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While inflammatory bowel disease (IBD) is a chronic condition, it is treatable. With a treatment plan that is personalized to your physical and mental health needs, you can control this condition and start feeling more like yourself again.
IBD shares a similar name—and some symptoms—with irritable bowel syndrome (IBS), but the two conditions manifest differently:
- IBD is characterized by chronic inflammation. It is a structural disease, which means it changes the appearance and formations of the intestines, causing ulcers, redness, and irritation of the intestinal lining.
- IBS is a functional disease—the intestines and colon look normal but don’t work properly.
IBD is an umbrella term for two autoimmune conditions: Crohn’s disease and ulcerative colitis. These conditions occur when your immune system dysfunctions and releases inflammatory signals that target your intestines.
Gastrointestinal (GI) tract conditions such as IBD can start in infancy and continue through adulthood, so I have cared for patients from pediatrics through geriatrics. I’m trained in both pediatrics and adult medicine, and the continuum of care needed for IBD offers a chance to help patients lead active, fulfilling lives at all ages and stages.
As patients grow, mentally and physically, their disease management needs change. Symptoms that might have been annoying in youth can become embarrassing and isolating in the teen years, leading to anxiety and depression.
Though there is not yet a cure for IBD, modern and personalized treatment options give patients more freedom and symptomless days than ever before. Our goals with treatment revolve around your specific condition—we’ll work to help you get better and stay better.
Causes and symptoms of IBD.
Genetics play a role in the development of IBD, but other triggers typically manifest the disease. Those triggers include environmental factors such as stress, tobacco use, diet, antibiotic or pain reliever use, low vitamin D levels, and the absence/presence of certain bacteria, fungi, and other microbes in the gut microbiome.
Age is also a risk factor. IBD can develop at any age, but it’s most often found in patients before they’re 30 years old. Some patients—especially those with ulcerative colitis (UC)—develop symptoms later in life, usually while in their 50s and 60s.
Crohn’s disease can affect the entire GI tract, whereas ulcerative colitis affects only the colon. Both share similar symptoms, which vary depending on the severity of the inflammation and where it occurs:
- Abdominal pain that ranges from mild to severe
- Bloody stool
- Bowel movements in the middle of the night
- Constipation
- Frequent and loose stool
- Mucus in stool
- Weight loss
Patients usually experience periods of active illness, which are called flares, followed by lower-symptom periods of remission.
However, the physical symptoms of IBD also can cause mental health concerns due to a well-studied gut-brain connection. Research suggests that healthy gut bacteria can influence behavior and emotion by helping to regulate neurotransmitters that balance brain chemistry. GI conditions such as IBD upset that balance, increasing the risk of mental health concerns.
Patients with IBD may feel isolated and embarrassed by their symptoms, which can lead to anxiety and depression. For example, teens who need to use the restroom frequently may struggle with academics, miss out on playing sports, or get left out from (or avoid attending) outings with friends.
Fear and anxiety can lead to negative self-care choices. Some years ago, I saw a young patient who was taking steroids as a long-term solution for IBD—an uncommon and potentially harmful treatment plan. She confided that she lived in constant fear of a flare, and she thought steroids were her only medical option. I referred her to a psychologist, who helped her understand and gain control over her anxiety.
Diagnosing IBD.
Our personalized approach starts with a conversation to understand your barriers and issues. Laboratory tests help us rule out infection or underlying conditions before moving on to endoscopic evaluation and imaging to pinpoint your diagnosis.
During an endoscopy, a long and flexible tube with a camera at its end is inserted into the body through the mouth or rectum. Endoscopy shows us the inside of the GI tract to assess structural damage. Imaging such as X-rays, CT scans, or MRI scans create images of the organs to help validate the diagnosis.
We listen before we try to manage your condition. Then, we tailor a treatment plan to help get you better and keep you feeling better long term.
Treatment options for IBD.
Patients with IBD can benefit from a variety of treatments, from diet and exercise changes to advanced medications. The goal of treatment is to slow the hyperactivity of the immune system and decrease inflammation and its resulting symptoms.
Lifestyle changes.
Dietary changes can help keep IBD in remission. Those changes include avoiding foods that could cause intestinal blockages, such as corn, fruits with skin and seeds, nuts, and whole grains.
During a flare, an IBD-friendly diet might include:
- Low-fiber fruits like bananas and cooked fruits
- Lean protein like fish and white meat chicken
- Refined grains like white rice and pasta
- Steamed vegetables like potatoes and squash
- The spice turmeric, which contains curcumin, an anti-inflammatory agent
People with IBD should avoid high-fiber foods during flares. However, after the flare subsides, it is important to resume eating these foods with a doctor’s recommendations.
Exercise also can help patients with IBD who struggle with mental health concerns. For example, walking, swimming, and running when you are feeling well can help clear your mind and relieve stress. Ask a friend to join you—exercise is a great social activity that can be as healthy for the mind as for the body.
Aminosalicylates.
These compounds contain 5-aminosalicylic acid, an anti-inflammatory agent, and reduce inflammation in the intestinal lining. While they often are used to treat both forms of IBD, they’re most effective in UC. These drugs can be given orally or rectally.
Corticosteroids.
Steroids such as prednisone or methylprednisolone suppress the entire immune system and work quickly to decrease acute IBD-related inflammation and symptoms. These drugs, while highly effective, should only be used for short periods as they may cause fluid retention, weight gain, mood changes and sleep disturbances.
Immunomodulators.
These medications modify the immune system to decrease the inflammatory response. Doctors may prescribe them if steroids don't work sufficiently. Treatment is typically given as a pill.
Biologic therapies.
Biologics are synthetic antibodies that prevent certain proteins from causing inflammation. They’re more precise than other therapies but require close monitoring. These medications come in IV and injectable formulations, which can be given at an infusion center or patients may learn to self-administer the injections at home.
Small molecule oral therapies.
Small molecule oral therapies are considered effective for UC but may increase infection. Because of the size of the molecules that make up these medications, they can “go deeper” into the cells and help disrupt the inflammatory response at the cellular level.
As new treatments for IBD are researched and developed, patients gain more options to increase flare-free days. While IBD is a chronic condition, personalized care that covers your physical and emotional needs can make a major difference in your quality of life.
