Inflammatory bowel diseases: Crohn's disease & ulcerative colitis

April 25, 2024

Inflammatory bowel disease (IBD) is a term used to describe disorders that involve chronic inflammation of the digestive tract. Types of IBD include ulcerative colitis and Crohn’s disease. Both conditions typically involve severe diarrhea, abdominal pain, fatigue, and weight loss. IBD can be debilitating and sometimes leads to life-threatening complications.

At Alabama Colon and Rectal Institute, our surgeons are experts when it comes to diagnosing and treating these conditions. Let’s take a closer look at IBD in general, and each individual disease.

General information about 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
• Fever and fatigue
• Abdominal pain and cramping
• Blood in stool
• Reduced appetite
• Unintended weight loss

The exact cause of inflammatory bowel disease remains unknown. Diet and stress were once suspected causes, but we know now that while these factors may aggravate IBD, they don’t cause it. 

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 may cause 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. 

Here are a few known risk factors:

• Age -- Most people are diagnosed before the age of 30, although some 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. 
• Family history -- You're at higher risk if you have a close relative, such as a parent, sibling or child with the disease.
• Smoking -- This is the most important controllable risk factor for developing Crohn's disease. 
• Use of nonsteroidal anti-inflammatory medications -- This includes ibuprofen (Advil, Motrin,and  others), naproxen sodium (Aleve), diclofenac sodium (Voltaren), and others. These medications may increase the risk of developing IBD or worsen the disease in people who have IBD.
• Where you live -- If you live in an industrialized country, you're more likely to develop IBD. This 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.

Treatments for inflammatory bowel disease

There are several treatments for IBD, including:

Medications -- Anti-inflammatory drugs are typically the first step in IBD treatment. These drugs decrease inflammation of the digestive tract. However, they have many side effects. Immune suppressants (or immunomodulators) prevent the immune system from attacking the bowel and causing inflammation. Antibiotics are used to kill bacteria that may trigger or aggravate IBD symptoms. Antidiarrheal drugs and laxatives can also be used to treat IBD symptoms.

Lifestyle choices -- This is very important when you have IBD. Drinking plenty of fluids helps compensate for those lost in your stool. Avoiding dairy products and stressful situations also improves symptoms. Regularly taking vitamin and mineral supplements may help as well. Exercising and quitting smoking can further improve IBD and overall health.

Surgery -- Surgery may be necessary sometimes for people with IBD, and options include: strictureplasty to widen a narrowed bowel; closure or removal of fistulas; removal of affected portions of the intestines for people with Crohn’s disease and removal of the entire colon and rectum for severe cases of ulcerative colitis.

One thing we’d also like to note is that having routine colonoscopies is very important for those with IBD. This allows us to monitor for colon cancer, since those with these conditions are at a higher risk for developing it.

More about Crohn’s disease

Despite treatment options listed above, Crohn’s disease is an incurable inflammatory disorder that can affect any part of the gastrointestinal tract. 

Crohn’s disease can present as abdominal disease, anorectal disease, or both. Patients with Crohn’s are at greater risk of developing a fistula. A fistula is a small tunnel that tracks from one portion of bowel to either another portion of bowel, another organ, or the skin. 

Symptoms vary widely among patients and often come and go over a long period of time. These include:

• Abdominal cramping
• Abdominal pain
• Ongoing diarrhea
• Chronic constipation
• Bleeding with bowel movements
• Fever
• Extreme tiredness
• Weight loss
• Drainage from the skin around the anus
• Abscesses (infections) around the anus that come back
• Anal fissures

With Crohn’s disease, surgery is typically performed when symptoms are no longer being controlled with medications. This usually means there is a section of bowel that is either too scarred or narrow to function properly. The surgery can be performed either through a traditional open approach or a minimally invasive procedure. 

More about ulcerative colitis

Ulcerative colitis (UC) can affect the entire large bowel (colon and rectum). The inflammation is confined to the innermost layer of the intestinal wall (mucosa). UC can go into remission and recur. 

The symptoms of UC are similar to Crohn’s disease, when the latter only affects the colon and rectum. The most common symptoms of UC include:

• Abdominal cramping.
• Pain
• Diarrhea
• Bleeding with bowel movements
• Fever
• Fatigue
• Weight loss 

With UC, medical treatment is always the first choice unless emergency surgery is required. The goal of medical therapy is to improve a patient's quality of life. Initially, the most common therapy is corticosteroids (steroid hormones) combined with anti-inflammatory agents. 

What inflammatory bowel disease is not

We want to note that IBD should not be confused with irritable bowel syndrome or IBS. Although people with IBS may experience some similar symptoms to IBD, IBD and IBS are very different. Irritable bowel syndrome is not caused by inflammation and the tissues of the bowel are not damaged the way they are in IBD. Treatment is also different. 

IBD is also not celiac disease, another condition with similar symptoms to IBD. It is also characterized by inflammation of the intestines, but the cause of celiac disease is known and very specific. It is an inflammatory response to gluten (a group of proteins found in wheat and similar grains).

If you are experiencing any of the symptoms of Crohn’s disease or ulcerative colitis, please come in and see us. We will help you figure out what’s going on, and find the best treatment plan for your situation.

Alabama Colon & Rectal Institute is centered around treating diseases of the colon, rectum, and anus.

Alabama Colon & Rectal Institute (also known as the “Butt Hutt” around town!) has been in practice since 1990 as a free-standing, private practice located in downtown Birmingham, Alabama.  We are known for our efficiency and patient care, in a more relaxed office-based setting.  Our doctors are known regionally for their expertise and are active in teaching surgical residents and other physicians.  We are also a major sponsor of The Rumpshaker 5K, a race that promotes awareness about colorectal cancer.  Check out our website for more information, or give us a call to make an appointment at (205) 458-5000, or email us at [email protected].