IBD Conditions & Complications
There are many areas of inflammatory bowel disease that can have impact throughout the body. This section outlines those areas which include:
IBD - Arthritis
Arthritis is a type of inflammation in the joints that can be a complication of IBD. There are two main types of arthritis that can affect people with IBD:
- Peripheral arthritis usually affects the large joints of the arms and legs, and can cause pain and swelling that lasts from a few days to several weeks
- Axial arthritis, also known as spondylitis or spondyloarthropathy, causes pain and stiffness in the lower spine and at the bottom of the back. It can cause permanent damage if the bones in the spine fuse together.
Treatment for arthritis in people with IBD may include medications such as biologic therapies, rest, moist heat, range of motion exercises, and stretching. It is important to talk to a doctor about the best treatment options
Arthritis is inflammation in the joints. It can cause pain, swelling, and stiffness in the arms and legs.
Yes, arthritis is a common complication of IBD. It is more common in younger people who have IBD.
The two main types of arthritis seen in IBD are peripheral arthritis and axial arthritis.
Peripheral arthritis usually affects the large joints in the arms and legs. It can cause pain and swelling that may last for several weeks.
Treatment for peripheral arthritis may include medications, resting the affected joint, using moist heat, and doing a range of motion exercises as recommended by a physical therapist.
Axial arthritis, also known as spondylitis or spondyloarthropathy, affects the lower spine and the sacroiliac joints at the bottom of the back. It can cause pain and stiffness in these areas.
Yes, axial arthritis can cause permanent damage if the bones in the vertebral column fuse together, leading to decreased range of motion in the back.
Treatment for axial arthritis may include medications called biologic therapies, as well as stretching exercises and the use of moist heat on the back.
NSAIDs, such as aspirin and ibuprofen, may not be a good option for people with IBD because they can irritate the intestines and increase inflammation. It is important to talk to a doctor before taking NSAIDs if you have IBD.
IBD - Fistulae
Crohn’s disease is a long-term health problem that affects the intestines. It can happen anywhere from the mouth to the anus (the opening at the end of the digestive system where stool comes out) and can affect the whole thickness of the intestinal wall.
Crohn’s disease can cause abnormal connections between two areas called fistulas. Fistulas can form when inflammation (swelling) spreads into the area around the bowel wall. There are different kinds of fistulas depending on where they are located. For example, there can be fistulas between two parts of the digestive system, between the digestive system and the bladder (where urine is stored), between the digestive system and the vagina, or between the digestive system and the skin. The most common place for fistulas is the ileum (the last part of the small intestine). A special kind of fistula that can happen with Crohn’s disease is called a perianal fistula, which connects the inside lining of the rectum (the last part of the colon) with the skin around the anus.
IBD - Fistulae Symptoms
People with fistulas can have different symptoms depending on where the fistulas are located.
- Fistulas between the small intestine and the large intestine can cause diarrhea or undigested food to pass through.
- Fistulas between the intestine and the bladder can cause urinary tract infections with symptoms like burning while urinating, cloudy urine, or blood in the urine.
- Fistulas to the vagina can cause air or stool to come out of the vagina.
- Fistulas to the skin can start as a painful bump or boil (called an abscess) that then opens up and drains fluid, air or stool.
There are medical and surgical options to treat fistulas, depending on the situation. Medical options may include antibiotics if there is also a lot of inflammation, and surgical options may be needed if strictures (narrowing of the intestine) keep coming back.
Perianal Crohn’s disease is a type of Crohn’s disease that affects the skin around the anus (the opening at the end of the digestive system where stool comes out).
The main symptoms of perianal Crohn’s disease are pain and swelling around the anus, along with bleeding and discharge. Other symptoms may include diarrhea, fever, and weight loss.
The exact cause of perianal Crohn’s disease is not known, but it is believed to be related to an abnormal immune response in the digestive system.
Perianal Crohn’s disease is usually diagnosed through a combination of a physical examination, blood tests, imaging tests, and a biopsy (removal of a small sample of tissue for testing).
Treatment for perianal Crohn’s disease may include medications to reduce inflammation and manage symptoms, as well as surgery to remove damaged or infected tissue.
There is no known cure for Crohn’s disease, including perianal Crohn’s disease. However, treatment can help manage the symptoms and prevent complications.
There is no known way to prevent perianal Crohn’s disease. However, maintaining a healthy lifestyle, including eating a balanced diet and avoiding smoking, may help reduce the risk of developing Crohn’s disease.
No, perianal Crohn’s disease is not contagious. It is a chronic condition that cannot be passed from one person to another.
Yes, perianal Crohn’s disease can lead to other health problems if it is not properly treated. These may include anemia (low red blood cell count), malnutrition (not getting enough nutrients), and abscesses (pockets of infected pus).
Perianal Crohn’s disease can cause permanent damage if it is not properly treated. This may include scarring, fistulas (abnormal connections between organs or tissues), and strictures (narrowing of the intestine).
Perianal Crohn’s disease is a chronic condition, meaning it can last for a long time. However, the severity of the condition can vary and may improve with treatment.
Yes, children can get perianal Crohn’s disease. It can occur at any age, but it is most common in people between the ages of 15 and 35.
Perianal Crohn’s disease may affect pregnancy in some women. It is important to discuss any concerns with a healthcare professional.
IBD - Flare
A flare is when the symptoms and inflammation of ulcerative colitis or Crohn’s disease become more active.
Flare-ups of inflammation can cause diarrhea, abdominal pain, and blood in the stools. Some things that can worsen inflammation and cause flare-ups include missing doses of medication, taking non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen, using certain antibiotics, smoking, and getting infections in the gastrointestinal tract. Stress and certain foods can also make symptoms worse, but may not actually worsen the inflammation.
Tips for managing flare-ups
- Keep track of symptoms, potential triggers, and when symptoms are more likely to happen.
- Exercise regularly.
- Don’t smoke, as it can make symptoms worse and make the inflammation worse.
- Use stress-management techniques like breathing exercises, yoga, or therapy.
- Use a moist towel instead of toilet paper to reduce irritation in the anal area.
- Use a hand shower or perianal cleansing product when showering, like Balneol.
- Before bed, apply ointment to protect skin around the anus, like Vitamin A&D ointment or Desitin.
- Soak in warm salt water to ease anal pain or tenderness.
- Plan a route and know where the nearest restrooms are when traveling or going out.
- Carry an emergency kit with toilet paper, spare underwear, and baby wipes to help with anxiety.
- Use an “I can’t wait” card from the Crohn’s and Colitis Foundation if no public restrooms are available.
- Talk to your employer about the Family and Medical Leave Act if you need to take time off for medical reasons.
- Find a local or online support group to connect with others going through similar experiences.
- Contact your provider to assess for infection and come up with a plan to treat your inflammation.
A flare is a time when the symptoms and inflammation from ulcerative colitis or Crohn’s disease become more active. This can cause diarrhea, abdominal pain, and blood in stools.
Several things can cause a flare in IBD, including missing doses of medication, taking non-steroidal anti-inflammatory drugs (NSAIDs), using certain antibiotics, smoking, getting infections, and feeling stressed. Some foods may also make symptoms worse, although they do not directly cause a flare.
If you have a flare in IBD, it is important to contact your doctor. They will be able to recommend treatment to help control your symptoms and reduce inflammation. It is also important to continue taking your medication as prescribed, even when you are feeling better.
Stress can worsen symptoms in patients with IBD, such as diarrhea and abdominal pain, but it does not directly cause a flare in the disease.
Certain foods may make symptoms worse in patients with IBD, but there is no direct evidence that they can cause a flare in the disease. If you think certain foods are affecting your symptoms, it may be helpful to talk to your doctor or a dietitian about making changes to your diet.
During a flare in IBD, it is generally recommended to avoid non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen. These medications can irritate the intestines and increase inflammation. It is also important to take your medication as prescribed and to avoid antibiotics unless they are specifically recommended by your doctor.
To help prevent flares in IBD, it is important to take your medication as prescribed, avoid smoking, and try to manage stress. You may also want to talk to your doctor or a dietitian about any dietary changes that may be helpful in managing your symptoms.
IBD - Nutrition
People with Crohn’s disease and ulcerative colitis may have trouble getting enough nutrients. This is because their disease can cause symptoms like diarrhea, stomach pain, and loss of appetite. These symptoms can make it hard to eat enough food and get enough nutrients.
Inflammation in portions of the intestines which are important for absorption can also affect nutrition. It’s important to make sure you’re getting enough nutrition and to talk to your doctor if you’re not. You may need to take supplements or see a dietitian to help you get the nutrients you need. Certain vitamin and minerals like iron, vitamin D, and vitamin b12 are frequently low in patients with IBD. If you have any questions, be sure to talk to your doctor.
People with IBD may have difficulty getting enough nutrients due to symptoms, complications, and medications. This can lead to malnutrition and other health problems.
It’s important to eat a varied and balanced diet, including plenty of fruits, vegetables, and protein. You may also need to take vitamin or mineral supplements, or see a dietitian for specific guidance.
Diets high in processed foods and saturated fats have been associated with the development of IBD. We recommend a diet low in fats and processed foods to minimize inflammation.
Yes, people with IBD may be at risk for malnutrition due to poor absorption of nutrients, decreased appetite, and frequent diarrhea.
It’s important to follow your treatment plan and take all medications as prescribed. You should also try to eat a balanced diet and speak to your healthcare provider about any concerns you have about malnutrition.
It is generally safe to take vitamin and mineral supplements if you have IBD, but it’s important to talk to your healthcare provider first. Some supplements may interfere with your medications or cause side effects.
IBD - Osteoporosis
Bone loss is a common problem for people with Crohn’s disease and ulcerative colitis. It can affect people at any age and often happens without symptoms until the bone becomes weak and breaks or fractures.
Steroid medications, having active inflammation, having low levels of vitamin D, and smoking can increase the risk of bone loss. A DEXA scan can be used to screen for bone loss, and if thinning of the bones is found, therapy can be started to prevent further bone loss.
To prevent bone loss, people should minimize use of steroids, stop smoking, exercise regularly, eat a diet rich in calcium and vitamin D, or talk to their doctor about taking calcium and vitamin D supplements.
Bone loss is when your bones become weak and fragile. It can affect people with inflammatory bowel disease (IBD) at any age.
There are a few ways that IBD can cause bone loss: taking steroid medications, having active inflammation, having low levels of vitamin D, and smoking.
A doctor can check for bone loss with a special test called a DEXA scan. If the test shows thinning of the bones, your doctor will start treatment to prevent further bone loss.
Osteopenia is mild weakening of the bones. Osteoporosis is significantly weakened and fragile bones as defined by a scoring system.
To prevent bone loss, you should minimize the use of steroids (as recommended by your doctor), stop smoking, exercise regularly, eat a diet rich in calcium and vitamin D, or talk to your doctor about taking calcium and/or vitamin D supplements.
In some cases, bone loss can be reversed with treatment. It is important to talk to your doctor about the best treatment plan for you.
Calcium and vitamin D supplements are generally safe, but they can cause some side effects. These may include constipation, upset stomach, and kidney stones. Talk to your doctor about any concerns you have about taking supplements.
Yes, it is possible to get enough calcium and vitamin D from your diet. Foods that are high in calcium include dairy products, leafy green vegetables, and nuts. Vitamin D is present in dairy products and is added to some other foods.
IBD - SKIN INVOLVEMENT
IBD can cause skin issues. These skin problems are often linked to how active the IBD is and may appear before or during a flare-up. They usually go away when the IBD is brought under control with medication, but sometimes antibiotics or skin ointments may be needed.
The most common skin complications of IBD include erythema nodosum, which causes red, tender bumps on the shins and ankles, and pyoderma gangrenosum, which starts as small blisters and becomes deep ulcers on the shins and ankles. If you notice any changes in your skin, talk to your doctor. Skin disorders affect about 20% of people with IBD.
Other skin conditions that may occur include continuous or contiguous CD, which causes rashes and ulcers around the anus, and skin problems due to nutritional deficiencies. These nutritional deficiencies may be caused by CD and some treatments for CD, and can cause red patches, dry skin and eczema, nail changes, and inflammation of the mouth and lips. These skin conditions can be treated with medications and sometimes supplements.
Erythema nodosum is a type of skin inflammation that causes red, painful lumps on the front of the legs below the knees. These lumps, called nodules, can be the size of a dime to a quarter and may come and go for a few weeks. They may leave a bruised appearance or a permanent indentation in the skin when they go away.
Sometimes, erythema nodosum can come back for weeks to months or even years. It may be linked to other medical conditions, such as certain medications, strep throat, cat scratch disease, fungal infections, and more. Erythema nodosum is treated with anti-inflammatory drugs, cortisone, or colchicine to reduce inflammation. It is important to note that while erythema nodosum can be annoying and painful, it does not harm internal organs and the long-term outlook is usually very good.
Pyoderma gangrenosum is a rare condition that causes big, painful sores (ulcers) to appear on the skin, usually on the legs. It is not known exactly what causes this condition, but it seems to be a problem with the immune system. People with certain health problems, like IBD or arthritis, are more likely to get pyoderma gangrenosum.
The sores usually start as a small, red bump that looks like a spider bite and then grow into a big, painful open sore. Treatment involves reducing inflammation, controlling pain, and promoting healing of the wounds. It may involve pills, creams, injections, or a stay in the hospital. Even after treatment, it is common for new wounds to appear.
Skin issues from IBD often appear before or during a flare-up of the disease.
Skin issues from IBD are usually treated by bringing the IBD under control with medication. Sometimes, antibiotics or skin ointments may also be needed.
The most common skin complications of IBD are erythema nodosum and pyoderma gangrenosum.
Erythema nodosum is a skin condition that causes red, tender bumps on the shins and ankles.
Pyoderma gangrenosum is a skin condition that starts as small blisters and becomes deep ulcers on the shins and ankles.
About 20% of people with IBD experience skin issues.
Yes, there are other skin conditions that may occur with IBD, such as continuous or contiguous CD, which causes rashes and ulcers around the anus, and skin problems due to nutritional deficiencies.
The symptoms of continuous or contiguous CD include rashes and ulcers around the anus.
Symptoms of skin problems due to nutritional deficiencies may include red patches, dry skin and eczema, nail changes, and inflammation of the mouth and lips.
Skin conditions related to IBD are usually treated with medications and sometimes supplements.
Yes, it is important to talk to a doctor if you have IBD and notice changes in your skin.
It is not always possible to prevent skin issues from IBD, but keeping the IBD under control with medication can help.
Skin issues are a common complication of IBD, but not everyone with IBD will experience.
IBD - Strictures
Crohn’s disease is a condition that causes inflammation in the digestive system. It can affect any part of the digestive tract from the mouth to the anus, and can involve the whole thickness of the intestine.
One of the problems that can happen with Crohn’s disease is strictures, which are narrow areas in the intestines. These can be caused by scar tissue that forms after inflammation and healing in the intestine. Strictures can cause blockage symptoms like nausea, vomiting, abdominal pain, bloating, or trouble passing gas and stool.
They can be diagnosed with a colonoscopy or a CT scan or MRI of the abdomen. There are medical and surgical options to treat strictures. It’s important to tell your doctor if you have any symptoms like this.
A stricture is an area of narrowing in the intestines.
Strictures can form in IBD when repeated cycles of inflammation and healing in the lining of the intestine lead to scar tissue replacing normal cells. This scar tissue can cause narrowing of the gastrointestinal tract.
The most common locations for strictures in IBD are the ileum (the last part of the small intestine) and the ileocecal valve (the entrance from small to large intestine). However, strictures can also occur in the upper gastrointestinal tract, colon, rectum, or anus.
Symptoms of strictures in IBD can include nausea and vomiting, abdominal pain, bloating, or difficulty passing gas and stool.
Strictures in IBD can be diagnosed using colonoscopy and CT scans or MRIs of the abdomen.
Treatment for strictures in IBD may involve medical options (if there is also significant inflammation) or surgical options (especially if strictures recur frequently). Some of the strictures within the reach of upper endoscopy or colonoscopy can be stretched open with a balloon.
Yes, strictures in IBD can cause blockages in the gastrointestinal tract.
It is not always possible to prevent strictures in IBD, but some strategies that may help include treating inflammation.
In some cases, strictures in IBD may resolve with proper treatment. However, it is important to follow your doctor’s recommendations and continue treatment as prescribed to ensure the best possible outcome.
If you have symptoms of a stricture in IBD, it is important to speak with your doctor as soon as possible. Early diagnosis and treatment can help to prevent more serious complications.
IBD - Uveitis
Eye problems can be a complication of IBD for about 10% of people with the condition. These problems are usually treatable and usually do not cause significant vision loss. However, it is important to see an eye doctor regularly and to let your doctor know if you experience any eye irritation, vision changes or inflammation.
Some medications used to treat IBD, such as corticosteroids, may also cause eye problems such as glaucoma and cataracts. If you have IBD, be sure to tell your eye doctor about your condition and any medications you are taking.
Some common eye problems that can be caused by IBD include inflammation, irritation, and cataracts.
IBD can cause inflammation in the eye, which can lead to irritation and other symptoms.
Yes, some IBD medications, such as corticosteroids, can cause eye problems like glaucoma and cataracts.
If you notice any eye irritation or inflammation, it’s important to bring it to your doctor’s attention as soon as possible.
It’s generally recommended that people with IBD see an ophthalmologist regularly to check for any eye problems.
In most cases, eye problems caused by IBD are treatable and do not pose a significant threat to vision. However, it’s important to get regular eye exams and follow your doctor’s recommendations to protect your vision.
To prevent eye problems, it’s important to follow your IBD treatment plan and see an ophthalmologist regularly. You should also avoid smoking and protect your eyes from UV rays.
Yes, IBD can cause dry eye syndrome, which is a condition in which the eyes do not produce enough tears or produce poor quality tears.
Yes, long-term use of corticosteroids, which are commonly used to treat IBD, can increase the risk of developing cataracts.