Inflammatory bowel disease (IBD) involves chronic inflammation of all or part of your digestive tract. IBD primarily includes ulcerative colitis and Crohn's disease. Both usually involve severe diarrhea, pain, fatigue and weight loss. IBD can be debilitating and sometimes leads to life-threatening complications.
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease that causes long-lasting inflammation and sores (ulcers) in the innermost lining of your large intestine (colon) and rectum.
Crohn's disease is an IBD that cause inflammation of the lining of your digestive tract. In Crohn's disease, inflammation often spreads deep into affected tissues. The inflammation can involve different areas of the digestive tract — the large intestine, small intestine or both.
Collagenous (kuh-LAJ-uh-nus) colitis and lymphocytic colitis also are considered inflammatory bowel diseases but are usually regarded separately from classic inflammatory bowel disease.
Inflammatory bowel disease symptoms vary, depending on the severity of inflammation and where it occurs. Symptoms may range from mild to severe. You are likely to have periods of active illness followed by periods of remission.
Signs and symptoms that are common to both Crohn's disease and ulcerative colitis include:
- Diarrhea. Diarrhea is a common problem for people with IBD.
- Fever and fatigue. Many people with IBD experience a low-grade fever. You may also feel tired or have low energy.
- Abdominal pain and cramping. Inflammation and ulceration can affect the normal movement of contents through your digestive tract and may lead to pain and cramping. You may also experience nausea and vomiting.
- Blood in your stool. You might notice bright red blood in the toilet bowl or darker blood mixed with your stool. You can also have bleeding you don't see (occult blood).
- Reduced appetite. Abdominal pain and cramping, as well as inflammation, can affect your appetite.
- Unintended weight loss. You may lose weight and even become malnourished because you cannot properly digest and absorb food.
Ulcerative colitis is classified according to the location of inflammation and severity of symptoms:
- Ulcerative proctitis. Inflammation is confined to the area closest to the anus (rectum), and rectal bleeding may be the only sign of the disease. This form of ulcerative colitis tends to be the mildest.
- Proctosigmoiditis. Inflammation involves the rectum and sigmoid colon (lower end of the colon). Signs and symptoms include bloody diarrhea, abdominal cramps and pain, and an inability to move the bowels in spite of the urge to do so (tenesmus).
- Left-sided colitis. Inflammation extends from the rectum up through the sigmoid and descending colon. Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and unintended weight loss.
- Pancolitis. Pancolitis often affects the entire colon and causes bouts of bloody diarrhea that may be severe, abdominal cramps and pain, fatigue, and significant weight loss.
- Acute severe ulcerative colitis. Previously called fulminant colitis, this rare form of colitis affects the entire colon and causes severe pain, profuse diarrhea, bleeding, fever and inability to eat.
Crohn's disease may involve inflammation in different parts of the digestive tract in different people. The most common areas affected are the last part of the small intestine (ileum) and the colon. Inflammation may be confined to the bowel wall, which can lead to narrowing from inflammation or scarring or both (fibrostenosis), or may tunnel through the bowel wall (fistula). Narrowing may lead to a blockage (obstruction). Obstructions, stenosis and fistulas are not associated with ulcerative colitis.
When to see a doctor
See your doctor if you experience a persistent change in your bowel habits or if you have any of the signs and symptoms of inflammatory bowel disease. Although inflammatory bowel disease usually isn't fatal, it's a serious disease that, in some cases, may cause life-threatening complications.
The exact cause of inflammatory bowel disease remains unknown. Previously, diet and stress were suspected, but now doctors know that these factors may aggravate but don't cause IBD.
One possible cause is an immune system malfunction. When your immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too. Heredity also seems to play a role in that IBD is more common in people who have family members with the disease. However, most people with IBD don't have this family history.
- Age. Most people who develop IBD are diagnosed before they're 30 years old. But some people don't develop the disease until their 50s or 60s.
- Race or ethnicity. Although whites have the highest risk of the disease, it can occur in any race. If you're of Ashkenazi Jewish descent, your risk is even higher.
- Family history. You're at higher risk if you have a close relative — such as a parent, sibling or child — with the disease.
- Cigarette smoking. Cigarette smoking is the most important controllable risk factor for developing Crohn's disease. However, smoking may provide some protection against ulcerative colitis. The overall health benefits of not smoking make it important to try to quit.
- Isotretinoin use. Isotretinoin (Amnesteem, Claravis, Sotret; formerly Accutane) is a medication sometimes used to treat scarring cystic acne or acne. Some studies suggest it may be a risk factor for IBD, but a clear association between IBD and isotretinoin has not been established.
- Nonsteroidal anti-inflammatory medications. These include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, Anaprox), diclofenac sodium (Voltaren, Solaraze) and others. These medications may increase the risk of developing IBD or worsen disease in people who have IBD.
- Where you live. If you live in an urban area or in an industrialized country, you're more likely to develop IBD. Therefore, it may be that environmental factors, including a diet high in fat or refined foods, play a role. People living in northern climates also seem to be at greater risk.
Crohn's disease may lead to one or more of the following complications:
- Inflammation. Inflammation may be confined to the bowel wall, which can lead to diarrhea and bleeding. Inflammation can also lead to scarring and narrowing (stenosis) or may spread through the bowel wall (fistula).
- Bowel obstruction. Crohn's disease affects the full thickness of the intestinal wall. Over time, parts of the bowel can thicken and narrow, which may block the flow of digestive contents. You may require surgery to remove the diseased portion of your bowel.
- Ulcers. Chronic inflammation can lead to open sores (ulcers) anywhere in your digestive tract, including your mouth and anus, and in the genital area (perineum).
Fistulas. Sometimes ulcers can extend completely through the intestinal wall, creating a fistula — an abnormal connection between different body parts. Fistulas can develop between your intestine and skin or between your intestine and another organ. Fistulas near or around the anal area (perianal) are the most common kind.
When fistulas develop in the abdomen, food may bypass areas of the bowel that are necessary for absorption. Fistulas may occur between loops of bowel, into the bladder or vagina, or out through the skin, causing continuous drainage of bowel contents to your skin.
In some cases, a fistula may become infected and form an abscess, which can be life-threatening if not treated.
- Anal fissure. This is a small tear in the tissue that lines the anus or in the skin around the anus where infections can occur. It's often associated with painful bowel movements and may lead to a perianal fistula.
- Malnutrition. Diarrhea, abdominal pain and cramping may make it difficult for you to eat or for your intestine to absorb enough nutrients to keep you nourished. It's also common to develop anemia due to low iron or vitamin B12 caused by the disease.
- Colon cancer. Having Crohn's disease that affects your colon increases your risk of colon cancer. General colon cancer screening guidelines for people without Crohn's disease call for a colonoscopy every 10 years beginning at age 50. However, depending on how long you have had Crohn's disease and how much of your colon is involved, you may need a colonoscopy as often as every one to two years. Ask your doctor how often you should have a colonoscopy.
- Other health problems. Crohn's disease can cause problems in other parts of the body, such as inflammation of the eyes, skin or joints; anemia; osteoporosis; inflammation of the liver or bile ducts; and delayed growth or sexual development in children.
Medications. Certain medications for Crohn's disease that act by blocking functions of the immune system are associated with a small risk of developing cancers such as lymphoma and skin cancers. They also increase risk of infection.
Corticosteroids can be associated with a risk of osteoporosis, bone fractures, cataracts, glaucoma, diabetes and high blood pressure. Work with your doctor to determine risks and benefits of medications.
Possible complications of ulcerative colitis include:
- Severe bleeding
- A hole in the colon (perforated colon)
- Severe dehydration
- Liver disease (rare)
- Bone loss (osteoporosis)
- Inflammation of your skin, joints and eyes
- Sores in the lining of your mouth
- An increased risk of colon cancer
- A rapidly swelling colon (toxic megacolon)
- Increased risk of blood clots in veins and arteries
Symptoms of inflammatory bowel disease may first prompt a visit to your family doctor or general practitioner. However, you may then be referred to a doctor who specializes in treating digestive disorders (gastroenterologist).
Because appointments can be brief, and there's often a lot of information to discuss, it's a good idea to be well-prepared. Here's some information to help you get ready and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you made the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, including over-the-counter medications and any vitamins or supplements that you're taking.
- Take a family member or friend along. Sometimes it can be difficult to remember everything during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Time with your doctor is limited, so preparing a list of questions beforehand may help you make the most of your visit. List your questions from most important to least important in case time runs out. For inflammatory bowel disease, some basic questions to ask your doctor include:
- What's causing these symptoms?
- Are there other possible causes for my symptoms?
- What kinds of tests do I need? Do these tests require any special preparation?
- Is this condition temporary or long lasting?
- What treatments are available, and which do you recommend?
- Are there any medications that I should avoid?
- What types of side effects can I expect from treatment?
- What sort of follow-up care do I need? How often do I need a colonoscopy?
- Are there any alternatives to the primary approach that you're suggesting?
- I have other health conditions. How can I best manage them together?
- Do I need to follow any dietary restrictions?
- Is there a generic alternative to the medicine you're prescribing?
- Are there brochures or other printed material that I can take with me? What websites do you recommend?
- Is there a risk to me or my child if I become pregnant?
- Is there a risk of complications to my partner's pregnancy if I have IBD and father a child?
- What is the risk to my child of developing IBD if I have it?
- Are there support groups for people with IBD and their families?
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or intermittent?
- How severe are your symptoms?
- Do you have abdominal pain?
- Have you had diarrhea? How often?
- Do you awaken from sleep during the night because of diarrhea?
- Is anyone else in your home sick with diarrhea?
- Have you lost weight unintentionally?
- Have you ever had liver problems, hepatitis or jaundice?
- Have you had problems with your joints, eyes or skin — including rashes and sores — or had sores in your mouth?
- Do you have a family history of inflammatory bowel disease?
- Do your symptoms affect your ability to work or do other activities?
- Does anything seem to improve your symptoms?
- Is there anything that you've noticed that makes your symptoms worse?
- Do you smoke?
- Do you take nonsteroidal anti-inflammatory drugs (NSAIDs), for example, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, Anaprox) or diclofenac sodium (Voltaren, Solaraze)?
- Have you taken antibiotics recently?
- Have you recently traveled? If so, where?
Your doctor will likely diagnose inflammatory bowel disease only after ruling out other possible causes for your signs and symptoms, including ischemic colitis, infection, irritable bowel syndrome (IBS), diverticulitis and colon cancer. He or she will use a combination of tests. To help confirm a diagnosis of IBD, you may have one or more of the following tests and procedures:
- Tests for anemia or infection. Your doctor may suggest blood tests to check for anemia — a condition in which there aren't enough red blood cells to carry adequate oxygen to your tissues — or to check for signs of infection from bacteria or viruses.
- Fecal occult blood test. You may need to provide a stool sample so that your doctor can test for hidden blood in your stool.
- Colonoscopy. This test allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis, which may help confirm a diagnosis. Clusters of inflammatory cells called granulomas, if present, help confirm a diagnosis of Crohn's disease.
- Flexible sigmoidoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the last section of your colon (sigmoid).
- Upper endoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the esophagus, stomach and first part of the small intestine (duodenum). While it is rare for these areas to be involved with Crohn's disease, this test may be recommended if you are having nausea and vomiting, difficulty eating or upper abdominal pain.
- Capsule endoscopy. This test is used to help diagnose Crohn's disease. You swallow a capsule that has a camera in it. The images are transmitted to a computer you wear on your belt, after which the camera exits your body painlessly in your stool. You may still need endoscopy with biopsy to confirm a diagnosis of Crohn's disease.
- Double-balloon endoscopy. For this test, a longer scope is used to look further into the small bowel where standard endoscopes don't reach. This technique is useful when capsule endoscopy shows abnormalities, but the exact diagnosis is still in question.
- X-ray. If you have severe symptoms, your doctor may use a standard X-ray of your abdominal area to rule out serious complications, such as a perforated colon.
- Computerized tomography (CT) scan. You may have a CT scan — a special X-ray technique that provides more detail than a standard X-ray does. This test looks at the entire bowel as well as at tissues outside the bowel. CT enterography is a special CT scan that provides better images of the small bowel. This test has replaced barium X-rays in many medical centers.
- Magnetic resonance imaging (MRI). An MRI scanner uses a magnetic field and radio waves to create detailed images of organs and tissues. MRI is particularly useful for evaluating a fistula around the anal area (pelvic MRI) or the small intestine (MR enterography). Unlike CT, there is no radiation exposure with MRI.
- Small bowel imaging. This test looks at the part of the small bowel that can't be seen by colonoscopy. After you drink a liquid containing barium, doctors take an X-ray of your small intestine. While this technique may still be used, it has largely been replaced by CT or MRI enterography.
The goal of inflammatory bowel disease treatment is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission and reduced risks of complications. IBD treatment usually involves either drug therapy or surgery. There is no cure for IBD.
Doctors use one of two approaches to treatment: "step-up," which starts with milder drugs first, versus "top-down," which gives people stronger drugs earlier in the treatment process. Researchers are actively exploring new approaches to treatment for IBD, especially as new technology becomes available. Investigators suggest links between diet, the immune system and bacteria in the digestive tract (microbiome).
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:
- Aminosalicylates. Sulfasalazine (Azulfidine) can be effective in reducing symptoms of ulcerative colitis and for some people with Crohn's disease confined to the colon, but it has a number of side effects, including digestive distress and headache. Certain 5-aminosalicylates — including mesalamine (Asacol, Lialda, Rowasa, Canasa, others), balsalazide (Colazal) and olsalazine (Dipentum) — are available in both oral and enema or suppository forms. Which form you take depends on the area of your colon that's affected. Rarely, these medications have been associated with kidney and pancreas problems.
Corticosteroids. These drugs, which include prednisone and hydrocortisone, are generally reserved for moderate to severe ulcerative colitis or Crohn's disease that doesn't respond to other treatments. They are given orally, intravenously, or by enema or suppository, depending on the part of the digestive tract affected.
Corticosteroids have numerous side effects, including a puffy face, excessive facial hair, night sweats, insomnia and hyperactivity. More-serious side effects include high blood pressure, diabetes, osteoporosis, bone fractures, cataracts, glaucoma and increased chance of infection. They are not usually given long term.
Immune system suppressors
These drugs also reduce inflammation, but they target your immune system rather than directly treating inflammation. Instead, they suppress the immune response that releases inflammation-inducing chemicals in the intestinal lining. For some people, a combination of these drugs works better than one drug alone. Immunosuppressant drugs include:
- Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). These are the most widely used immunosuppressants for treatment of inflammatory bowel disease. Taking them requires that you follow up closely with your doctor and have your blood checked regularly to look for side effects, including effects on the liver and pancreas. Additional side effects include lowered resistance to infection and a rare chance of developing cancers such as lymphoma and skin cancers. A blood test to determine the ability of your body to break down the medication should be done before starting. This will help identify the risk of suppression of the bone marrow and help with dosing.
- Cyclosporine (Gengraf, Neoral, Sandimmune). This drug is normally reserved for people who haven't responded well to other medications. Its use is generally confined to ulcerative colitis. Cyclosporine has the potential for serious side effects — such as kidney and liver damage, seizures and fatal infections — and is not for long-term use. There's also a small risk of cancer, so let your doctor know if you've previously had cancer. It is now used much less often because safer alternatives are available.
Infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi). These drugs, called tumor necrosis factor (TNF)-alpha inhibitors, or "biologics," work by neutralizing a protein produced by your immune system. They are for people with moderate to severe Crohn's disease or ulcerative colitis who don't respond to or can't tolerate other treatments. Infliximab is given by intravenous injection and the others by subcutaneous injection. They may be combined with other immunosuppressant medications such as azathioprine or mercaptopurine.
People with certain conditions can't take TNF-alpha inhibitors. If you have a history of tuberculosis, fungal infections or hepatitis B, you may experience a reactivation of your disease while on therapy. Your doctor will test you for previous exposure to tuberculosis and hepatitis B and may test you for possible fungal infection as well.
These drugs also are associated with a rare risk of developing certain cancers such as lymphoma and skin cancers.
- Methotrexate (Rheumatrex). This drug — which is used mainly to treat cancer, psoriasis and rheumatoid arthritis — is sometimes used for people with Crohn's disease who don't respond well to other medications. It is given by injection. Short-term side effects include nausea, fatigue and diarrhea, and rarely, it can cause potentially life-threatening pneumonia. Long-term use can lead to bone marrow suppression, scarring of the liver and sometimes cancer. You will need to be followed closely for side effects.
Natalizumab (Tysabri) and vedolizumab (Entyvio). These drugs work by stopping certain immune cell molecules — integrins — from binding to other cells in your intestinal lining. These drugs are approved for people with moderate to severe Crohn's disease and ulcerative colitis with evidence of inflammation who aren't responding well to any other medications.
Because natalizumab is associated with a rare but serious risk of progressive multifocal leukoencephalopathy — a brain infection that usually leads to death or severe disability — you must be enrolled in a special restricted distribution program to use it.
Vedolizumab recently was approved for Crohn's disease. It works like natalizumab but appears not to have a risk of brain infection.
- Ustekinumab (Stelara). This drug is used to treat psoriasis. Studies have shown it's useful in treating Crohn's disease as well and may be used when other medical treatments fail.
People with ulcerative colitis who run fevers will likely be given antibiotics to help prevent or control infection. Antibiotics can reduce the amount of drainage and sometimes heal fistulas and abscesses in people with Crohn's disease.
Researchers also believe antibiotics help reduce harmful intestinal bacteria and suppress the intestine's immune system. They may be used in addition to other medications or when infection is a concern — in cases of perianal Crohn's disease, for example. However, there's no strong evidence that antibiotics are effective for Crohn's disease.
Frequently prescribed antibiotics include:
- Metronidazole (Flagyl). At one time, metronidazole was the most commonly used antibiotic for Crohn's disease. It can cause serious side effects, including numbness and tingling in your hands and feet and, occasionally, muscle pain or weakness. If these effects occur, stop the medication and call your doctor. You should also not drink alcohol while taking this medication because of severe side effects — including nausea, vomiting and tremor — due to the interaction of the drug with alcohol.
- Ciprofloxacin (Cipro). This drug, which improves symptoms in some people with Crohn's disease, is now generally preferred to metronidazole. A rare side effect is tendon rupture, which is an increased risk if you're also taking corticosteroids.
In addition to controlling inflammation, some medications may help relieve your signs and symptoms, but always talk to your doctor before taking any over-the-counter medications. Depending on the severity of your Crohn's disease, your doctor may recommend one or more of the following:
- Anti-diarrheal medications. A fiber supplement — such as psyllium powder (Metamucil) or methylcellulose (Citrucel) — can help relieve mild to moderate diarrhea by adding bulk to your stool. For more severe diarrhea, loperamide (Imodium) may be effective. Anti-diarrheal medications should only be used after discussion with your doctor.
- Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others). However, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, Anaprox) and diclofenac sodium (Voltaren, Solaraze) likely will make your symptoms worse and can make your disease worse as well.
- Iron supplements. If you have chronic intestinal bleeding, you may develop iron deficiency anemia and need to take iron supplements.
- Vitamin B-12 shots. Crohn's disease can cause vitamin B-12 deficiency. Vitamin B-12 helps prevent anemia, promotes normal growth and development, and is essential for proper nerve function.
- Calcium and vitamin D supplements. Crohn's disease and steroids used to treat it can increase your risk of osteoporosis, so you may need to take a calcium supplement with added vitamin D.
- Nutrition. Your doctor may recommend a special diet given via a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat your Crohn's disease. This can improve your overall nutrition and allow the bowel to rest. Bowel rest can reduce inflammation in the short term. If you have a stenosis or stricture in the bowel, your doctor may recommend a low-residue diet. This will help to minimize the chance that undigested food will get stuck in the narrowed part of the bowel and lead to a blockage.
If diet and lifestyle changes, drug therapy, or other treatments don't relieve your IBD signs and symptoms, your doctor may recommend surgery.
Surgery for ulcerative colitis. Surgery can often eliminate ulcerative colitis, but that usually means removing your entire colon and rectum (proctocolectomy). In most cases, this involves a procedure called ileoanal anastomosis that eliminates the need to wear a bag to collect stool. Your surgeon constructs a pouch from the end of your small intestine. The pouch is then attached directly to your anus, allowing you to expel waste relatively normally.
In some cases, a pouch is not possible. Instead, surgeons create a permanent opening in your abdomen (ileal stoma) through which stool is passed for collection in an attached bag.
Surgery for Crohn's disease. Up to one-half of people with Crohn's disease will require at least one surgery. However, surgery does not cure Crohn's disease.
During surgery, the doctor removes a damaged portion of your digestive tract and then reconnects the healthy sections. Surgery may also be used to close fistulas and drain abscesses. A common procedure for Crohn's disease is strictureplasty, which widens a segment of the intestine that has become too narrow.
The benefits of surgery for Crohn's disease are usually temporary. The disease often recurs, frequently near the reconnected tissue. The best approach is to follow surgery with medication to minimize the risk of recurrence. If you have had surgery on your colon or where your small intestine and colon meet, your doctor may recommend a repeat colonoscopy in six to 12 months to look for signs of disease and help with correct treatment.
Sometimes you may feel helpless when facing inflammatory bowel disease. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.
There's no firm evidence that what you eat actually causes inflammatory bowel disease. But certain foods and beverages can aggravate your signs and symptoms, especially during a flare-up.
It can be helpful to keep a food diary to keep track of what you're eating, as well as how you feel. If you discover some foods are causing your symptoms to flare, you can try eliminating those foods. Here are some suggestions that may help:
- Limit dairy products. Many people with inflammatory bowel disease find that problems such as diarrhea, abdominal pain and gas improve when they limit or cut out dairy products. You may be lactose intolerant — that is, your body can't digest the milk sugar (lactose) in dairy foods. Using an enzyme product such as Lactaid may help as well.
- Try low-fat foods. If you have Crohn's disease of the small intestine, you may not be able to digest or absorb fat normally. Instead, fat passes through your intestine, making your diarrhea worse. Try avoiding butter, margarine, cream sauces and fried foods.
Take care with fiber. If you have inflammatory bowel disease, high-fiber foods, such as fresh fruits and vegetables and whole grains, may make your symptoms worse, especially if you have narrowing in the bowel. If raw fruits and vegetables bother you, try steaming, baking or stewing them.
In general, you may have more problems with foods in the cabbage family, such as broccoli and cauliflower, nuts, seeds, corn, and popcorn. You may be told to limit fiber or go on a low-residue diet if you have a narrowing of your bowel (stricture).
- Avoid other problem foods. Spicy foods, alcohol and caffeine may make your signs and symptoms worse.
Other dietary measures
- Eat small meals. You may find you feel better eating five or six small meals a day rather than two or three larger ones.
- Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.
- Consider multivitamins. Because Crohn's disease can interfere with your ability to absorb nutrients and because your diet may be limited, multivitamin and mineral supplements are often helpful. Check with your doctor before taking any vitamins or supplements.
- Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.
Smoking increases your risk of developing Crohn's disease, and once you have it, smoking can make it worse. People with Crohn's disease who smoke are more likely to have relapses and need medications and repeat surgeries.
Smoking may help prevent ulcerative colitis. However, its harm to overall health outweighs any benefit, and quitting smoking can improve the general health of your digestive tract, as well as provide many other health benefits. Nicotine patches have been used to treat ulcerative colitis, but the results have been disappointing.
The association of stress with Crohn's disease is controversial, but many people who have the disease report symptom flares during high-stress periods. If you have trouble managing stress, try one of these strategies:
- Exercise. Even mild exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your doctor about an exercise plan that's right for you.
- Biofeedback. This stress-reduction technique may train you to reduce muscle tension and slow your heart rate with the help of a feedback machine. The goal is to help you enter a relaxed state so that you can cope more easily with stress.
- Regular relaxation and breathing exercises. One way to cope with stress is to regularly relax and use techniques such as deep, slow breathing to calm down. You can take classes in yoga and meditation or use books, CDs or DVDs at home.
Many people with digestive disorders have used some form of complementary and alternative medicine (CAM). However, there are few well-designed studies of their safety and effectiveness.
The majority of alternative therapies aren't regulated by the FDA. Manufacturers can claim that herbal and nutritional supplements are safe and effective but don't need to prove it. What's more, even natural herbs and supplements can have side effects and cause dangerous interactions. Tell your doctor if you decide to try an herbal supplement.
Some commonly used therapies include:
- Probiotics. Researchers suspect that adding more of the beneficial bacteria (probiotics) that are normally found in the digestive tract might help combat IBD. Although research is limited, there is some evidence that adding probiotics along with other medications may be helpful, but this has not been proved.
- Fish oil. Fish oil acts as an anti-inflammatory, and there is some evidence that adding fish oil to aminosalicylates may be helpful, but this has not been proved. Fish oil can cause diarrhea.
- Aloe vera. Aloe vera gel may have an anti-inflammatory effect for people with ulcerative colitis, but it also can cause diarrhea.
- Turmeric. Curcumin, a compound found in the spice turmeric, has been combined with standard ulcerative colitis therapies in clinical trials. There is some evidence of benefit, but more research is needed.
- Acupuncture. This procedure involves the insertion of fine needles into the skin, which may stimulate the release of the body's natural painkillers. Only one clinical trial has been conducted regarding its benefit for ulcerative colitis.
- Prebiotics. Unlike probiotics — which are beneficial live bacteria that you consume — prebiotics are natural compounds found in plants, such as artichokes, that help fuel beneficial intestinal bacteria. Studies have not shown positive results of prebiotics for people with Crohn's disease.
IBD doesn't just affect you physically — it takes an emotional toll as well. If signs and symptoms are severe, your life may revolve around a constant need to run to the toilet. Even if your symptoms are mild, it can be difficult to be out in public. All of these factors can alter your life and may lead to depression. Here are some things you can do:
- Be informed. One of the best ways to be more in control is to find out as much as possible about inflammatory bowel disease. Look for information from reputable sources such as the Crohn's & Colitis Foundation of America (CCFA).
- Join a support group. Although support groups aren't for everyone, they can provide valuable information about your condition as well as emotional support. Group members frequently know about the latest medical treatments or integrative therapies. You may also find it reassuring to be among others with IBD.
- Talk to a therapist. Some people find it helpful to consult a mental health professional who's familiar with inflammatory bowel disease and the emotional difficulties it can cause.
Although living with IBD can be discouraging, research is ongoing, and the outlook is improving.
- Experience. Each year, Mayo Clinic doctors diagnose and treat nearly 12,500 adults and children with inflammatory bowel disease, including Crohn's disease, ulcerative colitis, collagenous colitis and microscopic colitis. Mayo Clinic specializes in helping people with severe symptoms that haven't responded well to treatment in the past.
- Advanced techniques. At Mayo Clinic, you have access to the latest diagnostic and treatment technologies. State-of-the-art imaging helps Mayo doctors diagnose and treat your IBD. Mayo's colorectal surgeons are committed to using minimally invasive surgical procedures.
- Multidisciplinary approach. At Mayo Clinic, specialists in digestive diseases (gastroenterology), surgery, pathology, radiology and nutrition services, as well as skin and wound care, work together to provide the care you need for IBD.
- Comprehensive care. IBD can cause other health problems, such as osteoporosis or liver disease. Virtually all medical services you might need are available at Mayo Clinic.
- Children's care. Mayo Clinic doctors specialize in providing the long-term care that children with IBD require, including an IBD Center for Children and psychological services. They use diagnostic tests that minimize exposure to X-rays.
Mayo Clinic in Rochester, Minn., ranks No. 1 for digestive disorders in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Scottsdale, Ariz., and Mayo Clinic in Jacksonville, Fla., are ranked among the Best Hospitals for digestive disorders by U.S. News & World Report. Mayo Clinic also ranks among the Best Children's Hospitals for digestive disorders.
Besides the usual tests, the following tests are available at Mayo Clinic:
- Computerized tomography (CT) enterography and magnetic resonance (MR) enterography. Mayo Clinic researchers helped develop these noninvasive tests, which are more sensitive than conventional imaging for finding inflammation in the intestines. MR enterography is a radiation-free alternative.
- Chromoendoscopy. Mayo Clinic doctors use this technology to screen for colorectal cancer, the most serious risk associated with ulcerative colitis and Crohn's disease involving the colon. Chromoendoscopy uses a spray dye to highlight abnormal tissue changes.
- Balloon-assisted enteroscopy. Mayo Clinic doctors may use this test to look for sources of bleeding that can't be found by other methods. After you are sedated, a scope equipped with two balloons is inserted through your mouth into your digestive tract. The balloons inflate and provide a clear view inside folds of tissue.
- Endoscopic ultrasound. An ultrasound probe attached to an endoscope allows doctors to examine the wall of the intestine. It's helpful for finding fistulas and looking for complications such as abscesses in the perianal area.
Absorbing nutrients and maintaining a healthy weight can be a problem for people with IBD. At Mayo Clinic, dietitians with expertise in inflammatory bowel disease are part of your treatment team. If your digestive problems are severe, Mayo specialists may recommend special diets or home parenteral nutrition.
Most women with IBD can have successful pregnancies, especially if they can keep the disease in remission during pregnancy. However, it's very important that both men and women with IBD who wish to have a child talk to their doctors. The disease and its treatments may affect the pregnancy and increase the risk of early labor or birth defects. Mayo Clinic doctors have expertise and experience guiding women with IBD through pregnancy and delivery.
Treatment of children
At Mayo Clinic, a team of specialists will work together to address your child's needs. Because long-term steroid use can have harmful effects on children, Mayo Clinic doctors often choose to use other anti-inflammatory or immunosuppressive drugs. Mayo Clinic also uses advanced diagnostic tests, such as MR enterography, that don't expose children to ionizing X-ray radiation.
Ulcerative colitis often takes an even greater physical and emotional toll on children and adolescents than it does on adults. The disease can slow children's growth and delay sexual maturation. At Mayo Clinic, young people and their families work closely with psychologists who can help them navigate the day-to-day difficulties of living with ulcerative colitis.
Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.
Inflammatory bowel disease (IBD) specialists at Mayo Clinic's campus in Arizona care for adults with inflammatory bowel diseases. Specialists from gastroenterology and hepatology, colon and rectal surgery, radiology, laboratory medicine and pathology, rheumatology, and nutrition provide solutions tailored to your individual needs.
For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.
- U.S. Patients
- International Patients
Inflammatory bowel disease (IBD) specialists at Mayo Clinic's campus in Florida care for adults with inflammatory bowel diseases. Specialists from gastroenterology and hepatology, colon and rectal surgery, radiology, laboratory medicine and pathology, and nutrition provide solutions tailored to your individual needs.
For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.
- U.S. Patients
- International Patients
The Inflammatory Bowel Disease (IBD) Clinic at Mayo Clinic's campus in Minnesota focuses specifically on people with inflammatory bowel diseases. The IBD Clinic brings together specialists from gastroenterology and hepatology, colon and rectal surgery, radiology, laboratory medicine and pathology, and nutrition to provide solutions tailored to your individual needs.
Children with inflammatory bowel disease receive care from a variety of pediatric specialists who address the unique concerns of children and teens with IBD. Young patients needing hospitalization are treated at Mayo Eugenio Litta Children's Hospital.
For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.
- U.S. Patients
- International Patients
See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.
Mayo Clinic has made important contributions to the treatment of IBD over the years, including pioneering the ileal-anal pouch surgery and laparoscopic surgery for ulcerative colitis. A Mayo Clinic researcher discovered that genetic differences significantly affected the way patients metabolized a widely used IBD drug, azathioprine and 6-mercaptopurine. Mayo Clinic researchers conducted the first clinical study of Asacol and have shown that nicotine is an effective therapy for ulcerative colitis.
Mayo Clinic's inflammatory bowel disease (IBD) serum and tissue biobank involves all Mayo Clinic campuses. Research into serologic and genetic markers may lead to individualized diagnosis and treatment.
Researchers in the Enteric Neuroscience Program (ENSP) on each of the Mayo Clinic campuses investigate the biology of the neuromuscular system of the gastrointestinal tract. They are conducting numerous clinical trials related to IBD and other conditions.
See a list of publications by Mayo Clinic authors on inflammatory bowel disease on PubMed, a service of the National Library of Medicine.
- David H. Bruining, M.D.
- Peter W. Carryer, M.D.
- Jonathan E. Clain, M.D.
- William A. Faubion, M.D.
- Jeff L. Fidler, M.D.
- Deborah K. Freese, M.D.
- Suryakanth (Suryakanth Reddy) R. Gurudu, M.D.
- Sunanda V. Kane, M.D.
- Edward V. Loftus Jr., M.D.
- Jonathan A. Leighton, M.D.
- Darrell S. Pardi, M.D.
- Michael F. Picco, M.D., Ph.D.
- Kenneth W. Schroeder, M.D., Ph.D.
- William J. Tremaine, M.D.
- Heidi K. Chua, M.D.
- Robert R. Cima, M.D.
- Richard M. Devine, M.D.
- Eric J. Dozois, M.D.
- Ron G. Landmann, M.D.
- Heidi Nelson, M.D.
- John H. Pemberton, M.D.
- Bruce G. Wolff, M.D.
- Tonia M. Young-Fadok, M.D.
- Jeff L. Fidler, M.D.
- Joel G. Fletcher, M.D.
- Amy K. Hara, M.D.
- C. (C Dan) Daniel Johnson, M.D.
Feb. 18, 2015
- Peppercorn MA, et al. Definition, epidemiology, and risk factors in inflammatory bowel disease. http://www.uptodate.com/home. Accessed June 16, 2014.
- Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed June 9, 2014.
- Ulcerative colitis. National Institute of Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/colitis/. Accessed June 16, 2014.
- What is ulcerative colitis? Crohn's & Colitis Foundation of America. http://www.ccfa.org/what-are-crohns-and-colitis/what-is-ulcerative-colitis/. Accessed June 16, 2014.
- Crohn's disease. National Institute of Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/. Accessed June 2, 2014.
- What is Crohn's disease? Crohn's & Colitis Foundation of America. http://www.ccfa.org/what-are-crohns-and-colitis/what-is-crohns-disease/. Accessed June 2, 2014.
- Ferri FF. Ferri's Clinical Advisor 2014: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2014. https://www.clinicalkey.com. Accessed June 2, 2014.
- Crohn's disease. The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/gastrointestinal_disorders/inflammatory_bowel_disease_ibd/crohn_disease.html. Accessed June 2, 2014.
- Peppercorn MA, et al. Clinical manifestations, diagnosis and prognosis of Crohn's disease in adults. http://www.uptodate.com/home. Accessed June 2, 2014.
- Ulcerative colitis. The Merck Manual for Health Care Professionals. http://www.merckmanuals.com/professional/print/sec02/ch018/ch018c.html. Accessed June 16, 2014.
- Dignass A, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 1: Definitions and diagnosis. Journal of Crohn's and Colitis. 2012;6:965.
- Inflammatory bowel disease. U.S. Centers for Disease Control and Prevention. http://www.cdc.gov/ibd/. Accessed June 9, 2014.
- Management of Crohn's disease in adults. Bethesda, Md.: American College of Gastroenterology. http://gi.org/guideline/management-of-crohn%e2%80%99s-disease-in-adults/. Accessed June 2, 2014.
- Etminan M, et al. Isotretinoin and risk for inflammatory bowel disease: A nested case-control study and meta-analysis of published and unpublished data. JAMA Dermatology. 2013;149:216.
- Peppercorn MA, et al. Clinical manifestations, diagnosis, and prognosis of ulcerative colitis in adults. http://www.uptodate.com/home. Accessed June 16, 2014.
- Crohn's disease. The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/gastrointestinal_disorders/inflammatory_bowel_disease_ibd/crohn_disease.html. Accessed June 2, 2014.
- Peppercorn MA, et al. Colorectal cancer surveillance in inflammatory bowel disease. http://www.uptodate.com/home. Accessed June 9, 2014.
- What should I know about screening for colorectal cancers? Centers for Disease Control and Prevention. http://www.cdc.gov/cancer/colorectal/basic_info/screening/. Accessed June 9, 2014.
- Leong RW, et al. Implementation of image enhanced endoscopy into solo and group practices for dysplasia detection in Crohn's disease and ulcerative colitis. Gastrointestinal Endoscopy Clinics of North America. 2014;24:419.
- Bruining DH, et al. Technology insight: New techniques for imaging the gut in patients with IBD. Nature Clinical Practice Gastroenterology & Hepatology. 2008;5:154.
- Kornbluth A, et al. Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee. American Journal of Gastroenterology. 2010;105:501.
- Dignass A, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: Current management. Journal of Crohn's and Colitis. 2012;6:991.
- Cohen RD, et al. Approach to adults with steroid-refractory and steroid-dependent ulcerative colitis. http://www.uptodate.com/home. Accessed July 7, 2014.
- Sandborn WJ, et al. Colectomy rate comparison after treatment of ulcerative colitis with placebo or infliximab. Gastroenterology. 2009;137:1250.
- What is complementary and alternative medicine (CAM)? International Foundation for Functional Gastrointestinal Disorders. http://www.iffgd.org/store/viewproduct/700. Accessed June 25, 2014.
- Living with Crohn's and Colitis. Crohn's & Colitis Foundation of America. http://www.ccfa.org/living-with-crohns-colitis/. Accessed June 2, 2014.
- Rakel D. Integrative Medicine. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com. Accessed June 4, 2014.
- Sartor RB. Probiotics for gastrointestinal diseases. http://www.uptodate.com/home. Accessed June 10, 2014.
- Korzenik JR. Investigational therapies in the medical management of Crohn disease. http://www.uptodate.com/home. Accessed June 5, 2014.
- Farrell RJ, et al. Overview of the medical management of severe or refractory Crohn disease in adults. http://www.uptodate.com/home. Accessed June 2, 2014.
- Farrell RJ, et al. Overview of the medical management of mild to moderate Crohn disease in adults. http://www.uptodate.com/home. Accessed June 2, 2014.
- Albenberg LG, et al. Food and the gut microbiota in inflammatory bowel diseases: A critical connection. Current Opinion in Gastroenterology. 2012;28:314.
- D'Haens GR, et al. Future directions in inflammatory bowel disease management. Journal of Crohns and Colitis. In press. Accessed June 2, 2014.
- Sakuraba A, et al. Natalizumab in Crohn's disease: Results from a US tertiary inflammatory bowel disease center. Inflammatory Bowel Diseases. 2013;19:621.
- Kane SV, et al. Natalizumab for moderate to severe Crohn's disease in clinical practice: The Mayo Clinic Rochester experience. Inflammatory Bowel Diseases. 2012;18:2203.
- Leiman DA, et al. Therapy of inflammatory bowel disease: What to expect in the next decade. Current Opinion in Gastroenterology. 2014;30:385.
- Smoking and your digestive system. National Institute of Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/smoking/. Accessed June 2, 2014.
- Crohn's and Colitis Community. Crohn's & Colitis Foundation of America, http://www.ccfacommunity.org/. Accessed August 3, 2014.
- Picco MF (expert opinion). Mayo Clinic, Jacksonville, Fla.
- U.S. News best hospitals 2014-2015. U.S. News & World Report. http://health.usnews.com/best-hospitals/rankings/gastroenterology-and-gi-surgery. Accessed July 5, 2014.
- Heppell J. Operative management of Crohn disease of the small bowel and colon. http://www.uptodate.com/home. Accessed June 2, 2014.
- Golden AK. Decision Support System. Mayo Clinic, Rochester, Minn. June 17, 2014.