Inflammatory bowel disease (IBD) affects approximately 3 million Americans with about 70,000 new cases diagnosed annually in the US. The prevalence of IBD appears to be on the rise with an increase from 2001 to 2018 among Medicare beneficiaries of all race and ethnicity groups.

What is IBD?

IBD is comprised of two diseases: Ulcerative Colitis (UC) and Crohn’s Disease (CD). Both conditions cause inflammation and damage to the intestinal tract (small and large intestine). CD can affect all parts of the intestinal tract while UC is limited to the colon. IBD can affect other parts of the body including joints (arthritis), eyes (uveitis), skin (pyoderma), liver, and more. IBD increases the risk of colorectal cancer and requires frequent surveillance with colonoscopy.

Are IBS and IBD the same thing?

Many people confuse IBS and IBD because they sound similar. Irritable bowel syndrome (IBS) is a clinical condition based on a set of symptoms: abdominal pain with diarrhea, constipation, or both.  IBD is a lifelong autoimmune disease caused by chronic inflammation of the intestinal tract. They are not the same disease but share many similar symptoms including diarrhea and abdominal discomfort which is why speaking to your doctor about your symptoms is important.

What are the most common symptoms of IBD?

The most common symptoms of IBD include diarrhea, abdominal pain, fatigue, weight loss, and rectal bleeding. The diarrhea may be frequent and result in the need to “rush” to the bathroom with urgency. Many of these symptoms can be debilitating and affect quality of life. People are often embarrassed to talk about their symptoms or seek help.

When are most people diagnosed with IBD?

While IBD can occur at any age, most patients are diagnosed before age 30.  Many people with IBD may have rectal bleeding and think it is from hemorrhoids not realizing it could be a sign of IBD. After age 30 there is a second “peak” of diagnoses in the 50-60s age range so it is important for everyone to pay attention to the symptoms and speak with their doctor.

Why do people get IBD?

The exact cause of IBD is not known. Researchers believe it is a combination of genetics, environmental factors, and the body’s immune response. There are genetic risk factors including having a first-degree relative with CD or UC. Historically, white populations had a higher incidence of IBD, but recent studies have shown an increase in IBD across other races and ethnicities.

How is IBD diagnosed?

The key part of diagnosing IBD starts with recognizing the symptoms. Let your doctor know if you are developing rectal bleeding, having pain after eating, or losing weight without intent. Your doctor may examine you and send you for blood and stool tests to check for anemia, signs of inflammation, or infection. To physically “look” at the intestinal tract your doctor may refer you to a gastroenterologist for an endoscopy and colonoscopy. This is done by putting a small, thin, flexible tube with a camera in the body. Pictures and biopsies can be taken to help diagnose IBD. Imaging tests including CT scans and MRI may help with the diagnosis as well.

Is there a cure for IBD?

While there is no “cure” for IBD, we do have some excellent treatments to keep the disease under control. IBD often has periods of remission and active flare-ups and should be monitored carefully. There are different medications used to treat IBD including anti-inflammatory agents, immunomodulators, and biologic therapy. However, it is critically important to start treatment early before irreversible structural damage occurs. Time is of the essence in diagnosing and treating IBD.

Will you need surgery if you have IBD? Will you need a bag (colostomy/ileostomy)?

Most IBD can be managed medically, but sometimes the disease has progressed to structural damage requiring surgery. The patient will be referred to a colorectal surgeon to discuss surgical options. Often, colorectal surgeons are able to offer minimally invasive surgical techniques (smaller incisions, less pain, earlier return to work/school) with laparoscopic or robotic surgery. Most IBD patients undergoing surgery worry if they will need a “bag” or “stoma” which refers to a colostomy or ileostomy. This is when a portion of the intestinal tract is brought up to the skin and waste is collected in a bag either temporarily or permanently. This is needed in a small number of IBD patients and why it is important to diagnose and treat early prior to structural damage.  

Does IBD affect your fertility?

With the peak of IBD in the 20s-30s this coincides with many starting families. It is important to make sure IBD is well controlled, ideally prior to becoming pregnant. Patients with female anatomy who conceive while in remission from IBD tend to remain in remission for the duration of their pregnancy. Conversely, poorly controlled IBD can lead to decreased fertility, and higher-risk pregnancies.  

Take home points about IBD

It is important to pay attention and listen to your body’s symptoms. Do not be embarrassed to call your doctor if you develop persistent diarrhea, rectal bleeding, or abdominal pain. Early diagnosis and intervention are key to achieving remission and preventing long-term structural damage in IBD. Here at Care New England (Kent Hospital/Women and Infant’s Hospital) we have dedicated teams including gastroenterology and colorectal surgery who work collaboratively to care for patients with IBD to ensure they are able to live their best possible healthy lives.