Crohn's disease and ulcerative colitis

About Crohn’s disease and ulcerative colitis

Crohn’s disease and ulcerative colitis are Iifelong gastrointestinal disorders, also known as inflammatory bowel diseases (IBD) that commonly present themselves in children, adolescents and adults.

The cause and cure of Crohn’s and colitis are currently unknown.

More than 100,000 Australians live with IBD and it is becoming more prevalent in the community.

About Crohn’s disease

Crohn’s disease is a type of inflammatory bowel disease (IBD) that can cause inflammation anywhere in the gastrointestinal tract from the mouth to the anus. Inflammation can cause redness, swelling and pain, and is the body’s response to injury or irritation.

There may be times when someone with Crohn’s has little to no symptoms (remission) and times when symptoms are more active (flare-ups).

Symptoms of Crohn’s disease

Symptoms of Crohn’s disease can be different for each person and can be serious or mild. Symptoms will depend on where inflammation appears in the gut.

The most common symptoms during a flare are:

• abdominal pain
• frequent diarrhoea (sometimes mixed with mucus and blood) and need to use the toilet
• tiredness, fatigue
• raised temperature, fever
• loss of appetite, weight loss
• anaemia (reduced level of blood cells).

Inflammation in the gut can make it harder for the body to absorb nutrients from food, leading to many of these symptoms.

Diagnosis of Crohn’s disease

To know if you have Crohn’s disease you will need to be tested by a doctor.

Symptoms of Crohn’s are similar to many other conditions so several tests will likely be needed before you can get a diagnosis.

In many cases doctors will want to make sure that your symptoms aren’t caused by an infection or irritable bowel syndrome (IBS). Investigations help to work out which parts of your bowel are affected to determine the best treatment options for you.

Tests may include:

• blood tests
• stool tests
• endoscopy
• bowel imagine and scans.

Crohn’s is a disease that will change over time. Tests may be used again to monitor disease and to see if the current treatment is working or if complications have developed.

Treatment of Crohn’s disease

Crohn’s disease cannot currently be cured but for most people it can be well managed through medication, lifestyle choices and sometimes surgery. Treatments may also need to change over time if they become less effective.

Medication

Medications for Crohn’s disease are mainly used to reduce inflammation. The main types include:

• aminosalicylates
• corticosteroids
• immunosuppressants
• biologics
• antibiotics.

Diet

Diet has an important role to play in many aspects of Crohn’s disease, including treating active disease, managing symptoms, ensuring nutritional adequacy and complications of Crohn’s disease. Diet may also potentially support remission.

Examples of dietary treatments include:

• exclusive enteral nutrition
• Crohn’s disease exclusion diet
• low or moderate FODMAP diet
• moderate, low fibre or low residue diet
• high energy and protein diet
• oral vitamin and mineral supplementation.

Surgery

Surgery for Crohn’s disease is a treatment not everyone will need.

Sometimes parts of the bowel are too damaged to be healed by medications and the best way to return you to health is with an operation. The goal of surgery is to keep as much of the bowel as possible while restoring quality of life.

Common types of surgery include:

• resection
• stricturoplasty
• creating a stoma.

Complementary medicine

Complementary and alternative medicine for Crohn’s disease can be used alongside conventional treatment to reduce symptoms and improve wellbeing. Research is still ongoing, so it is important to always talk about your options with your healthcare professional team.

Speak to a GP, gastroenterologist or dietitian about the treatment of Crohn’s disease, or before making any changes to your current treatment plan.

Download a Crohn's disease management plan to help improve communications with your healthcare professional team.

About ulcerative colitis

Ulcerative colitis is a type of IBD that can cause inflammation and ulceration in the large intestine (colon and rectum).

Inflammation can cause redness, swelling and pain, and is the body’s response to injury or irritation. Ulcers (sores) also develop on the surface of the intestines inner lining which may bleed and produce mucus.

The inflammation almost always involves the rectum and may extend up the large intestine, either when it first develops or sometimes extend over time.

Symptoms of ulcerative colitis

Symptoms of ulcerative colitis can be different for each person and may be serious or mild. Symptoms will depend on how much of the large intestine has become inflamed and how strong the inflammation is.

The most common symptoms during a flare are:

• abdominal pain
• frequent diarrhoea (sometimes mixed with mucus and blood) and urgent need to use the toilet often,
• tiredness, fatigue
• raised temperature, fever
• loss of appetite, weight loss, and
• anaemia (reduced level of blood cells).

Diagnosis of ulcerative colitis

To know if you have ulcerative colitis you will need to be tested by a doctor.

Symptoms of ulcerative colitis are similar to many other conditions so several tests will likely be needed before you can get a diagnosis. In many cases doctors will want to make sure that your symptoms aren’t caused by an infection or irritable bowel syndrome (IBS).

Investigations help to work out which parts of your bowel are affected to determine the best treatment options for you.

Tests may include:

• blood tests
• stool tests
• endoscopy
• bowel imagine and scans.

Ulcerative colitis is a disease that will change over time. Tests may be used again to monitor disease and to see if the current treatment is working or if complications have developed.

People who have had ulcerative colitis symptoms for at least 8 years should get a colonoscopy every one to 3 years as recommended by a specialist.

Treatment of ulcerative colitis

Ulcerative colitis cannot currently be cured but for most people it can be well managed through medication, lifestyle choices and sometimes surgery. Even while in remission you may still experience some symptoms and treatment may change over time.

Medication

Medications for ulcerative colitis are mainly used to reduce inflammation. The main types include:

• aminosalicylates
• corticosteroids
• immunosuppressants
• biologics
• Janus kinase inhibators
• thalidomide.

Diet

Diet has an important role to play in of many aspects of ulcerative colitis, including symptom management, ensuring nutritional adequacy and potentially treating active disease or supporting remission.

Examples of dietary treatments include:

• high energy and protein diet
• oral vitamin and mineral supplementation
• low or moderate FODMAP diet
• supplementary treatment.

Surgery

Surgery for ulcerative colitis is a treatment not everyone will need.

Sometimes parts of the bowel are too damaged to be healed by medications and the best way to return you to health is with an operation. The goal of surgery is to keep as much of the bowel as possible while restoring quality of life.

There are 2 main reasons why surgery may be an option for you:

• when current therapies are no longer effective
• when complications occur.

The 2 most common types of surgery for ulcerative colitis are ileostomies and pouch surgery, often called a j-pouch.

Complementary medicine

Complementary and alternative medicine for ulcerative colitis can be used alongside conventional treatment to reduce symptoms and improve wellbeing. Research is still ongoing, so it is important to always talk about your options with your healthcare professional team.

Speak to a GP, gastroenterologist or dietitian about the treatment of Crohn’s disease, or before making any changes to your current treatment plan.

Download an ulcerative colitis management plan to help improve communications with your healthcare professional team.

For more information about Crohn’s disease and ulcerative colitis, symptoms, diagnosis and treatment, please visit the Crohn’s and Colitis Australia website.

Living with Crohn’s disease or ulcerative colitis

Living with Crohn’s or colitis will mean making some lifestyle changes but it doesn’t have to stop you from getting the most out of life. By surrounding yourself with the right people and taking control of your health, you can still be successful in all that you do.

Diet

Most people with IBD should follow the Australian Guide to Healthy Eating, and do not need to restrict their diet. However, there is emerging or established evidence to support specialty diets for when IBD is in remission, when IBD is active and to treat complications of IBD.

Diet may be used to treat arising problems that commonly occur in people with IBD. Both under- and over-nutrition (overweight or obesity) is common in people with IBD and can lead to fatigue, reduced quality of life, depression and may weaken response to medications. People with malnutrition are more likely to become sick and take longer to recover. This can also lead to increased risk of complications after surgery.

Fertility, pregnancy and IBD

Most women with IBD are able to have children and raise a family. However, in certain situations like if you’re having a flare, on certain medications, or have had certain surgeries, it can make pregnancy more difficult.

Even without having IBD, there is a lot to think about when deciding to have a baby, so it’s important to learn about what you can do to keep both you and your child healthy before, during and after pregnancy.

If you or your partner with IBD plans on becoming pregnant in the future, it’s a good idea to talk with a doctor who understands the special care required during this important time in your life.

Psychological health

People with inflammatory bowel disease (IBD) are more likely to experience significant mental health problems, such as depression and anxiety. People with IBD face challenges that can make life difficult. They may find themselves feeling down, worried and uncertain at times. This is a normal part of living with an illness which can be disruptive and unpredictable.

Some of the types of psychological intervention available, amongst others, include:

• cognitive behavioural therapy
• acceptance and commitment therapy
• gut-directed hypnotherapy.

Exercise

Staying physically active is really important for people with Crohn’s and colitis because the disease can affect your bones, nutrition, psychological health and energy levels. Each of these can be improved with the help of exercise that suits your lifestyle.

Regular weight-bearing exercise, such as brisk walking, jogging, dancing, aerobics or active team sports, is good for your bones. Outdoor exercise is especially valuable as this will increase your exposure to sunlight and boost your vitamin D production.

Exercise can reduce stress by releasing endorphins, the chemicals in the brain that give you a sense of happiness and act as natural painkillers. Gentle exercise activities, such as yoga, can help improve the mind-body connection and lower stress, and may lead to decreased inflammation.

For more information about living with Crohn’s disease or ulcerative colitis, please visit the Crohn’s and Colitis Australia website.

Where to get help

• Your GP (doctor)
• Gastroenterologist
• Dietitian
• Psychologist
• Crohn’s and Colitis AustraliaTel. 1800 138 029
  • Telephone helplines
  • IBD service locator
  • Crohn’s disease and ulcerative colitis management plans