A pain in the gut, and a pain in the butt

Inflammatory Bowel Disease (IBD) refers to conditions in which either the small intestine, or the large, or both, undergo changes due to inflammation.  Conditions included under the umbrella term of inflammatory bowel disease are Crohn’s disease, ulcerative colitis and indeterminate IBD, which has features of both Crohn’s and UC.

Ulcerative colitis and Crohn’s disease are distinct conditions that have some strong similarities.  UC causes ulcers to develop in the lining of the colon and rectum.  Crohn’s disease also causes ulcer-like lesions but the pattern of the lesions differs from those in UC and they can occur anywhere in the intestinal tract.  Diarrhea with bleeding, weight loss and abdominal pain are found in both conditions.  The symptoms may come and go, but tend to last for a long time while they are active, and return repeatedly.  It’s not yet known what causes IBD but a family history of the condition is a strong risk factor.  The mix of bacteria in the gut seems to be implicated somehow but the relationship is not well understood.  Tobacco use a strong risk factor for Crohn’s disease but not as much for UC.  Young people (15 – 25) and middle-aged people (40 – 60) of both genders are most likely to be affected.

What It Feels Like

People with IBD may experience pronounced fatigue.  They may have loss of appetite or transient nausea.  The pain can be unrelenting and severe.  It is often described as a cramping pain.  Symptoms of anxiety and depression are also quite common.

Diagnosis

Because of variations in the way that IBD presents itself, it can take a while for a diagnosis to be made.  The diagnostic process starts with a review of your medical history and a physical exam.

Blood tests are usually done to look for signs of inflammation and anemia.  Stool specimens are examined for the presence of blood.  Sometimes the blood is obvious and sometimes it’s hidden (occult).  Endoscopic examinations in which the lining of the intestines are examined with a fiber-optic camera are usually performed.  Imaging studies, such as barium x-rays and CT scans, are often used.

Treatment Options

The principle treatments are medication, surgery, dietary changes, stress management and nutritional supplementation.

The medications can include pain killers, anti-inflammatories, and motility-modifying drugs.  Meds that modify motility help to lessen cramping and diarrhea.

Dietary changes may include assessment for food sensitivities and elimination of those foods.  A low residue diet may be recommended for periods of relapse.

Nutritional supplements may be necessary because the altered state of the intestines interferes with nutrient absorption from food.

The requirement for surgery is determined according to the severity of tissue damage.  Many people are able to avoid surgery but it a common form of treatment, with up to 40% of UC patients and up to 76% of Crohn’s patients eventually needing surgery.

The naturopathic approach to any condition always involves a search for a cause.  With IBD, we don’t know exactly what the cause is so we try to minimize modifiable risk factors as much as possible and use the tools we know will maximize intestinal health – an appropriate diet, probiotics, prebiotics and natural anti-inflammatories.

Stress, emotional conditions such as depression and anxiety, lifestyle factors such as tobacco and alcohol use, and dietary factors can all contribute to susceptibility to inflammatory states, so if any of these are present, they have to be addressed as well.

Outlook

IBD is a serious condition that undermines quality of life significantly.  At the time of diagnosis, conventional treatment with medications and/or surgery are very important.

Natural medicine can play a supportive role initially and assume a more prominent role as the person’s condition stabilizes.

While ongoing attention to diet, nutritional status and emotional well-being will always be needed, people with IBD can enjoy long periods of remission and a fantastic quality of life.