Living With Crohn’s Disease and Ulcerative Colitis

Crohn’s and Colitis Awareness Week: December 1 to 7, 2022

If you suffer from recurring abdominal pain, diarrhea, bloating, gas, and other disruptive symptoms, you may be one of the estimated three million Americans with Crohn’s disease or ulcerative colitis. Crohn’s disease and ulcerative colitis are the two main types of inflammatory bowel diseases (IBD), which cause inflammation in the digestive tract.

The exact cause of Crohn’s disease and ulcerative colitis is unknown, and as a result, there is no cure. However, researchers believe that the causes and risk factors of Crohn’s and colitis include genetics, the environment, and the microbiome. Although there is no cure, several treatment options are available to help people manage their symptoms and flare-ups.

Crohn’s Disease and Ulcerative Colitis Are Different Illnesses

Crohn’s disease can affect any part of the gastrointestinal tract, whereas ulcerative colitis is limited to the large intestine. However, they both share similar symptoms and treatments.

Crohn’s disease can be challenging to diagnose because its symptoms are so diverse: they include abdominal pain, diarrhea, rectal bleeding, fever, weight loss, and fatigue. On the other hand, ulcerative colitis has a more limited range of symptoms: frequent diarrhea or bloody stools with abdominal pain.

It is important to know that Crohn’s disease affects your digestive tract from mouth to anus. In contrast, ulcerative colitis only affects one segment of your colon called the mucosa lining, causing inflammation during flare-ups in only that area.

Symptoms of Crohn’s Disease

People living with Crohn’s disease can experience periods of severe symptoms (flare-ups) followed by periods with no or very mild symptoms (remission). Remission can last a few weeks or years. The timing of flare-ups is unpredictable.

Crohn’s disease symptoms can include:

• Abdominal pain
• Chronic diarrhea
• A feeling of fullness
• Fever
• A loss of appetite
• Weight loss
• Abnormal skin tags (usually on your buttocks)
• Anal fissures
• Anal fistulas
• Rectal bleeding

Symptoms of Ulcerative Colitis

Ulcerative colitis causes inflammation and ulcers (sores) in the digestive tract. It affects the innermost lining of the large intestine (colon) and rectum. Symptoms usually develop over time rather than suddenly.

Ulcerative colitis symptoms are similar to Crohn’s disease symptoms and can vary depending on the severity of inflammation and where it occurs. Symptoms may include:

• Diarrhea, often with blood or pus
• Rectal bleeding — passing a small amount of blood with stool
• Abdominal pain and cramping
• Rectal pain
• Urgency to defecate
• Inability to defecate despite urgency
• Weight loss
• Fatigue
• Fever
• Failure to grow in children

Diagnosing Crohn’s Disease and Ulcerative Colitis

A doctor will usually use a combination of tests and procedures to diagnose Crohn’s disease and ulcerative colitis, including:

Lab Tests

• Blood tests. Your doctor may suggest blood tests to check for anemia — a blood disorder that reduces oxygen levels — or to check for signs of infection.
• Your doctor may do additional tests to check for levels of inflammation, liver function, or inactive infections, such as tuberculosis. Your blood may also be screened to detect your level of immunity against infections.
• Stool studies. A stool sample to test for hidden (occult) blood or organisms, such as infection-causing bacteria or parasites (a rare occurrence) in your stool.

Procedures

• Colonoscopy. This exam allows your provider to view your entire colon with a thin, flexible, lighted tube with a camera on the end. Tissue samples are taken (called a tissue biopsy) during the procedure for laboratory analysis.
• Computerized tomography (CT) and magnetic resonance (MR) enterography. Your provider may recommend these noninvasive tests to exclude any inflammation in the small intestine. In addition, MR enterography is a radiation-free alternative.

Tests Used To Detect Crohn’s Disease only:

• Capsule endoscopy. Patients swallow a capsule with a camera in it. The camera takes pictures of your small intestine and sends them to a recorder you wear on your belt. When the camera completes its journey, it exits your body painlessly in your stool after downloading the images to a computer, displayed on a monitor, to check for signs of Crohn’s disease.
• Balloon-assisted enteroscopy. This test used a scope with a device called an overtube. It enables the doctor to look further into the small bowel beyond where standard endoscopes can see.

Test Used to Detect Ulcerative Colitis only:

• Flexible sigmoidoscopy. A slender, flexible, lighted tube is used to examine the rectum and sigmoid colon — the lower end of your colon. If your colon is severely inflamed, this test may be preferred instead of a complete colonoscopy.

Crohn’s Disease and Ulcerative Colitis Present Multiple Challenges

There are many challenges people with IBD face, from physical symptoms to challenges at work.

• Physical symptoms: Many physical symptoms — diarrhea, constipation, fatigue, and abdominal pain — can make it difficult to keep up with school or work.
• Challenges at work: Flare-ups may require leaving work early or missing a day, which can affect your career. People may also experience embarrassment or shame because they cannot do things as well as those without IBD.

It’s important for those who don’t have IBD to understand what life is like for those who do — so speak up! Let your boss know about any accommodations that will help support your efforts toward recovery (for example, staying home during clinical remission).

• Challenges in relationships: Having Crohn’s disease and ulcerative colitis could affect how others see and treat you — but remember that there will always be someone who understands what you’re going through! Don’t give up on friendships because one person doesn’t understand what it means when they say something insensitive.

Managing Crohn’s Disease and Ulcerative Colitis

Treatment varies depending on what’s causing your symptoms and how severe they are for you. Your healthcare provider may recommend one or more treatments:

• Anti-inflammatory Drugs: Often one of the first steps in treating Crohn’s disease and ulcerative colitis, anti-inflammatory drugs relieve pain and reduce swelling.
• Antibiotics: Antibiotics can prevent or treat infections. Severe infections can lead to abscesses (pockets of pus) or cause fistulas (openings or tunnels that connect two organs that don’t usually connect).
• Antidiarrheal medication: Prescription medications like loperamide (Imodium A-D®) can stop severe diarrhea.
• Biologics: Biologic medications can slow or stop the inflammation that can damage organs due to inflammatory diseases. These medications include monoclonal antibodies to suppress the immune response.
• Surgery: Surgery won’t cure Crohn’s disease but can treat complications. Surgery can, however, eliminate ulcerative colitis by removing your entire colon and rectum (proctocolectomy).

An inflammatory bowel disease can be an overwhelming and isolating experience, but it doesn’t need to take over your life completely.

Get Help for Crohn’s Disease and Ulcerative Colitis

If you’re experiencing symptoms of Crohn’s disease or ulcerative colitis, please contact your Primary Care Provider or Gastroenterology & Hepatology at Colorado Mountain Medical, a partner of Vail Health. The healthcare team will thoroughly examine you and provide treatment options to help you manage your condition.

This article was reviewed by Suzanne Torris, MS, RN, FNP.