Inflammatory Bowel Disease

Overview

Inflammatory bowel disease, or IBD, is a term for long-term conditions that cause ongoing inflammation in the digestive tract. Inflammation means redness and swelling inside the body. The two main types are Crohn's disease and ulcerative colitis. IBD is not the same as irritable bowel syndrome, or IBS, which is a different condition. IBD can make the bowel sore and cause symptoms like diarrhea, belly pain, and tiredness. It is a long-term condition that tends to come and go in flares, where symptoms get worse, and remission, where symptoms settle.

IBD is fairly common. Hundreds of thousands of people in the UK live with it, and it is seen around the world. It is not a rare condition.

Anyone can get IBD, but it often starts between the teenage years and age 40. It affects men and women, and people of all ethnic backgrounds. Some people are diagnosed in childhood, and some are diagnosed later in life.

Symptoms

Common symptoms

• Diarrhea that may be loose, urgent, or happen many times a day
• Belly pain or cramps
• Blood or mucus in your stool
• An urgent need to open your bowels, or feeling you still need to go after you have been
• Tiredness or low energy
• Weight loss or poor appetite
• Fever during a flare
• Mouth ulcers
• Joint pain, skin rashes, or red, sore eyes in some people

Symptoms in children

• Poor growth or slow weight gain
• Delayed puberty
• Belly pain and diarrhea
• Tiredness and missing school
• Anemia, which can cause pale skin and low energy
• Mouth ulcers or joint pain

Symptoms in older adults

• New diarrhea or urgency that does not settle
• Tiredness and anemia
• Belly pain or cramping
• Weight loss
• Symptoms that may be mistaken for other bowel problems, so tests are important

Causes

Main causes

• The exact cause of IBD is not fully understood.
• It is thought to happen when the immune system, which normally fights infection, reacts unusually and causes ongoing inflammation in the bowel.
• Genes play a part, so IBD can run in families, but most people with IBD do not have a relative with it.
• The environment and the gut bacteria may also play a role.
• Diet and stress do not cause IBD, but they can affect how you feel day to day.

Risk factors

• Having a close family member with IBD
• Age, as IBD often starts in young adulthood
• Smoking, which can make some types of IBD worse
• Living in certain parts of the world, although IBD is increasing in many countries
• A previous serious gut infection in some people, though this is not a direct cause

When to see a doctor

See a doctor urgently if:

• Blood in your stool
• Severe diarrhea with dehydration
• A high fever with belly pain
• Belly pain that is getting worse or is very severe
• Not being able to keep fluids down
• A sudden change that worries you, such as a lot of bleeding from your bottom

Book a routine appointment if:

• Diarrhea or loose stools that last more than a few weeks
• An urgent need to open your bowels that affects your daily life
• Belly pain or cramps that keep coming back
• Weight loss you cannot explain
• Tiredness or anemia found on a blood test
• Mouth ulcers, joint pain, or skin problems alongside bowel symptoms
• A family history of IBD and symptoms that concern you

Diagnosis

There is no single test that diagnoses IBD. Your doctor will ask about your symptoms, your health history, and your family history, and may examine your tummy. They will usually arrange blood and stool tests first. If IBD is suspected, you may be referred to a specialist, often a gastroenterologist, who can look inside the bowel and take small samples. Diagnosis can take time, and keeping a symptom diary can help.

Tests that may be done

• Blood tests to check for anemia, inflammation, and vitamin levels
• Stool tests to look for infection and signs of inflammation
• Colonoscopy, where a thin flexible tube with a camera checks the bowel and small samples are taken
• Flexible sigmoidoscopy, which looks at the lower part of the bowel
• Upper endoscopy, which looks at the food pipe, stomach, and first part of the small bowel
• MRI, CT, or ultrasound scans to look at the bowel and nearby areas
• Capsule endoscopy, where you swallow a small camera pill to look at the small bowel

What to expect at your appointment

You may need more than one appointment and test before your doctor can be sure what is going on. Some tests need preparation, such as clearing the bowel, and some use sedation. Ask your care team what to expect, how to prepare, and when you will get results. It is okay to bring someone with you or write down questions.

Treatment

IBD cannot usually be cured, but treatment can calm inflammation, control symptoms, and help you stay in remission for longer. Treatment is tailored to the type of IBD, where it is in the bowel, how severe it is, and what matters to you. Your care team will work with you to find the right plan and adjust it over time.

Self-care at home

• Take medicines as agreed with your care team, and do not stop or change them without advice
• Keep a simple diary of symptoms, food, and stress to spot patterns
• Stay well hydrated, especially during flares
• Eat regular, balanced meals and ask for a dietitian if you need personalized advice
• Prioritize sleep and gentle regular activity
• Avoid smoking, and ask for help to stop if you smoke
• Keep up with appointments and routine health checks
• Ask your care team what to do when a flare starts, so you have a plan ready

Medical treatments

Treatment is chosen by your specialist team based on your type of IBD, how severe it is, and which parts of the bowel are affected. It can include medicines that reduce inflammation, medicines that calm the immune system, and special targeted medicines that act on specific parts of the immune system. Some are taken by mouth, some are given by injection, and some by drip. Short courses of powerful anti-inflammatory medicines may be used to bring a flare under control. Your team will explain the benefits, risks, and monitoring you need. Some people also need medicines to treat symptoms, such as diarrhea, or to correct low vitamins and minerals.

When is surgery considered?

Surgery may be needed when complications happen or when symptoms cannot be controlled with other treatments. It can involve removing a damaged section of bowel, repairing narrowings, or treating a collection of infection. In ulcerative colitis, surgery to remove the colon can be a cure, but it is a major step and is discussed carefully. Surgery is not a failure of care; it is one option among many.

Living with this condition

Living with IBD often means planning ahead. You may need to know where toilets are, carry spare underwear or wipes, and allow extra time on busy days. Flares can be unpredictable, so a clear plan from your care team can help. Many people work, study, travel, and take part in family life with the right support.

Lifestyle tips

• Eat a balanced diet and ask a dietitian about any foods that seem to trigger symptoms for you
• Stay active with gentle exercise you enjoy, and build up slowly if you are tired
• Get enough sleep and rest during flares
• Find ways to manage stress, such as breathing exercises, hobbies, or talking to someone
• Avoid smoking and keep alcohol within sensible limits
• Ask your team about vitamins, bone health, and routine vaccinations
• Plan travel with extra medicines and a copy of your care plan

Diet and exercise

There is no single IBD diet that works for everyone. Some people find that keeping a food and symptom diary helps them see patterns. During a flare, softer, simpler foods may feel easier, while some people need to avoid high-fiber foods for a short time if they have a narrowing. Ask for a dietitian rather than cutting out many foods on your own. Regular movement can help energy, mood, and bone health. Choose activity that suits you and build up gently.

Mental health and emotional wellbeing

IBD can affect mood and confidence. Anxiety, low mood, and worry about accidents or flares are common, and they deserve support. Talking to your team, a counselor, or a support group can help. If you ever have thoughts of harming yourself, contact your local crisis service or your local emergency number right away.

Prevention

There is no proven way to prevent IBD. It is not caused by personal choices, diet, or stress. Healthy habits can still help your overall health and may help you cope better with flares.

Vaccines

Keep your routine vaccines up to date. If you take medicines that calm the immune system, ask your care team before any live vaccines, as some may not be suitable. Your team can advise on extra vaccines that may help protect you.

Screening programmes

There is no general screening test for IBD in people without symptoms. If you have had inflammation in the colon for many years, your team may recommend regular bowel checks to look for early changes. You may also have blood tests to check for anemia, vitamin levels, and bone health.

Complications

If left untreated

• Ongoing inflammation can cause anemia and low vitamin levels
• Poor nutrition and weight loss
• Dehydration, especially during severe diarrhea
• Narrowings in the bowel, called strictures
• Small tunnels or connections between parts of the bowel, called fistulas
• Collections of infection, called abscesses
• A higher long-term risk of bowel cancer in some people with many years of colon inflammation
• Bone thinning and blood clots in some people
• Anxiety, low mood, and strain on work, school, and relationships

Long-term outlook

Most people with IBD can live full lives with modern care. Treatment can calm flares and help you stay well for longer. IBD is a long-term condition, so regular check-ups matter, but many people work, study, travel, and build relationships. Your care team can help you adjust your plan as your needs change.

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