15587 Inflammatory Bowel Disease

Overview

Inflammatory bowel disease (IBD) is a long-term condition where the gut (digestive tract) becomes inflamed. The two most common types are Crohn’s disease and ulcerative colitis. It can cause tummy pain, diarrhoea, tiredness and weight loss. IBD is not an infection, and it is not the same as irritable bowel syndrome (IBS).

IBD affects about 1 in 250 people in the UK. It is much less common than irritable bowel syndrome (IBS), but it is a well-recognised condition in general practice.

IBD can start at any age, but it most often begins between the ages of 15 and 40. It affects men and women fairly equally. It can run in families, and smoking is a strong risk factor for Crohn’s disease.

Symptoms

Common symptoms

• Persistent diarrhoea
• Tummy pain and cramping
• Blood or mucus in your stools
• A sudden, urgent need to go to the toilet
• Feeling very tired
• Unintentional weight loss

Symptoms in children

• Tummy pain
• Diarrhoea
• Poor growth or slow weight gain
• Delayed puberty
• Low energy and poor appetite

Symptoms in older adults

• Diarrhoea and tummy pain
• Weight loss
• Joint pain
• Skin changes
• Fatigue that can be mistaken for getting older

Causes

Main causes

• The exact cause of IBD is not fully understood.
• It probably happens when the body’s immune system attacks harmless bacteria in the gut, causing long-lasting inflammation.
• It is not caused by stress or what you eat, but these can trigger symptoms once you have IBD.

Risk factors

• Having a close family member with IBD
• Smoking – this is a strong risk factor for Crohn’s disease
• Being diagnosed under the age of 40
• Some medicines used for other conditions – ask your doctor if you have concerns

When to see a doctor

See a doctor urgently if:

• See a doctor or use your local urgent care service on the same day if you have blood in your stools, severe belly pain, a high fever, or signs of dehydration.

Book a routine appointment if:

• Make an appointment with your GP if you have had diarrhoea or tummy pain for more than a few weeks, keep needing the toilet urgently, or have lost weight without trying.

Diagnosis

A GP will ask about your symptoms and medical history. They may feel your tummy and do simple tests. If IBD is suspected, your GP will refer you to a gastroenterologist, a doctor who specialises in digestive conditions.

Tests that may be done

• Stool (poo) tests to look for inflammation or infection
• Blood tests to check for anaemia and signs of inflammation
• A colonoscopy – a thin, flexible telescope is used to look inside your bowel
• A flexible sigmoidoscopy – a shorter look at the lower part of the bowel
• Imaging scans such as MRI or CT, if needed

What to expect at your appointment

For a colonoscopy or sigmoidoscopy, you will be asked to take a laxative preparation to clear your bowels. The test can feel uncomfortable, but you can have sedation and pain relief. Your doctor will explain the results and next steps.

Treatment

There is no cure for IBD, but treatment can control inflammation, reduce symptoms and help you feel better. Most people with IBD are supported by a healthcare team that includes specialists in gastroenterology, diet and nursing.

Self-care at home

• Eat smaller, more frequent meals to ease digestion
• Drink plenty of fluids to avoid dehydration
• Keep a diary of foods that make symptoms worse
• Rest and pace yourself, especially during flare-ups
• Take gentle exercise like walking or swimming

Medical treatments

Medicines for IBD aim to reduce inflammation in the gut. These may be taken as tablets, injections, or given through a drip. Treatment may also include immune-suppressing medicines and biologic therapies. Your doctor will tailor the plan to your type of IBD and how severe it is. Do not take over-the-counter medicines for diarrhoea without asking your doctor, as they can sometimes make IBD worse.

When is surgery considered?

Surgery may be offered if medicines are not controlling symptoms, or if complications like a blocked gut, severe bleeding or a tear in the bowel develop. Your specialist team will explain exactly what the operation involves and help you make an informed choice.

Living with this condition

Living with IBD can be unpredictable, but many people learn to manage their condition well. Plan ahead when going out, know where toilets are, and carry a small 'IBD kit' with wipes and a change of underwear if that makes you feel safer.

Lifestyle tips

• Get enough sleep and try to keep a regular routine
• Manage stress with breathing exercises, mindfulness or hobbies
• Stay active but listen to your body
• Talk openly to your family, friends or employer about what you need

Diet and exercise

There is no single diet that works for everyone with IBD. A dietitian can help you find and avoid trigger foods while keeping your nutrition balanced. Regular, moderate exercise can improve your energy, mood and bone health.

Mental health and emotional wellbeing

Living with a long-term condition can cause stress, anxiety or low mood, especially during flare-ups. These feelings are common and it is important to talk about them. You can speak to your GP or IBD team, and if you are in crisis, call your local emergency number or a crisis helpline.

Prevention

IBD cannot be completely prevented, and there is no known way to avoid getting it. You can reduce the chance of a flare-up by not smoking, taking your medicines as prescribed, and working with your team to identify your personal triggers.

Vaccines

Some IBD treatments affect the immune system, so it is important to keep your routine vaccinations up to date. Ask your GP or pharmacist which vaccines are recommended before starting any new medicine.

Screening programmes

People with IBD may need regular checks to look for early signs of bowel changes, but this is a monitoring plan rather than a general screening test. Your specialist will discuss what checks you need.

Complications

If left untreated

• Narrowing or blockage of the bowel
• Fistulas – abnormal tunnels that form between the bowel and other body parts
• Ulcers or deep sores in the bowel lining
• Anaemia and other nutritional deficiencies
• Inflammation in other parts of the body, such as the joints, skin or eyes

Long-term outlook

With proper treatment and support, most people with IBD lead active, full lives. Symptoms may come and go, but many people achieve long periods of remission. Most people with IBD have a normal life expectancy.

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