Part One – Inflammatory Bowel Disease

Inflammatory Bowel Disease " Part One
by Jonathan Blood Smyth

The bowel inflammatory diseases

These are disorders where the bowel becomes red and inflamed. In ulcerative colitis the lining of the large bowel is involved. In Crohn's disease (named after an American physician) any part of the digestive tract can be affected and the full thickness of the bowel wall can become inflamed. Crohn's disease, when it affects the colon and ulcerative colitis are similar so it is sometimes hard to tell which one the patient has.

Why does ulcerative colitis and Crohn's disease come on?

The cause or causes are not known. It is possible that affected people have an abnormal defence mechanism against the bacteria which are normally present in the gut. A long-term reaction to a particular bacterium or virus may be important. People in some families are more susceptible than in others, but the chance of passing this tendency on to children is small.

Symptoms of ulcerative colitis

Symptoms can be troublesome variably throughout a person's life. Typically people suffering from ulcerative colitis are well and do not have symptoms, a disease condition known as remission. Relapses occur when the disease flares up again, with the resulting relapses being unpredictable in terms of being worse than before, or better or similar to previous ones. Urgent need to pass mucus and blood with the stool, a general tiredness, abdominal pain prior to passing stool and diarrhoea in severe flare ups are the typical symptoms. If the condition affects only the rectum, the final part of the bowel, it is called proctitis and the typical symptoms are the passing of blood and mucus but in the absence of diarrhoea.

Crohn's disease symptoms

Crohn's disease also tends to occur throughout life with similar inactive remissions and relapsing flare ups as ulcerative colitis. Due to the fact that Crohn's disease can be active anywhere in the bowel the symptoms can be very variable. Most commonly there is:

Diarrhoea sometimes with bleeding

Abdominal pain. The inflammation either causes pain directly or causes narrowing of the bowel (stricture) resulting in gripey pains and bloating (distension) with wind.

Bodyweight loss due to a reduction in appetite when active disease is present along with potential poor nutrient absorption.

A fistula (leak between two organs) can occur in the inflamed bowel and burst through into an organ such as the bladder, vagina or skin, with a discharge.

In some patients a leak (fistula) develops through the inflamed bowel into another organ, such as skin, bladder or vagina, causing a discharge.

Local inflammation can cause abdominal pain or cause a narrowing of the bowel (a stricture) with symptoms of abdominal bloating, wind and pain of a gripey nature.

Reasons why the disease relapses

It is not always possible to identify the causes of relapse and even when the trigger occurrence is identified this is not the cause of the condition. Possible reasons are:

Dietary intake. Milk products can make people react and then they should try a diet free from milk. Particular foods, for example cereals, can produce an unwelcome reaction. Excluding the trigger foods from the diet and then re-introducing them later is useful.

Widespread infections such as gastroenteritis, flu and colds.

Personal worries and stress.

Diet. Some patients may react to milk products, in which case they will need a milk-free diet. Some sufferers find that certain foods, such as cereals, can cause problems. These foods can be cut out of the diet and tried again later.

The diagnosis of inflammatory bowel disease

Crohn's disease of the bowel (known as Crohn's colitis) or ulcerative colitis can be diagnosed by sigmoidoscopy. This involves the insertion of a narrow endoscope with a light up the rectum and into the bowel so the lining of the organ can be checked. A sample of the bowel lining may be biopsied for microscopic examination. Other tests include:

An x-ray during a barium enema where the liquid barium is injected into the bowel through the anus.

Exclusion of infection by taking stool specimens.

Barium enema x-ray (barium liquid is run into the bowel through the anus).

Blood samples are routinely taken.

If Crohn's disease of the upper gut is suspected:

An endoscopy of the upper gastrointestinal tract can allow inspection and biopsies of the upper intestine and stomach, passing the endoscope through the mouth.

The intestine may be investigated by a barium x-ray examination.

Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for Physiotherapists in Coventry visit his website.

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