A 3d image of the human intestines illustrating the area affected by inflammatory bowel disease.

Inflammatory Bowel Disease: Symptoms, Causes, Treatments & More

by Dr. Matt Olesiak, M.D.

Inflammatory bowel disease (IBD) is a term that refers to disorders that involve chronic inflammation of the gastrointestinal (GI) tract., primarily Crohn's disease and ulcerative colitis. The exact cause of IBD is unknown but experts believe that a malfunctioning immune system may play a role.

3d images of human intestines illustrated the parts affected by inflammatory bowel disease.

What is the Difference Between Inflammatory Bowel Disease and Irritable Bowel Syndrome?

Inflammatory bowel disease is a class of disorders characterized by inflammation in the GI tract that can be detected with diagnostic tests. On the other hand, inflammatory bowel disease is a functional disorder of the GI tract that usually cannot be seen with diagnostic tests.

Types of Inflammatory Bowel Disease

The two main types of inflammatory bowel disease are Crohn's disease and ulcerative colitis (UC).

Crohn's Disease

Crohn's disease can involve any part of the GI tract from the mouth to the anus. However, it most commonly affects the lower end of the small intestine and/or the upper part of the colon.

Crohn's not only negatively alters the surface lining of the GI tract, but it can also penetrate the deeper layers of colon tissue and reach other parts of the bowel. As a result, it can cause permanent intestinal damage if untreated.

An image of a mature woman sitting on the foot of a bed holding her stomach in pain.

Ulcerative Colitis

Ulcerative colitis is limited to the colon's innermost lining (large intestine) and rectum. The inflammation creates ulcers (sores) in your digestive tract, causing abdominal discomfort and pain.

This condition can cause severe complications if untreated.

Prevalence of Inflammatory Bowel Disease

There were approximately 2.5 million people with inflammatory bowel disease in the United States in 2020. (These are combined figures for Crohn's disease and ulcerative colitis.) This figure is expected to rise to around 3.5 million by 2030. (1)

Here is the estimated prevalence of each IBD type.

Crohn's Disease

Crohn's disease often goes undiagnosed, so there are no exact statistics on this condition. However, the latest estimates suggest that over half a million people in the U.S have Crohn's disease. (2)

Crohn’s disease can occur at any age, but those between 20 and 29 are more likely to develop it. (3)

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Ulcerative Colitis

UC is the most common inflammatory bowel disease globally, affecting an estimated 600,000 to 900,000 people in the United States. (4, 5, 6)

According to the Ulcerative Colitis Foundation, the age of onset is 15 to 35 years and 55 to 70 years. (7)

Symptoms of Ulcerative Colitis And Crohn's Disease

Symptoms of UC and Crohn's disease are similar, but there are a few differences due to the specific parts of the GI tract affected.

Similar symptoms include: (8)

Abdominal pain and cramps
Weight Loss
Constipation
Fatigue
Persistent diarrhea that may be bloody
Bloating
Nausea
Vomiting
Blood in the stool
Fever
Frequently feeling the need to have a bowel movement
Loss of appetite
A feeling of incomplete bowel evacuation
Rectal bleeding
Night sweats

Additional Ulcerative Colitis Symptoms

Additional symptoms of ulcerative colitis include: (9)

Dehydration
Rectal pain

Additional Crohn's Disease Symptoms

Because Crohn's disease is a widespread systemic inflammatory condition, symptoms often occur outside of the gastrointestinal tract and may include: (10)

Skin issues, i.e., rash, bumps, lesions, etc.
Eye problems, i.e., vision changes, redness
Osteoporosis
Joint swelling and pain
Sores in the mouth
Kidney stones
Liver disease

The symptoms can range from mild to severe in both conditions. Symptoms can flare up occasionally and then go into remission in milder cases.

Health Risks of Inflammatory Bowel Disease

Complications of untreated or mismanaged inflammatory bowel disease for a prolonged period vary depending upon the type of IBD.

Severe IBD symptoms can occur and require surgery and hospitalization.

Complications of Crohn's Disease

Complications of Crohn's disease may include: (11)

Hemorrhoids
Anal fissures (small tears in anal tissue)
Skin tags (painless, non-cancerous skin growth)
Acute bowel blockage requiring emergency surgery
Acute lower GI bleeding (rare)
Fistula (an abnormal passage between the intestine or bowel and nearby organs occurring when inflammation passes through the GI tract wall). A fistula usually requires surgery to repair.
An abscess (a buildup of pus inside the body, also occurring then inflammation passes through the GI tract wall.) An abscess often requires surgery to heal.
Colorectal cancer

Complications of Ulcerative Colitis

Complications of UC include: (12)

Anemia, a deficiency of red blood cells. Those with ulcerative colitis can develop a couple of different forms of anemia: iron-deficiency anemia and anemia of inflammation -- aka anemia of chronic disease (ACD) -- which is anemia that sometimes develops in inflammation-causing conditions, such as autoimmune diseases or infections.
Low bone mass (osteopenia), low bone density (osteoporosis), or other bone problems.
Stunted growth and development in children
Malnutrition or malabsorption
Colon cancer

Severe ulcerative colitis symptoms include: (13)

Perforation of the large intestine
Toxic megacolon occurs when inflammation reaches deep within the tissue layers of the colon (large intestine), causing it to stop working.
Excessive rectal bleeding
Severe dehydration
Fulminant ulcerative colitis causes severe, life-threatening symptoms, such as more than ten bloody bowel movements in a day, frequently with rapid heart rate, fever, and severe anemia.

What Causes Inflammatory Bowel Diseases?

The exact cause of IBD is unknown. However, experts believe that IBD could be similar to an autoimmune disease, meaning that the immune system malfunctions, causing it to attack the cells in your digestive tract. Poor dietary habits may also play a role and can worsen symptoms.

IBD Risk Factors

Though the cause of IBD has not been established, a few factors increase your risk of developing this disease.

Age. Those younger than 30 are most often diagnosed with this disease. But it can also develop in your 50s or 60s.
Ethnicity. Caucasians have a greater risk of developing IBD, but it can afflict any race.
Family history. Having a close family member with IBD, such as a parent or sibling, significantly increases your risk of receiving an IBD diagnosis.
Cigarette smoking
Overuse of nonsteroidal anti-inflammatory medications, such as Aleve and Motrin.

How is IBD Diagnosed?

Below are several tests medical personnel use to diagnose IBD or the specific health issues associated with this disease (14).

Blood Tests: Blood tests alone cannot diagnose inflammatory bowel disease. But it can tell your doctor whether you have anemia or infections potentially caused by IBD.
Stool Sample: Stool samples are used to detect inflammation and can indicate whether imaging tests of the intestines are warranted.
Colonoscopy: To give a detailed view of the inside of the intestines.
X-ray: typically performed if an intestinal rupture is suspected.
CT scan: gives a detailed view of the intestines with cross-sectional images that can accurately detect abnormalities, such as an abscess.
Magnetic resonance imaging (MRI): Usually performed to evaluate a fistula around the anus.
And more.

IBD Treatments

Medical Treatment

Biologic Therapies

Biologics are substances or products made from a living system, such as a microorganism, and are often used in medications or treatments for various health conditions.

How do biologics treat IBD?

According to the Crohn's & Colitis Foundation, biologics for IBD "are antibodies created in the laboratory that stop certain proteins in the body from causing inflammation. Biologic therapies offer a distinct advantage in IBD treatment because their mechanisms of action are more precisely targeted to the factors responsible for IBD." (15)

In other words, instead of affecting the entire body, IBD biologics target particular proteins proven to be involved in the inflammatory process of this disease.

Surgical Treatment

Surgery is often needed to help those with IBD manage their condition. Indeed, an estimated 70% of those with Crohn's disease and 25% with ulcerative colitis will need surgery at some time in their lives to help treat IBD. (16)

IBD, especially Crohn's disease, can damage certain parts of the intestines, making surgical removal necessary. In addition, surgery can be utilized to treat narrowing (strictures) of the bowel or to treat a fistula or an abscess.

Medications

An image of a middle-aged woman taking a pill with a glass of water in a chair at home.

Doctors prescribe specific medications to reduce inflammation and relieve IBD symptoms.

Anti-Inflammatory Drugs, i.e., Sulfasalazine or Corticosteroids
Antibiotics (for bacterial infections), i.e., Ciprofloxacin or Metronidazole
Immune Suppressants (To keep the immune system from mistakenly attacking its cells), i.e., Azathioprine
Anti-diarrheal medications, i.e., Loperamide, Diphenoxylate, or Cholestyramine
Analgesics (for pain), Acetaminophen

Natural Treatment

Several natural treatments can help relieve IBS symptoms and be used as adjunct therapy for this disease. Here are just a few of them.

Vitamin Supplements

IBD patients have a higher risk of specific vitamin and mineral deficiencies, so taking particular dietary supplements can be an essential treatment strategy. In addition, if you have IBD, you may want to be tested for nutrient deficiencies.

Here are a few vitamins and minerals that you might want to supplement:

Calcium is essential if you have osteoporosis (weak bones), osteopenia (low bone density), or are taking corticosteroids for inflammation. Calcium-rich foods and beverages such as dairy products, tofu, broccoli, and sardines are also a great way to increase calcium levels.

Folic acid or vitamin B-9 is essential for health. However, some drugs used to treat IBD can interfere with folate absorption, so it's a good idea to take a supplement or increase your intake of folate-rich foods, such as beef liver, dark leafy greens, asparagus, and kidney beans.

Iron is a trace mineral needed to make hemoglobin. IBD increases your risk for iron deficiency anemia due in part to the poor absorption of vitamins and minerals. So, it's a good idea to supplement with iron or eat iron-rich foods like beef liver. However, before taking iron supplements, you must check your iron levels because excess iron is toxic and can damage your liver.

Vitamin D is essential for calcium absorption. It may also help reduce intestinal inflammation. You must take vitamin D with calcium to help your body absorb this mineral. Your body makes vitamin D from sunlight, but many people aren't in the sun enough to get enough. Therefore, you must either take a regular vitamin D supplement or consume foods and beverages fortified with vitamin D. There are also a few foods that naturally contain vitamin D, such as salmon, mushrooms, and eggs.

Anti-Inflammatory Diet

Eating an anti-inflammatory diet can help reduce inflammation in your GI tract, thereby relieving IBD symptoms. Anti-inflammatory foods include:

Fatty fish like salmon
Flax seeds
Walnuts
Chia seeds
Brussels Sprouts
Avocados

You should also reduce your intake of these foods:

Sugar
Heavily processed foods, such as cookies, potato chips, candy, etc.
Fast foods, Convenience foods
Trans fats
Refined carbs, such as white bread, white rice

Drink Lots of Water

You must drink plenty of water when you have inflammatory bowel disease. After all, this disease often causes diarrhea where the body loses electrolytes and can also cause dehydration.

Drink at least 8-9 glasses of water each day to replenish fluids lost. You may also drink herbal teas and broths. You may also eat more foods with high water content, such as watermelon, iceberg lettuce, radishes, etc.

Get More Sleep

Research suggests that sleep deprivation may lead to unbalanced gut bacteria that can lead to numerous GI problems, including inflammatory bowel disease.

So, getting sufficient quality sleep each night is a good idea. Here are some tips to help you do so.

Go to bed at the same time every night. A consistent sleeping schedule is critical, as it trains your body to start getting tired near bedtime.
Avoid devices before bed. The blue light emitted from device screens interferes with melatonin production. So, to cultivate a good night's sleep, you may want to put away your devices an hour before bedtime.
Make sure your bedroom temperature is cool. Sleeping in a cool temperature -- around 65-68 degrees -- helps you fall asleep faster. It also helps your body produce more melatonin.
Reduce light in your bedroom. Any light can interfere with melatonin production, even if it's coming from the neon numbers on your alarm clock. So, you might want to turn your alarm clock away from you, put black drapes on your window, or wear a sleep mask to bed.

Manage Stress

Stress has been shown to worsen IBD symptoms, so if you have this disease, you must take steps to reduce stress whenever possible.

Here are a few stress-relieving activities to get you started.

Practice deep breathing exercises
Take frequent walks, especially when stressed
Practice progressive muscle relaxation exercises
Play with your dog
Take up a hobby
Go out with friends
Take every opportunity to laugh. Studies show that laughter lowers blood pressure and triggers a release of "feel-good hormones" endorphins.
Spend time outdoors in the sun
Take a swim
Meditate
Exercise at a moderately intense pace
Do crossword puzzles
Go hiking
Practice deep breathing exercises
Have sex more often. Sex is a great stress reliever!
Listen to music
Practice random acts of kindness. Studies show that helping others can reduce stress and make you feel better.

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