Frequently asked questions

1. What is IBD? Is it the same as IBS?

IBD stands for inflammatory bowel disease. IBD, also known as Crohn's & colitis, is a medical term that describes two separate diseases affecting the digestive system: Crohn's disease (CD) and ulcerative colitis (UC).

CD and UC damage the lining of the digestive system by causing inflammation, sores, bleeding, and scarring. This can lead to symptoms such as abdominal pain and cramps, diarrhea (which may be bloody), loss of appetite, malnutrition, and weight loss. IBD can also cause other symptoms, such as fatigue, fever, mouth ulcers, skin rashes, eye inflammation, or joint pain.

IBD is not the same as IBS, which stands for irritable bowel syndrome. Both can cause diarrhea and stomach cramps, but otherwise the two conditions are very different. IBD causes inflammation and damage to the tissues of the digestive system, while IBS causes a change in the bowel's functioning. IBD can increase the risk of colorectal cancer, while IBS does not. IBS is more common than IBD, and it is possible to have both conditions at the same time.

2. What's the difference between Crohn's disease and ulcerative colitis?

Crohn's disease (CD) and ulcerative colitis (UC) both damage the lining of the digestive system. They have many symptoms in common, including diarrhea (which may be bloody), abdominal pain and cramps, loss of appetite, malnutrition, and weight loss. However, they are separate medical conditions. The main differences between CD and UC are:

• UC affects only the colon (large intestine), while CD can affect any part of the digestive system, from the mouth to the anus.
• UC tends to damage only the inner layer of bowel tissue, while CD can damage many layers of bowel tissue.
• CD sores tend to occur in patches affecting any part of the digestive system, while UC tends to affect a continuous area of the colon (not patchy), usually starting from the rectum and moving up through the colon.
• UC can be cured surgically by removing the colon, but CD cannot. Surgery is often recommended for IBD when other treatments, such as nutrition therapy and medications, have proven ineffective.

3. I think I might have IBD. What are the symptoms?

The symptoms of IBD (inflammatory bowel disease) include:

• abdominal tenderness or swelling
• diarrhea, which may be bloody
• fever
• weakness or tiredness
• urges to empty the bowel even when the bowel is already empty
• loss of appetite and weight loss
• rectal bleeding
• stomach cramps

You may also have symptoms in other areas of the body, such as:

• blood clots in the leg
• eye inflammation (red eye)
• joint pain
• skin rash

If you are experiencing these symptoms, it's possible you may have IBD. But only your doctor can provide a diagnosis. If you think you might have IBD, visit your doctor to find out for sure.

4. How can I tell whether my IBD is under control?

It's not always easy to tell if your IBD is under control. After living with their symptoms, people with IBD may be so happy to get some relief that they may not realize that their condition could be even better controlled. So how can you tell if your IBD is under control?

Ask yourself:

• Am I having symptoms from my IBD (such as diarrhea, bleeding, abdominal cramps, or fatigue)?
• Do I worry about being able to get to a toilet in time?
• Have I lost 10% or more of my body weight because of my IBD?
• Have I changed my eating habits (without a doctor or dietician's advice) because of my IBD?
• Have I been feeling frustrated with my IBD?
• Is my IBD interfering with my social life?
• Is my IBD interfering with my ability to work?
• Is my IBD interfering with my ability to do my usual daily activities?
• Have I stopped enjoying life the way I used to because of my IBD?
• Am I having side effects from my IBD treatment?
• Do I ever wonder whether my IBD treatment is really working?

If you answered "Yes" to any of these questions, your IBD may not be under control. Visit your doctor to find out how to get better control of your IBD. You can get a printable version of these questions to bring to your doctor's visit.

5. What are the options for treating my IBD?

There are three main treatment options for IBD: medications, nutritional therapy, and surgery.

Medications: Medications are used for a variety of purposes in treating IBD. Depending on the medication, they may be used to relieve symptoms during a flare-up, to keep your condition in remission, to treat or prevent complications of IBD, or to control the condition itself.

Nutritional therapy: The role of nutritional therapy is to provide the nutrients a person needs so they do not become malnourished due to IBD. Nutritional therapy may include vitamin or mineral supplements, liquid meals, or avoiding foods that make symptoms worse.

Surgery: The role of surgery depends on the type of IBD you have. For people with ulcerative colitis (UC), surgery can provide a cure for IBD. However, because of the risks of surgery, it's not for everyone. For people with Crohn's disease (CD), surgery can help relieve symptoms and improve quality of life.

You and your doctor will work together to choose the treatments that are most appropriate for you. Your treatment decisions will be based on many factors, including your type of IBD, how much of your digestive system is affected, how severe your symptoms are, and the treatments you've already tried. See treatment options for more information. If you're wondering about your treatment options, speak with your doctor.

6. How can IBD affect a person's quality of life?

IBD (inflammatory bowel disease) is an unpredictable health condition. Each individual's experience is different, so it's hard to predict exactly how someone's quality of life (ability to enjoy the normal activities in life ) may be affected. But for many people with IBD, the condition can take a major toll on their life:

• The unpredictability of IBD can be stressful. Never knowing when an attack may occur can be a source of anxiety.
• Knowing that there's currently no cure for IBD can be depressing.
• During an attack, symptoms can make it difficult or impossible for a person to do their regular activities, which can affect a person's work, home, and social life.
• Approximately one-third (for people with ulcerative colitis) to three-quarters (for people with Crohn's disease) of people with IBD will eventually need surgery to treat their condition.

IBD can have devastating effects on quality of life. But there is hope! Although IBD cannot be cured (except in the case of ulcerative colitis), it can be treated effectively. Proper treatment can help control the condition and improve quality of life. Talk to your doctor to find a treatment option that works for you.

7. Are there any foods or diet changes that can help people with IBD?

Yes. Nutritional therapy can help many people with IBD. People with IBD can become malnourished for many reasons: IBD damages the walls of the intestine, which makes it harder for the body to absorb nutrients; people may not feel like eating when symptoms are severe; diarrhea moves food move faster out of the body, so there's less time for nutrients to be absorbed into the body; and IBD surgery can reduce available areas along the digestive system for nutrients to be absorbed.

The goal of nutritional therapy is to give you the nutrients you need so you don't become malnourished. Nutritional therapy may mean taking nutritional supplements such as vitamin or mineral tablets, liquid nutrition, or nutrition solutions that are injected into a vein (called total parenteral nutrition or TPN). It may also involve avoiding foods that make your symptoms worse, or using an elemental diet, a liquid nutrition product that is already pre-digested, to give your bowels a rest. It is usually given through a feeding tube.

If you have IBD, you may need nutritional therapy. Talk to your doctor or registered dietician for more information.

8. I'm embarrassed to talk to my doctor about IBD. How can I make it easier?

If you're feeling embarrassed about talking to your doctor or gastroenterologist (a doctor who specializes in diseases of the stomach and intestines), don't worry - you're not alone! Keep in mind that your doctor is a trained professional who can only help you effectively if you explain exactly how your condition is affecting you. Taking a bit of time to prepare for your visit will help you feel more comfortable.

Try the Doctor Discussion Guide to help you prepare for your visit. It has a printable list of symptoms and questions that you can customize for your needs. Just complete the guide, print it, and bring it to your doctor's appointment so it can do some of the talking for you!

9. Will I need to have surgery for my IBD?

It's possible that you may need surgery to treat your IBD. The chance of needing surgery and what surgery can do for you are both related to the type of IBD you have: ulcerative colitis (UC) or Crohn's disease (CD). Due in part to the risks associated with surgery, it's usually reserved for severe cases where other IBD treatments haven't worked.

People with UC have a one-in-three chance of eventually needing surgery. Surgery to remove the affected area of the colon can cure UC. However, because of the risks of surgery, it's usually reserved for people with severe UC where other treatments haven't worked, severe bleeding caused by UC, colorectal cancer, or a serious UC complication called toxic megacolon (a condition where the colon swells up to the point where it may tear open).

For people with CD, surgery cannot provide a cure. However, surgery can still help relieve symptoms and improve quality of. Surgery for CD involves repairing damage, removing diseased areas, and removing blockages from the bowel. People with CD are more likely to need surgery than those with UC. About three-quarters of people with CD will eventually need surgery.

If you are wondering about the role surgery may play in your treatment, speak to your doctor.

10. Where can I get more information on IBD?

Your doctor and pharmacist are excellent sources of information on IBD and its treatment. Speak to these healthcare professionals for information about your particular treatment needs. There are also a number of useful websites that can provide more information on IBD, including:

• Crohn's and Colitis Foundation of Canada: www.ccfc.ca
• Crohn's and Colitis Channel
• Mount Sinai Hospital IBD Centre: www.mtsinai.on.ca/ibd/
• Canadian Society of Intestinal Research: www.badgut.com