Inflammatory Bowel Disease

“The first time I had a flare up, I seriously thought I was going to die. The pain was so bad, I couldn’t stand up straight. I couldn’t sleep. I was afraid to eat. And the symptoms were so embarrassing, I kept putting off going to the doctor. I was sure it was something terminal, like colon cancer. I was almost relieved to find out it was “just Crohn’s” – but then I found out what Crohn’s really is and how it could interfere with my life.”

22-year old Karine, like many other women diagnosed with Inflammatory Bowel Disease (or IBD), had never suffered from a major illness before in her life. She followed a healthy vegetarian diet, exercised regularly, and practiced yoga and meditation to cope with the stress of a busy college schedule. To find out she had such a serious intestinal ailment came as a complete surprise.

Over four million people worldwide suffer from IBD (which includes Ulcerative Colitis and Crohn’s Disease), and more than 35,000 new cases are diagnosed each year. The vast majority of these cases are Americans, and although the incidence of IBD is roughly equal between the sexes, women are the faster growing group. Although IBD strikes across races, genders, and classes, some groups are more likely to develop IBD than others. These include:

• People with a family history of IBD
• Caucasian people of Jewish descent
• People of higher socioeconomic classes
• People who live in cities
• People who live in developed countries.

Some scientists have tied the incidence of IBD to meat consumption (see The New Eating Right for a Bad Gut by James, Scala, Ph.D. ISBN 0-452-27976-3) and lack of Omega-3 oils in the diet. Smoking also seems to effect a person’s risk of developing IBD. A person who smokes is more likely to develop Crohn’s Disease, while less likely to get Ulcerative Colitis.

The Scientific community as a whole, however, is baffled by IBD, and have as yet been unable to agree on a direct causal effect across cases. The most likely candidates include a faulty immune system, heredity, and environmental factors. The immune system theory contends that some virus or bacteria causes the body to react in a normal way, but it then fails to shut down, attacking the digestive tract and causing the inflammation that is the cornerstone of both kinds of IBD. Geneticists in recent years believe they have discovered at least one flawed gene that contributes to the development of IBD. In environmental theories, stress, lack of exercise, socioeconomic status and living in highly developed countries are also factors, although the specifics of these are yet to be discovered.

In other words, although no direct causal link has been tied to the incidence of IBD, it does appear that Americans, with our unhealthy diets, high levels of stress, and lack of regular exercise are at far greater risk than other populations of the world. That offers yet another good reason to change our lifestyles and take better care of our bodies!

IBD should not be confused with IBS – Irritable Bowel Syndrome, a far more common and generally less serious form of digestive disorder. Where IBD is marked by inflammation of the intestines, IBS is not. IBS includes some symptoms similar to Ulcerative Colitis, such as alternating diarrhea and constipation, abdominal pain, bloating, spasms and nausea. Unlike UC, however, IBS can b treated with fiber, reduction of stress levels, proper rest, and exercise. These things alone do not seem to significantly effect the symptoms of UC, and medication remains necessary for most sufferers.

IBD’s, on the other hand, come with a list of more dire and often debilitating symptoms, and require careful observation of diet, medication, or even surgery to control. Common symptoms of IBD include:

– severe abdominal pain
– weight loss
– recurring or lingering fever
– rectal bleeding or bloody stool
– skin and eye irritations
– frequent diarrhea

It is often difficult for doctors to determine which form of IBD a person may have, and someone exhibiting these symptoms will often go through a series of test batteries to narrow down their particular disease. These include blood tests, stool samples, barium enemas, flexible signmoidoscopy, upper gastrointestinal series, and the most popular and effective diagnostic tool, colonoscopy. The latter is preferred to clarify exactly how much of the patient’s intestinal tract is engaged by the disease. If only the inner lining of the large intestine (the colon) and rectum are effected, a patient is generally diagnosed with UC. However, if all layers of the intestinal wall and/or both small and large intestine or other parts of the digestive tract are involved, the diagnosis is one of Crohn’s Disease.

While the two diseases are similar, especially in symptomology, they often require very different treatments. Treatment options include dietary and lifestyle changes, medicines, and surgery. The most common medicinal treatments for both forms of IBD include anti-inflammatory drugs called aminosalicylates, corticosteroids such as Prednisone, antibiotics, immunomodulators (which are considered mostly undesirable due to serious side effects), and over the counter medications such as pain relievers, anti-diarrhea medications, and laxatives, but these latter should be taken only with a doctor’s strict supervision.

Lifestyle changes include dietary considerations such as taking specific nutritional supplements, limiting dairy products (lactose intolerance can greatly exacerbate IBD symptoms), eating low fat foods, avoiding “gassy,” spicy, or highly seasoned foods, avoiding foods high in indigestible fiber, and eating smaller, more frequent meals.

Surgical options are usually only exercised as a last resort, although some experts encourage surgery in earlier stages of the IBD’s rather than force patients to live in pain for years first. Crohn’s Disease requires eventual surgery in about 75 percent of patients, UC in about 20-40 percent, according to the U.S. Department of Health and Human Services. Surgical options include removal of sections of, or the entire, colon and inserting what is called an ileal pouch to remove waste from the body after such intestinal removal.

Although IBD’s are serious conditions, with proper diet, exercise, and medication, most people with IBD continue to lead healthy, active lives. It is important, however, to seek treatment as soon as possible in spite of the embarrassing symptoms you may experience. Some people with IBD have a higher incidence of colon cancer, and IBD patients need to be screen regularly. Women’s menstrual cycles and fertility are often adversely effected due to fluctuations in hormones associated with IBD.

IBD is also associated with other health problems that may require separate treatment, including:

• arthritis
• inflammation of the eye
• liver and bile duct disease
• skin disorders
• anemia
• kidney stones
• nutritional deficiencies
• anemia
• bleeding ulcers and fistulas that break through the intestinal walls and effect the bladder, vagina, and skin

It is important to seek medical attention as soon as possible if you experience:

• severe abdominal cramps or pain
• severe diarrhea or bloody diarrhea
• weight loss
• unexplained fever lasting more than 3 or 4 days
• exhaustion
• loss of appetite
• nausea

“Having an IBD is scary and embarrassing,” Karine says, “But with my doctor’s help, getting more exercise, watching what I eat and taking my medication, it doesn’t always have to effect my life negatively.”

If you are diagnosed with IBD, you are not alone. Ask your doctor or local hospital about support groups in your area, or go to the Crohn’s and Colitis Foundation of America website (http://www.ccfa.org) or The Healing Well Community (http://www.healingwell.com/community/default.aspx?f=17) for more information.