Inflammatory Bowel Disease (Overview)

What is inflammatory bowel disease (IBD)?

Inflammatory bowel disease (IBD) refers to diseases that cause chronic inflammation in your gastrointestinal (GI) tract. Its symptoms may come on suddenly (flares) and cause intense stomach cramps and diarrhea, among other issues. But IBD can affect more than your gut — it can affect your overall physical health, emotional well-being and even your mental health.

Inflammatory bowel disease is a lifelong illness for which there’s no cure. This may sound grim. But there are treatments that manage IBD symptoms, and steps you can take to keep IBD from disrupting your life.

Types of IBD

Crohn’s disease and ulcerative colitis are the main types of IBD:

• Crohn’s disease: This disease causes sores (ulcers) in your GI tract. It can affect any part of your GI tract, from your mouth to your anus (butthole), but it typically develops in your small intestine and the upper part of your large intestine.
• Ulcerative colitis (UC): UC causes swelling and sores (ulcers) in your large intestine. It usually starts in your rectum and can spread to part or all of your colon.

How common is IBD?

Experts estimate that 1.6 million people in the U.S. have IBD. The disease can affect anyone from young children to adults age 65 and older. But it most commonly affects people ages 15 to 35.

What are the symptoms of inflammatory bowel disease?

IBD symptoms may be mild or severe. They come and go, and you can’t always predict when they’ll happen. When they do, a healthcare provider may say you’re having an IBD flare (active disease). When your symptoms go away after treatment, a provider may say the disease is in remission. Common IBD symptoms include:

• Lower abdominal pain that may feel like stomach cramps.
• Blood in your poop (stool).
• Chronic diarrhea.
• Fatigue.
• Unintended weight loss.

What causes inflammatory bowel disease?

IBD happens when immune system cells in your GI tract mistakenly attack healthy tissue, causing inflammation that leads to Crohn’s disease and ulcerative colitis. Researchers don’t know the exact reason why this happens. But they’re studying mutations in certain genes that normally:

• Keep your immune system on an even keel so it doesn’t overreact when it detects intruders.
• Affect your mucosal barrier, which is the first line of defense in your intestine.
• Control bacteria growth in your intestine.

When these genes mutate (change), it increases your risk of IBD. Researchers may call these genes susceptibility genes. There are more than 160 different susceptibility genes. If you inherited any number of them, several everyday activities could trigger IBD symptoms. These activities don’t cause the disease. Common IBD triggers include:

• Antibiotics.
• NSAIDS (nonsteroidal anti-inflammatory drugs).
• Smoking cigarettes.
• Stress.

Researchers are also investigating if issues with your gut microbiome may play a part in the chronic inflammation that causes IBD.

Can food cause IBD symptoms?

No, but you may notice that your symptoms get worse after you consume certain foods or liquids. Everyone is different, but food and drink that may make you feel worse may include:

• Beverages with alcohol.
• Caffeinated drinks.
• Carbonated drinks.
• Food made with milk.
• Food with lots of fiber.
• Greasy food.

What are the risk factors for IBD?

The most significant risk is having a family history of IBD. Studies show that 5% to 20% of people with IBD have a close family member — parent, sibling or child — who has IBD.

What are the complications of inflammatory bowel disease?

IBD may cause other medical conditions in your GI tract and beyond. Some may be medical emergencies or serious illnesses, including:

• Colon cancer: Having IBD increases the chance you’ll develop colon cancer.
• Perforated bowel: Symptoms include severe belly pain and cramping, bloated belly and pain when you touch your belly.
• Toxic megacolon: Symptoms include bloody diarrhea, severe belly pain and pain when you touch your belly.

Other IBD complications that affect your GI tract are anal fistula and anal stenosis. Anal stenosis is when your anal canal narrows, making it hard for poop to leave your body.

IBD may increase your risk of complications like:

• Anemia (low levels of red blood cells).
• Blood clots.
• Eye pain and irritation.
• Kidney stones.
• Mouth sores.
• Liver diseases like cirrhosis and primary sclerosing cholangitis.
• Malabsorption and malnutrition.
• Swollen joints.
• Skin sores and rashes.
• Weakened bones (osteoporosis).

How do healthcare providers diagnose inflammatory bowel disease?

A healthcare provider will do a physical examination. They’ll ask about your symptoms, including how long you’ve had them, if your symptoms are mild or severe and if they come and go. They may order the following tests:

• Complete blood count (CBC).
• Capsule endoscopy.
• Colonoscopy.
• Computed tomography (CT) scan.
• EUS (endoscopic ultrasound).
• Flexible sigmoidoscopy.
• Magnetic resonance imaging (MRI) scan.
• Upper endoscopy.

How is inflammatory bowel treated?

Treatments vary depending on the type of IBD that you have, but all treatments focus on bringing IBD into remission — and keeping it there. A healthcare provider may prescribe medication to ease symptoms. In some cases, you may need surgery if medications aren’t effective.

Medication

In general, medications for IBD focus on managing inflammation and controlling your immune system’s response. Healthcare providers may use the same types of prescription medication to treat Crohn’s disease and ulcerative colitis. Medications may include:

• Antibiotics: You may receive antibiotics if you have an infection from an anal fistula.
• Antidiarrhea medication: If you have Crohn’s disease, your provider may prescribe medications like loperamide (Imodium® A-D).
• Biologics: These medications calm your immune system, so it doesn’t release antibodies that trigger inflammatory bowel disease.
• Corticosteroids: You may receive this medication for inflammation.
• Immunomodulators and immunosuppressants: These medications also help to calm your immune system.

Surgery

IBD medication may manage your symptoms for many years. But if medications stop working, your provider may recommend surgeries like a colectomy.

What can I expect if I have inflammatory bowel disease?

IBD is a chronic condition that you’ll need to manage for the rest of your life. Having this condition also increases your risk of serious illnesses like colon cancer.

For those reasons, you should plan on regular visits to your healthcare provider even when you don’t have symptoms. Your provider may recommend you schedule appointments every six months when IBD is in remission, and more often when you have an IBD flare. If you’re in your 30s or 40s, your provider may recommend you start receiving routine colonoscopies earlier than most people.

How do I take care of myself?

It’s not always easy to live with IBD. Symptoms may flare up and then go away for weeks and months. You may find yourself wondering when the next flare will hit. You may feel embarrassed or self-conscious about symptoms like sudden bouts of diarrhea that make you race for the bathroom. Here are some suggestions that may help you manage IBD:

• Eat well: Take time to track and identify food and drink that trigger your IBD. Talk to a dietitian about meal plans that avoid trigger food and drink but provide enough nutrition.
• Track your symptoms during a flare: If you can pinpoint when you’re more likely to have symptoms, you can plan your day. That includes identifying restrooms so you know where to go when you really need to go.
• Pack an emergency kit: Accidents can and will happen. Consider carrying an emergency kit with spare underwear, panty liners, toilet tissue and baby wipes. You may never need your kit but having it at hand may make you feel less anxious should you need it.
• Share your situation: You may want to keep details about your IBD issue to yourself. That’s completely understandable. But consider telling a close friend or work friend about your IBD issues. It may help to have someone you can call on when you need help.
• Manage your stress: Stress can trigger IBD symptoms. Stress management programs may reduce or delay your symptoms.
• Seek support: Millions of people in the U.S. have IBD. There are support groups where you can spend time with people who know what you’re going through.
• Consider mental health support: IBD may lead to depression. Talking to a psychologist may help.
• Quit smoking: Research shows smoking cigarettes can trigger inflammatory bowel disease symptoms.

When should I see my healthcare provider?

Medication and self-care often help keep IBS in remission. But you should contact your healthcare provider if you have IBS flares that don’t go away.

When should I go to the emergency room?

If you have IBD, you have an increased risk of conditions like toxic megacolon or perforated bowel that are medical emergencies. Call 911 (or your local emergency service number) or go to the emergency room if you have the following symptoms:

• Fever above 100.3 degrees Fahrenheit (37.9 degrees Celsius) and chills that could be signs of infection.
• Severe abdominal cramping or pain that doesn’t go away.
• Severe nausea and vomiting.
• Rectal bleeding with clots of blood in your poop.
• Swollen abdomen.

What’s the difference between IBD and IBS?

Both IBD and IBS affect your gut. The difference is that IBD involves inflammation, but IBS doesn’t.

A note from Cleveland Clinic

If your diagnosis is inflammatory bowel disease, you may be relieved to know why you have a crampy belly and diarrhea for days on end. And it probably helps to know how treatment can make your symptoms go away. But you may worry about what it means to have a chronic disease with uncomfortable and sometimes embarrassing symptoms that may happen without warning. Your healthcare providers know that IBD can disrupt your daily routine. They’ll have suggestions for managing your symptoms and living well with IBD.