First things first. Let’s not get inflammatory bowel disease (IBD) mixed up with irritable bowel syndrome (IBS). It happens too often because of the similar acronyms, according to consultant gastroenterologist Professor Barbara Ryan, who is based at Tallaght Hospital and Trinity College Dublin.
“Inflammatory bowel disease involves inflammation, swelling and ulceration of the bowel. IBS doesn’t. While irritable bowel syndrome (IBS) has some similar symptoms and can cause a lot of misery and discomfort, it’s never going to cause the bowel to perforate. Inflammatory bowel disease – IBD – on the other hand, if left untreated, can lead to serious complications.
“It’s important to remember, however, that IBD is extremely treatable and that new medications are coming on stream all the time.”
Symptoms of IBD include:
With ulcerative colitis, there can also be a feeling of being unable to completely empty the bowel.
“Ulcerative colitis affects the large intestine only, but Crohn’s disease can occur anywhere along the digestive tract, and the inflammation can be much deeper, even perforating the bowel, so it’s important to get seen by a doctor,” says Professor Ryan.
Crohn’s disease is also often associated with anal problems such as fissures, tags and abscesses. IBD can also affect other parts of the body, particularly the joints, skin, eyes and liver.
Don’t be too shy to get checked out
Professor Ryan is making a plea for those with the IBD symptoms mentioned above to seek medical advice.
“Research has shown that too many people leave it too long and that a lot of people are very embarrassed talking about these things, particularly the older population,” she says.
That’s why the support organisation, Crohn’s and Colitis Ireland, has launched a new symptom checker (See www.crohnscolitis.ie/symptomchecker). This is part of its Poo Taboo campaign aimed at getting rid of the stigma around IBD symptoms and stressing the importance of people not being too shy to get checked out.
“The research found that while four in 10 people would go to see a doctor immediately if they saw blood in the toilet bowl, an equal number would delay getting seen to,” says Professor Ryan.
“We want people to stop ignoring the key signs of what can be a serious disease, to overcome any embarrassment that they may have, and to seek medical advice.”
The newly-developed symptom checker asks people a series of questions. “In less than a minute, they will know if they need to see a GP for further examination,” she says.
She also advises anyone with some other ailments to seek a check-up.
“If anyone has joint pain, skin rashes or sore eyes along with diarrhoea they should tell their doctor as these could also be related to IBD.”
Who can it affect?
IBD is believed to affect at least 40,000 people in Ireland. Most are between the ages of 15 and 35 and the ages of 50 to 70.
What triggers inflammatory bowel disease?
“The answer is we often don’t know,” she says. “It can be a combination of genetic and environmental factors. Children can get it if there is a strong family history, infection like gastro enteritis can trigger it, sometimes certain medications like antibiotics or anti-inflammatory medications can too. It might be related to hormonal factors, after puberty, too and in those in their 60s and 70s it could be related to changes in our immune systems as we get older. Stress can play a role as well and can cause flares.”
Treatment has improved
While there is currently no cure for IBD, treatment and lifestyle change can help stabilise the disease and provide a return to a normal quality of life.
Professor Ryan has also seen many new treatments introduced in her 25 years as a consultant gastroenterologist.
“Thankfully, once the diagnosis is made, we now have an excellent and ever-expanding array of treatments available, and people can experience a rapid improvement in symptoms,” she says.
“IBD is manageable through medication and lifestyle change. A small number of people might need surgery but it’s important to be under the care of a gastroenterologist if you have Crohn’s or ulcerative colitis.”
Lifestyle wise, she advises looking at everything you do.
“IBD is one of those conditions that needs a holistic approach. Malnutrition can affect up to 85% of people with IBD, so a well-balanced and healthy diet is important. This should incorporate protein [key to muscle growth] and good fats, known as unsaturated fats, which have health-promoting properties, and carbohydrates which are an important source of energy and B-vitamins. Of course, every person with IBD is different, and so too will their dietary plan, so working with a dietitian would be a good idea.
“Getting adequate sleep, not smoking and not drinking too much alcohol and learning to manage stress are important also.”
Professor Barbara Ryan is co-founder of The Gut Experts, an educational platform for people suffering with gut conditions. See https://thegutexperts.com/ She also co-authored the book What Every Woman Needs to know about her Gut, published in 2022.
Rachel Drury, 39, is from Carney, Co Sligo. She was diagnosed with ulcerative colitis in 2014 when she was living in Australia. At the time, she had been experiencing symptoms of a tummy bug that had lasted for more than two weeks and had been under stress trying to find a job.
“I have learnt to live as positively as I can with inflammatory bowel disease,” says Rachel.
“In the past, when the condition flared, it was a really difficult time. It is hard to be dependent on others and to have to leave your full-time paid employment. IBD, like any long-term illness, presents many challenges and we can be angry about it at first. As time passes, we can learn to adjust our lifestyle and learn to accept the condition as best we can. We can also try and take a positive attitude and change the things that no longer work for us.
“Professional help is important, of course. Not just medical help but also counselling and finding the right person or support group to speak to. It can be really overwhelming in the early days, and you will have plenty of questions and concerns. The more you reach out and ask for help, the better.
“I would also advise you to tell your employer so that they are understanding if you need time off or need to go to appointments.
Fatigue can be a common symptom and, if you need to rest, then do. Let IBD show you to put yourself first, and not to feel guilty about it.
“Before the diagnosis, I travelled the world as an engineer and had an incredible job. That path took me to Australia where I met my fiancée, Des, and we had an incredible five years together living there. Since 2018 and, mostly because of my health, we relocated home to Ireland and got our home in Sligo and our beautiful dog, Jack. We have also both started working for ourselves and completely turned around our lifestyle to work for us. We work hard but also enjoy time out to go to the beach with Jack and enjoy the sunshine when it comes. The love Des has shown me at my lowest times has been the biggest blessing of having IBD.
“The early stages of a diagnosis can be a very scary and daunting time and so, in sharing my story, I want others to know that IBD is not a negative life sentence. It is something that can be managed, and you can still have a great life.”
Rachel takes a holistic approach to her condition.
“I would advise looking at everything in your lifestyle, including stress management, food choices and seek counselling also,” she says. “I have found all this beneficial in coping with the physical, mental and emotional aspects of a chronic condition.”
Rachel is author of Powered to Fall, Empowered to Rise and runs the online buythebook.ie bookstore for self-published authors.