Crohns Disease And Ulcerative Colitis

Overview

Crohn's disease and ulcerative colitis are the two main types of inflammatory bowel disease, or IBD. IBD is a long-term condition where the immune system causes inflammation in the gut. Crohn's disease can affect any part of the digestive tract, from the mouth to the anus, and can affect the full thickness of the bowel wall. Ulcerative colitis affects the lining of the colon and rectum. IBD is not caused by something you ate, and it is not contagious.

IBD is not rare. Millions of people around the world live with Crohn's disease or ulcerative colitis. It is more common in some parts of the world, such as North America and Europe, but cases are rising in many other places too.

Anyone can get IBD, including children and older adults. It often starts between the teenage years and the 30s, but ulcerative colitis can also start later in life. It affects men and women in similar numbers. Some groups, including people of Ashkenazi Jewish descent, have higher rates of Crohn's disease.

Symptoms

Common symptoms

• Diarrhea, sometimes with a sudden urgent need to go to the toilet
• Blood or mucus in the stool
• Tummy pain or cramps
• Feeling very tired or lacking energy
• Losing weight without trying
• Feeling sick or not wanting to eat
• Fever during a flare
• Mouth sores
• Pain or soreness around the anus, which is more common in Crohn's disease

Symptoms in children

• Poor growth or slower growth than expected
• Delayed puberty
• Weight loss or poor weight gain
• Tummy pain and diarrhea
• Low energy or anemia, which means not enough healthy red blood cells
• Missing school because of symptoms or hospital visits

Symptoms in older adults

• IBD can first appear in later life, even though it is often thought of as a younger person's condition
• Symptoms may be less obvious, such as weight loss, low energy, anemia, or changes in bowel habits
• Dehydration and tiredness can build up quickly
• Other health conditions and medicines may need to be reviewed with the care team

Causes

Main causes

• The exact cause is not fully known. IBD happens when the immune system mistakenly attacks the gut.
• Genes can play a part, so IBD can run in families.
• The mix of bacteria and other tiny organisms in the gut may be involved.
• Environmental triggers may play a role, but food and stress do not cause IBD. They can make symptoms feel worse for some people.

Risk factors

• Having a close family member with Crohn's disease or ulcerative colitis
• Being a young adult, though IBD can start at any age
• Smoking, which is linked to Crohn's disease and can make it worse
• Some ethnic backgrounds, including Ashkenazi Jewish descent for Crohn's disease
• Living in an industrialized area, where IBD is more common
• Some medicines, such as certain painkillers, may worsen symptoms in some people. Ask your pharmacist or doctor before using them.

When to see a doctor

See a doctor urgently if:

• You have blood in your stool for the first time
• You have severe tummy pain, a swollen belly, or a high fever
• You cannot keep fluids down or feel very dehydrated
• You feel faint, very weak, or unwell
• A known flare is getting worse quickly or not settling

Book a routine appointment if:

• Diarrhea lasts more than a few weeks or keeps coming back
• You notice blood or mucus in your stool
• You are losing weight without trying
• You feel very tired or have low energy that does not improve
• You have ongoing tummy pain or a change in bowel habits
• A close family member has IBD and you have gut symptoms
• Symptoms are affecting school, work, sleep, or daily life

Diagnosis

There is no single test for IBD. A doctor will ask about your symptoms, family history, and medicines, and will examine you. They may then arrange blood tests, stool tests, and scans. The key test is usually a colonoscopy, where a small camera looks inside the colon and tiny tissue samples called biopsies are taken. Some people also need an upper endoscopy or a capsule endoscopy, which uses a tiny camera in a pill you swallow.

Tests that may be done

• Blood tests to check for anemia, inflammation, and general health
• Stool tests to rule out infection and look for signs of inflammation
• Colonoscopy with biopsies, where small tissue samples are taken from the bowel lining
• Upper endoscopy to look at the food pipe, stomach, and first part of the small bowel
• Capsule endoscopy, a small camera in a pill that passes through the gut
• MRI, CT, or ultrasound scans to look at the bowel and nearby organs
• Growth and nutrition checks in children

What to expect at your appointment

You will usually be referred to a specialist, often a gastroenterologist, which is a doctor who focuses on the gut. Diagnosis can take more than one visit because tests and results take time. Some tests need preparation, such as clearing the bowel before a colonoscopy. You may be given medicine to keep you comfortable during the procedure. Ask your care team what to expect and bring someone with you if you feel anxious.

Treatment

There is no single cure for Crohn's disease or ulcerative colitis, but treatment can control inflammation, heal the gut, prevent flares, and help you feel well. The right plan depends on which type of IBD you have, how severe it is, and which parts of the gut are affected.

Self-care at home

• Take your medicines as prescribed, even when you feel well
• Do not stop or change medicine without talking to your care team first
• Keep a simple symptom diary to spot patterns and triggers
• Drink enough fluids, especially during flares or hot weather
• Eat regular balanced meals and ask for a dietitian if you need extra help
• Get enough sleep and build rest into busy days
• Find ways to manage stress, such as gentle exercise, breathing, or hobbies
• Stop smoking if you smoke, and ask for support to quit
• Check with your pharmacist before using over-the-counter medicines
• Keep up to date with vaccines and talk to your team before travel

Medical treatments

Doctors use several types of treatment to calm inflammation and keep flares away. These include anti-inflammatory medicines, medicines that calm the immune system, biologic treatments given by injection or drip, and short courses of stronger anti-inflammatory medicines for flares. Some treatments are tablets, some are injections, and some are given through a drip. Your care team will explain the benefits, risks, and monitoring needed. They will also check your blood, nutrition, and bone health from time to time.

When is surgery considered?

Surgery may be needed if medicines are not working well enough, or if there are complications such as a narrowed bowel, a blocked bowel, an abscess, a fistula, or a hole in the bowel. For ulcerative colitis, surgery to remove the colon can cure the colitis, but it is a major step with its own risks and recovery. For Crohn's disease, surgery can remove damaged sections of bowel, but it is not a cure and the disease can return. Your specialist team will discuss timing and choices carefully.

Living with this condition

Living with IBD can mean planning ahead. You may want to know where toilets are, carry a spare pair of underwear and wipes, and choose aisle seats when travelling. Talk to your school or workplace about flexible breaks and access to a toilet. During flares, you may need extra rest. Between flares, many people live full and active lives.

Lifestyle tips

• Keep a diary of foods, symptoms, and stress to spot patterns
• Stay physically active when you feel able, as it can help energy and mood
• Prioritise sleep and rest during flares
• Avoid smoking and get support to quit
• Keep routine vaccines up to date and ask before travel vaccines
• Tell your care team about all medicines and supplements you use
• Plan travel with extra supplies and a letter from your team if needed
• Ask about workplace or school adjustments if symptoms affect you

Diet and exercise

There is no single IBD diet that works for everyone. Some people find smaller meals, staying hydrated, and avoiding foods that clearly trigger symptoms helpful. During a flare, you may need softer, lower-fibre foods for a short time, but ask your care team or dietitian first. A dietitian can help you eat well while avoiding foods that cause problems. Gentle exercise, such as walking, can support general health and mood when you feel well enough.

Mental health and emotional wellbeing

IBD can affect how you feel about your body and can cause worry about accidents, pain, or missing out. Anxiety, low mood, and embarrassment are common. These feelings matter, and support is available. Talk to your GP or IBD team. If you have thoughts of harming yourself, call your local emergency number or a local crisis service right away.

Prevention

There is no proven way to prevent Crohn's disease or ulcerative colitis, and you cannot catch IBD from someone else. Healthy habits may support general health and help you cope with flares, but they do not guarantee prevention. Early diagnosis and good care can reduce the risk of complications.

Vaccines

People with IBD, especially those taking medicines that calm the immune system, should discuss vaccines with their care team. Some live vaccines may not be suitable. Routine vaccines and travel vaccines should be planned with your team.

Screening programmes

People with long-standing inflammation in the colon may need regular colonoscopy checks to look for early changes that could lead to cancer. Your specialist will advise when this should start. Other checks may include blood tests for anemia, bone health, and nutrition.

Complications

If left untreated

• Anemia, which can cause tiredness and breathlessness
• Dehydration and poor nutrition
• Weight loss and slowed growth in children
• Narrowed bowel, called a stricture
• Fistulas, which are abnormal tunnels between parts of the bowel or nearby skin
• Abscesses, which are pockets of infection
• A hole in the bowel or a rare, severe widening of the colon, which are emergencies
• Higher risk of colon cancer after many years of colitis
• Blood clots and bone thinning
• Anxiety, low mood, and social isolation

Long-term outlook

Most people with Crohn's disease or ulcerative colitis can live full lives. Treatment has improved a lot, and many people have long periods of feeling well between flares. Some people need surgery, and some need changes in treatment over time. Regular follow-up, early help during flares, and good support make a real difference.

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