It's time to talk about your bowels.
Sure, nobody likes to talk about what happens behind a closed bathroom door, but your bowels can signal serious health issues that you may otherwise write off.
Take something as common as rectal bleeding. It could be anything from a hemorrhoid or anal fissure to something more serious like inflammatory bowel disease or even colon cancer.
“People often ignore bowel symptoms out of embarrassment, but these signs can point to serious conditions,” says Dr. Mehwish Ahmed, a gastroenterologist at The Iowa Clinic. “Early evaluation can make a big difference in outcomes.”
Symptoms that last for weeks, months or longer should raise a red flag that you might have a more serious condition such as inflammatory bowel disease.
What is inflammatory bowel disease?
Inflammatory bowel disease, or IBD, includes both Crohn’s disease and ulcerative colitis. IBD is characterized by immune-mediated chronic inflammation of the gastrointestinal tract. The two major classifications have some characteristic features:
- Ulcerative colitis – In ulcerative colitis, chronic inflammation is limited to the large intestine and limited to the inner layer of the colon wall. It extends continuously upward from the anus a variable distance. This disease is characterized by rectal bleeding and ulcers along the lining of the colon and rectum.
- Crohn’s disease – Crohn’s disease also involves ulcerations and inflammation in the intestines. It can occur anywhere along the digestive tract, from your mouth to your anus and can be patchy. Crohn’s disease most commonly occurs in the last part of the small intestine (ileum) and the colon. Often the rectum is spared in this disease. Crohn’s disease tends to involve inflammation of the entire thickness of the wall of the intestine and therefore can sometimes lead to complications such as strictures, which can cause narrowing or blockage of the intestines, and fistulae, which are abnormal connections between the bowel and other organs.
You can also have an inflammatory bowel disease that doesn’t quite fit either of those two conditions. No matter where the IBD diagnosis falls on the spectrum, symptoms can overlap. The main symptoms of inflammatory bowel disease include diarrhea, rectal bleeding, abdominal pain, anemia and unexplained weight loss.
What’s the difference between IBD and IBS?
One of the bowel conditions that has similar symptoms to IBD is IBS, or irritable bowel syndrome. Despite the overlapping symptoms and similar names, they are two very different conditions. And you can have both at the same time.
The difference lies in the underlying cause: inflammation. IBD is a chronic inflammatory disorder, the diagnosis of which is confirmed with testing. Chronic bowel inflammation involves injury to the bowel. Over time, such damage to the large bowel can lead to colorectal cancer.
IBS, on the other hand, is a disorder with irritation rather than inflammation. It includes things like bowel spasms and sensitivity, which don’t damage the bowel.
Irritable bowel syndrome is far more common. It’s estimated to affect up to 15 percent of Americans — more than 10 times the amount of people living with inflammatory bowel disease. In some cases, you may need to see a gastroenterologist and undergo testing, like a colonoscopy, to distinguish IBS from IBD and get the appropriate treatment.
How do you treat IBD?
IBD treatment is not one-size-fits-all. Every person’s condition is different, so the treatment approach must be personalized.
“IBD care is highly personalized,” says Dr. Ahmed. “We work closely with our patients to adjust their treatment plans based on symptoms, lab results, and how they’re feeling overall.”
Treatment includes:
- Anti-inflammatory medications, such as 5-ASA based therapies, for mild ulcerative colitis
- Immunosuppressants, such as steroids, immunomodulators, biologics, or small molecule therapies to reduce inflammation in the bowel for both ulcerative colitis and Crohn’s disease
Living with IBD isn’t easy. Symptoms can be severe and debilitating. Even when the symptoms have gone away, the inflammation may still be there, causing damage and putting your health at risk. Your provider will work with you to not only improve symptoms but also improve inflammation. Being free of symptoms can make you feel good. But reducing inflammation — or getting rid of it entirely — helps keep those symptoms away for good and prevents complications down the line.
There’s been a paradigm shift in IBD treatment in the past 15 years, according to The Iowa Clinic’s IBD experts. Once a diagnosis is made, the disease is objectively monitored and tightly controlled, similar to the way blood sugars are closely watched with diabetes. While everybody’s treatment plan is different, it primarily comes down to the right medication regimen for you.
You share in the decision-making with your GI doctor to figure out the best medication regimen for you and your lifestyle. Together, you fine-tune the treatment plan to resolve your unique symptoms and triggers.
An IBD Diet
“Eat a healthy diet” is not new advice or even nutrition guidance specific to inflammatory bowel disease. But the effects of chronic inflammation in your digestive tract can leave you deficient in essential nutrients, low in iron, B12, or vitamin D, and struggling to maintain your weight. So eating a well-balanced, anti-inflammatory diet with an emphasis on fruits and vegetables is important.
You need to make sure that you’re getting enough protein, calories and nutrients. You can have low levels of vitamin B12, vitamin D or other nutrients. You need to know which ones you are lacking so you can adjust your diet accordingly. Even if you eat a well-balanced diet, you may still need to fortify it with the appropriate vitamins and supplements for your deficiencies.
Where do I go if I have bowel problems?
With inflammatory bowel disease on the rise across the world, it’s important to open up and discuss your bowel issues with your primary care provider. They can help you rule out the multitude of other conditions that may appear to be IBD.
If your provider suspects inflammatory bowel disease — or other serious bowel problems — they’ll refer you to a gastroenterologist for further testing. With modern diagnostic tools and treatment approaches, there are many options to address your symptoms, treat your bowel inflammation and improve your quality of life.
Schedule a consultation with a gastroenterologist by calling 515.875.9115 or schedule online.
MehwishAhmed , MD
Mehwish Ahmed, MD joined The Iowa Clinic Gastroenterology department because of its unique model of patient-centered care, strong physician leadership, and collaborative network of providers and administrators working together to deliver the best possible care for patients. Dr. Ahmed chose gastroenterology because she values its combination of medical and procedural care, as well as its ability to improve patients’ quality of life. She is passionate about preventing disease through screening colonoscopies and managing chronic conditions such as Inflammatory Bowel Disease (IBD).
Outside of medicine, Dr. Ahmed enjoys traveling, gardening, stargazing, and spending time with her family. She has long been fascinated by space and even minored in Astronomy during college.