Crohn's disease and ulcerative colitis

Crohn’s disease and ulcerative colitis are lifelong gastrointestinal disorders known together as inflammatory bowel diseases (IBD). They can appear in children, adolescents and adults. The cause and cure of Crohn’s and colitis are currently unknown, and IBD is becoming more common.

About Crohn’s disease#

Crohn’s disease can cause inflammation anywhere in the gastrointestinal tract, from the mouth to the anus. Inflammation — the body’s response to injury or irritation — causes redness, swelling and pain. There may be times with little or no symptoms (remission) and times when symptoms are more active (flare-ups).

Symptoms differ from person to person, can be mild or serious, and depend on where the inflammation is. Inflammation can make it harder for the body to absorb nutrients, which contributes to many symptoms. The most common symptoms during a flare include:

• Abdominal pain.
• Frequent diarrhoea, sometimes mixed with mucus and blood, and an urgent need to use the toilet.
• Tiredness and fatigue.
• Raised temperature or fever.
• Loss of appetite and weight loss.
• Anaemia (a reduced level of blood cells).

Diagnosis#

To find out whether you have Crohn’s disease, you need to be tested by a doctor. Because the symptoms resemble many other conditions, several tests are usually needed before a diagnosis can be made. Tests help identify which parts of the bowel are affected and guide treatment. They may include:

• Blood tests.
• Stool tests.
• Endoscopy.
• Bowel imaging and scans.

Crohn’s disease changes over time, so tests may be repeated to monitor it, check whether treatment is working, and detect any complications.

Treatment#

Crohn’s disease cannot currently be cured, but for most people it can be well managed with medication, lifestyle choices and sometimes surgery. Treatment may need to change over time if it becomes less effective.

Medication is mainly used to reduce inflammation. Main types include aminosalicylates, corticosteroids, immunosuppressants, biologics and antibiotics.

Diet plays an important role in treating active disease, managing symptoms, ensuring good nutrition, managing complications and potentially supporting remission. Examples of dietary approaches include exclusive enteral nutrition, the Crohn’s disease exclusion diet, a low or moderate FODMAP diet, a moderate, low-fibre or low-residue diet, a high-energy and high-protein diet, and oral vitamin and mineral supplementation.

Surgery is not needed by everyone. Sometimes parts of the bowel are too damaged to heal with medication, and an operation is the best way to restore health. The goal is to keep as much of the bowel as possible while restoring quality of life. Common procedures include resection, stricturoplasty and creating a stoma.

Complementary and alternative medicine can be used alongside conventional treatment to reduce symptoms and improve wellbeing. Research is ongoing, so always discuss your options with your healthcare team. Speak to a doctor, gastroenterologist or dietitian about treatment, or before making any changes to your current plan.

About ulcerative colitis#

Ulcerative colitis causes inflammation and ulceration in the large intestine (colon and rectum). As with Crohn’s, inflammation causes redness, swelling and pain. Ulcers form on the inner lining of the intestine and may bleed and produce mucus. The inflammation almost always involves the rectum and may extend up the large intestine, either at first or over time.

Symptoms differ from person to person, can be mild or serious, and depend on how much of the large intestine is inflamed and how strong the inflammation is. The most common symptoms during a flare include:

• Abdominal pain.
• Frequent diarrhoea, sometimes mixed with mucus and blood, and an urgent need to use the toilet often.
• Tiredness and fatigue.
• Raised temperature or fever.
• Loss of appetite and weight loss.
• Anaemia (a reduced level of blood cells).

Diagnosis#

You will need to be tested by a doctor. As the symptoms resemble many other conditions, several tests are usually needed, and doctors will often want to rule out an infection or irritable bowel syndrome (IBS). Tests may include blood tests, stool tests, endoscopy, and bowel imaging and scans. Ulcerative colitis changes over time, so tests may be repeated to monitor it and check for complications. People who have had ulcerative colitis symptoms for at least eight years are generally advised to have a colonoscopy, repeated every one to three years as recommended by a specialist, to check for changes in the bowel.

Treatment#

Ulcerative colitis cannot currently be cured, but for most people it can be well managed with medication, lifestyle choices and sometimes surgery. Even during remission you may still have some symptoms, and treatment may change over time.

Medication is mainly used to reduce inflammation. Main types include aminosalicylates, corticosteroids, immunosuppressants, biologics, Janus kinase inhibitors and thalidomide.

Diet helps with symptom management, ensuring good nutrition, and potentially treating active disease or supporting remission. Examples include a high-energy and high-protein diet, oral vitamin and mineral supplementation, and a low or moderate FODMAP diet.

Surgery is not needed by everyone. It may be considered when current therapies are no longer effective or when complications occur. The goal is to keep as much of the bowel as possible while restoring quality of life. The two most common procedures are ileostomy and pouch surgery (often called a j-pouch).

Complementary and alternative medicine can be used alongside conventional treatment to reduce symptoms and improve wellbeing. Research is ongoing, so always discuss your options with your healthcare team. Speak to a doctor, gastroenterologist or dietitian before making changes to your treatment plan.

Living with Crohn’s disease or ulcerative colitis#

Living with Crohn’s or colitis means making some lifestyle changes, but it does not have to stop you from getting the most out of life. With the right support and by taking control of your health, you can still do what matters to you.

Diet and nutrition#

Many people with IBD do not need to restrict their diet generally, though there is emerging and established evidence for specialty diets when IBD is active, in remission, or to treat complications. Both under-nutrition and over-nutrition are common in IBD and can lead to fatigue, reduced quality of life and depression, and may weaken the response to medication. People with malnutrition are more likely to become unwell, take longer to recover, and face a higher risk of complications after surgery.

Fertility, pregnancy and IBD#

Most women with IBD are able to have children and raise a family. It can be more difficult in certain situations, such as during a flare, on certain medications, or after certain surgeries. If you or your partner with IBD plans to become pregnant, it is a good idea to talk with a doctor who understands the special care needed before, during and after pregnancy.

Psychological health#

People with IBD are more likely to experience significant mental health problems, such as depression and anxiety. Facing an unpredictable and disruptive illness, they may feel down, worried or uncertain at times, which is a normal part of living with such a condition. Psychological supports that may help include cognitive behavioural therapy, acceptance and commitment therapy, and gut-directed hypnotherapy.

Exercise#

Staying physically active is important, because IBD can affect your bones. Regular weight-bearing exercise — such as brisk walking, jogging, dancing, aerobics or active team sports — helps keep bones strong. Outdoor exercise is especially valuable, as sunlight boosts vitamin D production. Exercise also reduces stress by releasing endorphins, the brain chemicals that lift mood and act as natural painkillers, and gentler activities such as yoga can improve the mind-body connection, lower stress, and may help reduce inflammation.

Key points#

• The cause and cure of Crohn’s and colitis are currently unknown.
• Inflammation causes redness, swelling and pain, and is the body’s response to injury or irritation.
• Symptoms of Crohn’s disease differ from person to person and can be mild or serious.
• Symptoms depend on where inflammation appears in the gut.
• A common symptom during a flare is anaemia (a reduced level of blood cells).

Where to get help#