Inflammatory Bowel Disease: Symptoms and Treatment

Medically Reviewed by Shruthi N, MD on December 12, 2024
Written by Kim Painter
13 min read

Inflammatory bowel disease (IBD) is a group of disorders in which the intestines become inflamed. It happens when your immune system launches repeated attacks that harm your gut. 

While some experts call IBD an autoimmune disorder -- one in which your immune system attacks your own tissues -- others don't. That's because there's evidence that the immune system is reacting to harmless bacteria or other microbes in your gut, rather than the gut tissue itself. In any case, the result is inflammation that injures your bowels.

There are two major types of IBD:

Ulcerative colitis. In this disease, the inflammation causes sores and swelling in your colon (large intestine) and your rectum, the end of your digestive tract. It often starts in the rectum.

Crohn's disease. In this disease, you can have inflammation in any part of the gastrointestinal tract from the mouth to the anus. Most commonly, though, it affects the last part of the small intestine, the colon, or both.

These are both lifelong conditions, but symptoms can come and go and range from mild to severe. Treatments and lifestyle changes can help you live with inflammatory bowel disease. 

 

The causes of IBD are complex and not fully understood. 

Whether the immune system's attack on the digestive tract is autoimmune or aimed at bacteria or other microbes, it's likely that genes also play a role.  

Evidence to suggest a genetic role for IBD is strong, including:

Family history. As many as 20% of people with IBD have a family history of it.

Race and ethnicity. IBD is more common in White people. It's also more common in Jewish people, especially Ashkenazi Jews.

Scientists have found more than 200 genetic mutations that may increase your risk for IBD. These mutations might affect:

  • How your immune system reacts to threats
  • How well the protective mucus lining of your gut works
  • How your body controls bacterial growth in your intestines

Some environmental factors may also play a role in whether you develop IBD and when you have symptoms. For example, smoking may double your risk of Crohn's disease. And symptoms of inflammatory bowel disease are sometimes triggered by:

  • Taking antibiotics
  • Taking nonsteroidal anti-inflammatory drugs (like ibuprofen)
  • Stress

While foods don't cause IBD, some people feel worse when they eat or drink certain things such as:

  • Alcoholic drinks
  • Caffeinated drinks
  • Carbonated drinks
  • Milk and foods made with milk
  • High-fiber foods
  • Greasy foods

Scientists are looking at other factors that might play roles, including eating a lot of highly processed foods and taking birth control pills.

 If you have IBD, you can expect times when the disease flares up and causes symptoms and times when your symptoms decrease or disappear for a while. Symptoms range from mild to severe and generally depend upon what part of the digestive tract is involved. They can include:

  • Abdominal cramps and pain
  • Chronic diarrhea
  • Bloody poop
  • Feeling an urgent need to poop 
  • Fever
  • Unintended weight loss
  • Poor appetite
  • Fatigue 
  • Nausea
  • Vomiting

IBD symptoms in women may get worse before or during menstrual periods. Also, premenstrual symptoms, like headaches and cramps, might be worse if you have IBD.  It may also be harder to get pregnant during flare-ups of IBD.

Some people with IBD have so much bloody diarrhea that they develop iron deficiency anemia from blood loss. That's especially common in women. You also can get dehydrated from diarrhea. Because the inflamed intestines don't absorb nutrients well, you can get malnourished, too. If you have IBD from childhood, it could interfere with your growth. 

In addition, IBD can lead to several serious complications in the intestines, including:

  • Heavy bleeding from ulcers
  • Holes in the bowel
  • Narrowed or blocked bowels, found in Crohn's
  • Fistulae (abnormal passages) and tears around the anus, more commonly in Crohn's than in ulcerative colitis
  • Toxic megacolon, which is a life-threatening widening and swelling of the colon, more often with ulcerative colitis than Crohn's

IBD also increases the risk of colon cancer. The risk rises after several years because chronic inflammation in your colon or rectum can cause abnormal cells to form. 

IBD can also affect other parts of your body. For example, someone with IBD may have:

  • Arthritis
  • Skin conditions
  • Eye inflammation
  • Liver disease
  • Kidney disease
  • Bone loss
  • Blood clots 

Having inflammatory bowel disease can be a mental health challenge.  It's not unusual to develop depression, anxiety, and other kinds of distress.

Your doctor makes the diagnosis of inflammatory bowel disease based on your symptoms and various exams and tests. Here are some of the most common.

Lab tests

Stool exam. You'll be asked for a poop sample to send to a lab. One reason is to rule out infections that could be causing diarrhea. Also, the lab will look for traces of blood that can't be seen with the naked eye.

Complete blood count. A nurse or lab technician will draw blood, which will be tested in a lab. They'll look for increases in white blood cells, suggesting inflammation. If you have severe bleeding, the test may find low levels of red blood cells and hemoglobin (a protein in red blood cells). 

Other blood tests. Electrolytes (sodium, potassium), protein, and markers of inflammation, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), may be measured to see how serious the disease is. Perinuclear antineutrophil cytoplasmic antibody (pANCA) levels may be up in ulcerative colitis.

Scoping procedures

Sigmoidoscopy. In this procedure, a doctor uses a sigmoidoscope, a narrow, flexible tube with a camera and light, to look at the last third of your large intestine and rectum. The scope goes through your anus. The doctor looks for ulcers, inflammation, and bleeding. They may also take samples, called biopsies, that can be  examined in a laboratory under a microscope.

Colonoscopy.  The doctor uses a colonoscope, a longer flexible tube, to examine the entire colon. Biopsies also can be taken during this procedure.

Upper endoscopy. If you have symptoms such as nausea and vomiting, suggesting problems in your upper digestive tract, you might get this test. The doctor uses an endoscope, a narrow, flexible tube with a camera and light, inserted through the mouth. They look at your esophagus, stomach, and duodenum, which is the first part of your small intestine. 

Capsule endoscopy. For this test, you swallow a small capsule that has a camera in it. It takes pictures of your esophagus, stomach and small bowel and then sends them to a receiver you wear on a belt. The pictures are downloaded from the receiver onto a computer. You poop out the capsule. 

Imaging tests

To get images of your digestive tract, your doctor might order

  • Computed tomography (CT scan)
  • Magnetic resonance imaging (MRI)
  • Ultrasound
  • X-rays

One type of X-ray involves the use of barium, a chalky liquid that will show up on X-ray images of your digestive tract. You might swallow the barium or have it inserted through your rectum or a tube in your nose or mouth.

When your doctor tells you that you have inflammatory bowel disease, you'll want to get as much information as possible. Be prepared with questions, such as:

  • Could any condition other than IBD be causing my symptoms?
  • Do I have ulcerative colitis or Crohn's disease?
  • What parts of my digestive system has it affected?
  • What treatments do you recommend?
  • How soon should I expect relief?
  • What side effects from the medicines should I watch out for? What should I do if I notice them?
  • What should I do if my symptoms return? Are any considered an emergency?
  • Are there symptoms outside the digestive system that could be caused by IBD?
  • Should I change my diet or take nutritional supplements?
  • Would it help me to make any other lifestyle changes?
  • When should I have a follow-up appointment, and should I see a specialist?
  • What is the long-term outlook for my IBD?
  • How often do I need to get a colonoscopy?

Treatment for IBD involves a combination of self-care and medical treatment.

Self care for inflammatory bowel disease

Tracking symptoms. Pay attention to the times your symptoms are likely to worsen, especially during flares, so you can plan your activities -- and know where your nearest bathroom will be when you need it. 

Eating carefully. Although no specific diet is known to prevent or treat IBD, dietary changes may help  manage your symptoms.  For instance,  the doctor may suggest  smaller, more frequent meals or limiting certain foods that trigger symptoms for you. During IBD flares or after a surgery, they may suggest a very restricted diet.  You might need vitamin and mineral supplements at those times. Talk to your doctor or a dietitian trained in IBD management to make sure you get enough nourishment.

Not smoking. If you smoke, having IBD is one more powerful reason to quit. Smoking can make your symptoms worse and your medications less effective.

Managing stress. Since stress can make symptoms worse, learn what stress management techniques work for you. Consider meditation, exercise, deep breathing, journaling, and taking time for activities you enjoy. 

Getting mental health support. If you are depressed, anxious, or otherwise distressed about your inflammatory bowel disease, talking with a psychologist or other mental health professional may help. 

Finding support groups. It also can help to talk with others going through IBD. In a support group, you can get and share tips for day-to-day living with inflammatory bowel disease. 

Maintaining your health. Protect your overall health by keeping  up with your usual screenings, like mammograms and blood pressure checks, and getting checked for colon cancer as often as your doctor recommends. Some people with IBD may need extra checks for cervical cancer, skin cancer, and bone health. And don't neglect routine vaccines for flu, COVID-19, and other infectious diseases since IBD and some medications to treat it can lower your immunity. Ask your doctor if any vaccines aren't appropriate for you.

Medical treatment for inflammatory bowel disease

The goal of medical treatment is to stop the abnormal inflammation so intestinal tissue has a chance to heal. As it does, diarrhea and abdominal pain should ease. Once the symptoms are under control, treatment will focus on reducing flare-ups and keeping your symptoms at bay for as long as possible. 

Doctors often take a step-by-step approach with medications for inflammatory bowel disease. This way, the least harmful drugs or drugs that are only taken for a short time are used first. If they don't work, more powerful drugs are used.

Here are some of the common drugs used.

 Anti-inflammatory drugs

Treatment typically begins with aminosalicylates, which are aspirin-like anti-inflammatory drugs such as:

  • Balsalazide (Colazal)
  • Mesalamine (Asacol, Apriso, Lialda, Pentasa)
  • Olsalazine (Dipentum)
  • Sulfasalazine (Azulfidine)

Some of these drugs can be given as suppositories or enemas. Others are pills.

You might also get temporary treatment with corticosteroids, which quickly reduce inflammation and also dampen the immune system. They can have serious long-term side effects, such as increases in infection and bone loss, so they aren't used for a long time.

Immune system suppressors

If anti-inflammatory drugs don't work, these might be tried next. These drugs dampen the immune system activity that can damage the lining of your digestive tract. They aren't used for acute flare-ups because they may take as long as two to three months to work. They include drugs like:

  • 6-mercaptopurine, or 6-MP (Purinethol)
  • Azathioprine (Imuran)
  • Methotrexate (Rheumatrex)
  • Ozanimod (Zeposia)
  • Tofacitinib (Xeljanz)
  • Upadacitinib (Rinvoq)

Note: In preliminary studies, tofacitinib has been linked with an increased risk of serious heart-related problems and cancer.

Biologics

These are newer drugs that target specific proteins in your body that cause inflammation. You might inject these drugs yourself or go to a clinic to get intravenous (IV) infusions.

These include drugs like:

  • Adalimumab (Humira)
  • Certolizumab (Cimzia)
  • Golimumab (Simponi)
  • Infliximab (Remicade)
  • Risankizumab (Skyrizi)
  • Ustekinumab (Stelara)
  • Vedolizumab (Entyvio)

Antibiotics

You might need antibiotics, which are drugs that treat bacterial infections, if you have Crohn's disease, especially if you have diseased tissue around your anus. Antibiotics are less commonly used for ulcerative colitis.

Other drugs and supplements

The doctor may also recommend medicines or supplements to help with your bowel movements. These might include drugs that treat diarrhea, like loperamide (Imodium A-D), or fiber supplements, like psyllium powder (Metamucil) or methylcellulose (Citrucel) that add bulk to your stool. You shouldn't use these without a doctor's advice.

You might get drugs called antispasmodics that reduce muscle spasms in your gut, easing pain. If you need pain relieving drugs as well, your doctor might recommend acetaminophen. You shouldn't take drugs like aspirin, ibuprofen, or naproxen, which can increase stomach bleeding.

You also might need nutritional supplements, like vitamins and minerals. Talk to your doctor or dietitian about your needs. 

Formula feeding (enteral nutrition)

In some cases, you might temporarily get all your nutrition through a liquid formula that you drink or get through a tube in your nose or stomach. This is used when your doctors think a break from normal eating will help heal your digestive tract and get your symptoms under control. It also may be used when a child with IBD isn't growing well.

Clinical trials

If you don't respond to the drugs and other treatments recommended for IBD, talk with your doctor about enrolling in a clinical trial. Clinical trials are the way new treatments for a disease are tested to see how effective they are and how patients respond to them. You can find out about clinical trials at the Crohn's & Colitis Foundation of America website.

If medicines for IBD stop working for you or you have severe complications, your doctor might recommend surgery. In general, these surgeries are done to remove, widen, or repair damaged parts of your intestines. The kind of surgery possible depends on what kind of IBD you have and where the damage is. Your age and overall health will also be considered.

Be sure you ask questions and understand the goals of the surgery, its pros and cons, and what could happen if you don't have the procedure.

Surgery for ulcerative colitis  

About 30% of people with ulcerative colitis need surgery at some point. You might need surgery for ulcerative colitis if you have:

  • Life-threatening complications like severe bleeding, toxic megacolon, or a hole in your large intestine
  • Colon cancer or precancerous growths
  • Severe symptoms that don't improve with medication 
  • Symptoms that only respond to corticosteroids, putting you at risk for severe side effects

The main surgery for ulcerative colitis  involves the removal of the entire colon and rectum. Once they're removed, your surgeon will perform an additional procedure or set of procedures to create a new path for your poop. The common choices are:

Proctocolectomy with ileal pouch-anal anastomosis. This is removal of the colon and rectum, followed by the creation of an internal pouch that will let you poop through your anus. You may temporarily need an external pouch and may need several surgeries to complete the treatment. 

Proctocolectomy with end ileostomy. This is used less often. It involves removal of the colon, rectum, and anus. Then, the surgeon makes an opening in the abdomen that connects with your small intestine. This opening allows your poop to empty into a removable outer bag, called an ostomy pouch. 

Surgery for Crohn's disease

Up to 55% of people with Crohn's disease need some kind of surgery within a decade of diagnosis. These surgeries often are done to:

  • Repair fistulas, abscesses, or blockages
  • Stop bleeding
  • Remove severely inflamed tissues
  • Remove cancers or precancers and prevent future colon cancers

Surgical procedures for Crohn's can include:

Small bowel resection. This is surgery to remove part of your small intestine. You might need it if you have a blockage or severe damage in your small intestine.

Large bowel resection. This is surgery to remove part of your large intestine. You might need it if you have a blockage, a fistula, or severe damage in your large intestine.

Proctocolectomy and ileostomy. This is surgery to remove your entire colon and rectum. You'll get a removable outer pouch to collect your poop. Unlike ulcerative colitis patients, Crohn's patients usually can't get an internal pouch because of the risk of inflammation returning.

When you have IBD, the symptoms will come and go over many years. It's important to work with your health care team to find management strategies that work best for you. That might mean some lifestyle changes, along with medications and, in some cases, surgery. 

Can children have IBD?

Yes, children can have inflammatory bowel disease. About one in four people with IBD are diagnosed before age 20, most often in teen years. But even young children can have it. Symptoms in children can include poor growth and weight loss. 

What's the most common age to get IBD?

It's most common to get it between ages 15 and 35.

What's the difference between IBD and IBS?

IBS is irritable bowel syndrome and it's a very different condition from IBD, inflammatory bowel disease. Like IBD, IBS can cause diarrhea, bloating, and other digestive symptoms. But unlike IBD, irritable bowel syndrome doesn't involve inflammation and doesn't damage your gut. It also doesn't lead to symptoms elsewhere in your body, like your eyes and joints. Irritable bowel syndrome can have a big impact on your quality of life, but doesn't threaten your health as much as inflammatory bowel disease might.

Can coffee help treat inflammatory bowel disease?

While some people with IBD believe coffee helps them, other say it makes their symptoms worse.  Studies are unclear. Some studies in animals suggest substances in coffee might protect the gut from inflammation. But other studies suggest no effect or the opposite effect.

What can happen if IBD goes untreated?

Untreated IBD can mean more symptoms, more frequent flare-ups, and a greater risk of irreversible damage to your bowels. Even if you're not having symptoms, you should see your doctor regularly after an IBD diagnosis because of the risk of complications and related conditions, such as colon cancer. 

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