colon
(referred to as toxic megacolon) may result in a perforation.
In severe Crohn's disease, if the intestine wall becomes fully blocked
(called an obstruction) it must be treated in the hospital. Another
possible problem is a fistula, or tunnel caused by inflammation that
goes from one part of the intestine to another or to the skin (for
example, from the bowel to the skin near the anus).
Severe disease may be associated with joint pain or arthritis,
inflammation of the eyes and mouth, liver diseases, gallstones, skin
rashes, anaemia (low red blood cell count) or kidney stones.
In severe ulcerative colitis, some people have all or part of their
large intestine removed. Because ulcerative colitis can only affect the
large intestine, if it is removed, their disease is considered to be
that not everyone will have these problems, which are usually associated
with more severe disease.