Crohn’s Disease and Ulcerative Colitis are often viewed as ‘invisible illnesses’. It was our mission this Awareness Week to increase understanding of Crohn’s and Colitis and ensure the true impact of these debilitating conditions is visible.
Crohn's disease is a long-term condition that causes inflammation of the lining of the digestive system.
Inflammation can affect any part of the digestive system, from the mouth to the back passage, but most commonly occurs in the last section of the small intestine (ileum) or the large intestine (colon).
Common symptoms can include:
fatigue (extreme tiredness)
unintended weight loss
blood and mucus in your faeces (stools)
People with Crohn's disease sometimes go for long periods without symptoms or with very mild symptoms. This is known as remission. Remission can be followed by periods where symptoms flare up and become particularly troublesome.
Why it happens
The exact cause of Crohn's disease is unknown. However, research suggests a combination of factors may be responsible. These include:
genetics – genes you inherit from your parents may increase your risk of developing Crohn's disease
the immune system – the inflammation may be caused by a problem with the immune system (the body's defence against infection and illness) that causes it to attack healthy bacteria in the gut
previous infection – a previous infection may trigger an abnormal response from the immune system
smoking – smokers with Crohn's disease usually have more severe symptoms than non-smokers
environmental factors – Crohn's disease is most common in westernised countries such as the UK, and least common in poorer parts of the world such as Africa, which suggests the environment has a part to play (known as the hygiene hypothesis)
Treating Crohn's disease
There's currently no cure for Crohn's disease, so the aim of treatment is to stop the inflammatory process, relieve symptoms (induce and maintain remission) and avoid surgery wherever possible.
The first treatment offered to reduce symptoms is usually steroid medication (corticosteroids). If this doesn't help, medication to suppress the immune system (immunosuppressants) and medication to reduce inflammation may be used.
In some cases, surgery may be needed to remove the inflamed section of intestine.
Once your symptoms are under control (in remission), further medication may be needed to help maintain this.
Who is affected?
Crohn's disease is a relatively uncommon condition. There are currently at least 115,000 people living with the condition in the UK.
Crohn's disease can affect people of all ages, including children. However, most cases first develop between the ages of 16 and 30.
A large number of cases also develop between the ages of 60 and 80.
It affects slightly more women than men, but in children more boys are affected than girls.
The condition is more common in white people than in black or Asian people. It's most prevalent among Jewish people of European descent.
Ulcerative colitis is a long-term condition, where the colon and rectum become inflamed .
The colon is the large intestine (bowel), and the rectum is the end of the bowel where stools are stored.
Small ulcers can develop on the colon's lining, and can bleed and produce pus.
Symptoms of ulcerative colitis
The main symptoms of ulcerative colitis are:
recurring diarrhoea, which may contain blood, mucus or pus
abdominal (tummy) pain
needing to empty your bowels frequently
You may also experience fatigue (extreme tiredness), loss of appetite and weight loss.
The severity of the symptoms varies, depending on how much of the rectum and colon is inflamed and how severe the inflammation is. For some people, the condition has a significant impact on their everyday lives.
Symptoms of a flare-up
Some people may go for weeks or months with very mild symptoms, or none at all (known as remission), followed by periods where the symptoms are particularly troublesome (known as flare-ups or relapses).
During a flare-up, some people with ulcerative colitis also experience symptoms elsewhere in their body. For example, some people develop:
painful and swollen joints (arthritis)
areas of painful, red and swollen skin
irritated and red eyes
In severe cases, defined as having to empty your bowels six or more times a day, additional symptoms may include:
shortness of breath
a fast or irregular heartbeat
a high temperature (fever)
blood in your stools becoming more obvious
In most people, no specific trigger for flare-ups is identified, although a gut infection can occasionally be the cause. Stress is also thought to be a potential factor.
When to seek medical advice
You should see your GP as soon as possible if you have symptoms of ulcerative colitis and you haven't been diagnosed with the condition.
They can arrange blood or stool sample tests to help determine what may be causing your symptoms. If necessary, they can refer you to hospital for further tests.
What causes ulcerative colitis?
Ulcerative colitis is thought to be an autoimmune condition. This means the immune system – the body's defence against infection – goes wrong and attacks healthy tissue.
The most popular theory is that the immune system mistakes harmless bacteria inside the colon for a threat and attacks the tissues of the colon, causing it to become inflamed.
Exactly what causes the immune system to behave in this way is unclear. Most experts think it's a combination of genetic and environmental factors.
It's estimated that around 1 in every 420 people living in the UK has ulcerative colitis; this amounts to around 146,000 people.
The condition can develop at any age, but is most often diagnosed in people from 15 to 25 years old.
It's more common in white people of European descent (especially those descended from Ashkenazi Jewish communities) and black people. The condition is rarer in people from Asian backgrounds (although the reasons for this are unclear).
Both men and women seem to be equally affected by ulcerative colitis.
How ulcerative colitis is treated
Treatment for ulcerative colitis aims to relieve symptoms during a flare-up and prevent symptoms from returning (known as maintaining remission).
In most people, this is achieved by taking medication such as:
Mild to moderate flare-ups can usually be treated at home. However, more severe flare-ups need to be treated in hospital to reduce the risk of serious complications, such as the colon becoming stretched and enlarged or developing large ulcers. Both of these can increase the risk of developing a hole in the bowel.
If medications aren't effective at controlling your symptoms, or your quality of life is significantly affected by your condition, surgery to remove your colon may be an option.
During surgery, your small intestine will either be diverted out of an opening in your abdomen (known as an ileostomy), or used to create an internal pouch that's connected to your anus (known as an ileo-anal pouch).
IBD or IBS?
Inflammatory bowel disease (IBD) is a term mainly used to describe two conditions that cause inflammation of the gut (gastrointestinal tract). They are:
IBD shouldn't be confused with irritable bowel syndrome (IBS), which is a different condition and requires different treatment.