Inflammatory Bowel Disease (IBD) is associated with unpredictable bouts of diarrhea, excessive gas, and abdominal cramping, among other painful and potentially embarrassing symptoms.
IBD includes the conditions ulcerative colitis and Crohn's disease. Both are autoimmune diseases that involve chronic gut inflammation, but their treatments and outcomes can vary. The signs of colitis and Crohn's typically appear and worsen between the ages of 15 and 30. But, recently, more adults are being diagnosed with IBD in their retirement years.
What's causing this change in IBD diagnoses?
While the data shows a slight increase in IBD diagnoses among Medicare recipients, "there's even more of an increase among older patients in Asia and certain parts of Europe," says Siobhan Proksell, M.D., a gastroenterologist with the University of Miami Health System. "This change is potentially due to an increased awareness of these conditions, improved access to care, and new treatment options. But, it can be difficult to identify what unmasks IBD for each patient."
IBD is caused by a genetic predisposition and an internal or environmental trigger unique to each patient. "There are hundreds of genes that make people susceptible to developing these diseases. We can identify certain risks factors — such as antibiotic use, GI infection, stressors, and smoking — but these are not the sole causes. Subsequently, the body has a dysregulated response to the intestinal inflammation, allowing for it to further progress," Dr. Proksell says. "With IBD, gut inflammation typically continues to worsen without medical treatment."
What does IBD feel like?
The symptoms of Crohn's disease and colitis are slightly different and can range from mild to severe. Patients suffer from flare-ups when symptoms come on suddenly and worsen, then experience relief during periods of disease remission.
IBD symptoms include:
- an urgency to evacuate the bowels
- bloody stool
- loss of appetite
- excessive gas
- abdominal cramping
- abdominal pain and tenderness
Dealing with bouts of these symptoms can lead to other issues, including:
- unintentional weight loss
- anal fissures and fistulas
- oral sores
- kidney stones
- joint pain
- night sweats
- skin rashes
Anxiety and depression are common among those living with IBD.
The frequent struggle of unpredictable and painful bowel movements can cause distress, isolation, and a sense of loss of control. Some research shows that changes in the gut flora may also contribute to these psychosocial experiences.
"There's a huge emotional impact because you're being diagnosed with a chronic disease that requires lifelong management," Dr. Proksell says. "A psychotherapist can help, when appropriate. Finding local chapters of national organizations, such as the Crohn's and Colitis Foundation, as well as online support groups can also be a huge help."
How do people live with IBD?
If you've recently started experiencing the disruptive signs of GI tract inflammation, you shouldn't ignore these changes happening in your body. Dr. Proksell says, "Any time that you have persistent symptoms, you should speak with your doctor. Start with your primary care physician to help direct you to a specialist. Choose a gastroenterologist you can communicate well with and are comfortable being honest with," even about embarrassing symptoms. Your relationship with this doctor could benefit you for years, as IBD symptoms can change throughout your life and new treatment options become available.
The first line of treatment is typically immuno-suppressive medications that reduce gut inflammation by lowering the body's immune response. These medications include mesalamines (nonsteroidal anti-inflammatories), immunomodulators (various medicines that are infrequently used on their own), biologics (patient-administered injections or in-office infusion treatments), and small molecules (the latest, most recently approved medications for colitis).
"In my practice, we often see more severe cases," Dr. Proksell says. "So, we're typically initiating treatment with biologic therapies. We aim to provide individualized treatments and integrated treatment options."
At UHealth, patients receive the expertise and guidance of a dietitian and psychotherapist or licensed clinical social worker. Dietary changes may help prevent or reduce GI inflammation. Stress management, mindfulness, and hypnosis techniques can help IBD patients learn how to calm their minds and relax their bodies when dealing with painful symptoms. If pelvic floor muscle weakness is also an issue for IBD patients, targeted physical therapy may be added to their care plan to improve muscle control.
If you and your family are new to an IBD diagnosis, know that "you are not alone," says Dr. Proksell. Approximately 1.6 million Americans are living with Crohn's or colitis. While 70,000 IBD diagnoses are made in the U.S. each year, and new patients now include more older adults, "there's a light at the end of the tunnel," Dr. Proksell says. The latest medications and therapies are improving the lives of IBD patients every day.
Dana Kantrowitz is a contributing writer for UMiami Health News.
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