Dr Dulcy: A real pain in the belly

INFLAMMATORY BOWEL DISEASE: CAN BE EXTREMELY DEBILITATING

Ulcerative colitis and Crohn’s disease both fall into this category.

Inflammatory bowel disease (IBD) is an all encompassing term used to describe disorders that involve chronic inflammation of your digestive tract. These disorders usually involve severe diarrhoea, abdominal pain, fatigue and weight loss.

It can be debilitating and sometimes leads to life-threatening complications.

You need to visit 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.

There are different types of inflammatory bowel disease and include:

Ulcerative colitis. This condition causes long-lasting inflammation and sores (ulcers) in the innermost lining of your large intestine (colon) and rectum.

Crohn’s disease. This type is characterised by inflammation of the lining of your digestive tract, which often spreads deep into affected tissues.

Causes

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 do not cause the disease.

A 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.

Risk factors

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.

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.

Although smoking may provide some protection against ulcerative colitis, the overall health benefits of not smoking make it important to try to quit.

Nonsteroidal anti-inflammatory medications. These include ibuprofen (Advil, Myprodol, others), naproxen sodium (Aleve), diclofenac sodium (Voltaren) 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 industrialised country, you’re more likely to develop IBD.

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.

Symptoms

Signs and symptoms may change, depending on how severe the disease is and where in the intestines it is located.

Symptoms may range from mild to severe. You are likely to have periods of active illness followed by periods of remission where you do not feel any abnormalities.

Signs and symptoms that are common to both Crohn’s disease and ulcerative colitis include: Blood or mucous in your stool. Diarrhoea.

Fever and fatigue. Abdominal pain and cramping. Reduced appetite. Unintended weight loss.

Complications

Complications found in both conditions may include:

Colon cancer. General colon cancer screening guidelines for people without IBD call for a colonoscopy every 10 years beginning at age 50.

Skin, eye and joint inflammation.

Medication side-effects. Primary sclerosing cholangitis. In this condition, inflammation causes scars within the bile ducts.

Blood clots. Complications of Crohn’s disease may include:

Bowel obstruction. Crohn’s disease affects the full thickness of the intestinal wall.

You may require surgery to remove the diseased portion of your bowel.

Malnutrition. It’s also common to develop anaemia due to low iron or vitamin B12. Ulcers.

Fistulas.

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. Complications of ulcerative colitis may include:

Toxic megacolon. Ulcerative colitis may cause the colon to rapidly widen and swell, a serious condition known as toxic megacolon.

A hole in the colon (perforated colon). A perforated colon most commonly is caused by toxic megacolon, but it may also occur on its own.

Severe dehydration. Excessive diarrhoea can result in dehydration.