Do you have frequent abdominal pain, bloating, diarrhea, or constipation? Maybe you feel good some of the time, but other times you are just miserable. It might be that you think that you have eaten something bad, or that you have a food intolerance. Sometimes, this can be the case. However, if you are experiencing these kinds of symptoms frequently, it is probably time to go discuss it with a doctor. Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) can also cause these types of problems. But while the symptoms may be similar, the illnesses are very different in terms of what causes them, and how they are treated. So what exactly is the difference between IBS and IBD?
Inflammatory Bowel Disease (IBD)
IBD refers to a group of intestinal illnesses that are usually caused by a person’s immune system. The two most common forms of IBD are ulcerative colitis (UC) and Crohn’s disease (CD). While these illnesses have their own distinct characteristics, both are known to rotate between periods of acute symptoms, and periods of remission. And while some of their symptoms and many of their treatments are similar, they affect different parts of the intestines. It is believed that there is a hereditary tendency to develop either UC or CD; however, only 15% of all people with known disease have had family members who also had the illness. Most people with IBD are diagnosed between the ages of 10 and 40, and women and men are affected equally.
Ulcerative Colitis (UC)
UC only affects the lining of the colon and rectum, or the large bowel. The cause of the illness is not known, but when a trigger—either food or environmental—causes the immune system to react, it treats the bowel like a foreign intruder and initiates an inflammatory response. This response causes tissue damage, ulcers, or erosions and abscesses. The symptoms that result from this process are abdominal cramping, bloody diarrhea with mucus, and watery diarrhea. Depending on the severity of the illness, people report anywhere from 4 to 10 episodes per day of varying types of bowel movements, and sometimes more. They also experience varying degrees of abdominal pain, that is sometimes relieved with a bowel movement. More severe symptoms can include fever, rapid heart rate, weight loss, anemia, low blood pressure, and poor nutrition (from malabsorption). Over time, this can result in thinning and weakening of the walls of the intestines, which can then lead to a tearing of the bowel and leakage of its contents into the abdomen. This is called a bowel perforation, and it requires surgery and the removal of bowel sections. In addition to the symptoms associated with the illness, UC also increases the risk of colon cancer. Diagnosis can be made based on laboratory testing, stool testing, X-rays, and direct observation of the bowel during a colonoscopy. Treatment includes limiting caffeine, raw fruits, vegetables, and other high fiber foods during acute attacks. Additionally, steroids or other medications to suppress the immune system may be necessary. Finally, people experiencing acute symptoms that do not improve with medical treatment will need surgery to remove the affected bowel.
Crohn’s Disease (CD)
An inflammatory process also causes Crohn’s Disease, but it can occur throughout the entire gastrointestinal tract. While 80% of people who have it have problems with their small bowel, symptoms can occur anywhere from the mouth to the anus. Just as in UC, CD can cause ulcerations, but also obstructions and fistulas (abnormal connections usually between two areas of the bowel). And CD is also associated with a greater risk of developing colon cancer. People affected with CD often complain of abdominal cramping and tenderness, fever, loss of appetite, weight loss, and gas. Stools are often soft, can also contain blood and mucus, and sometimes are loose and “greasy”. Like those with UC, people with CD experience periods with acute symptoms, and periods that are symptom-free. Stress and eating spicy foods can cause worsening symptoms. This illness can also be diagnosed based on laboratory findings, stool sampling, X-rays, and colonoscopy. A CT scan may also be necessary. Treatment includes many of the same medications used for UC, and during an acute phase, eating nuts or seeds should be avoided. Surgery is not necessarily used to treat CD, however it may be necessary to treat complications of the illness.
Irritable Bowel Syndrome (IBS)
Like IBD, irritable bowel syndrome (IBS) is a chronic illness, however, it is not caused by the immune system. It is seen primarily in women, and it is estimated that up to 20% of the population have the symptoms associated with IBS. Generally, symptoms first appear between adolescence and early adulthood, and rarely occur after the age of 50. The cause of IBS is unknown, but it is often associated with other syndromes such as fibromyalgia, chronic fatigue syndrome, reflux disease, major depression, and anxiety. People with IBS often complain of abdominal pain, bloating, diarrhea, and/or constipation. Abdominal pain usually goes away after a bowel movement or the passing of gas. However, these individuals often report a sensation of incomplete evacuation and having to have frequent bowel movements. Often, discomfort occurs after meals, and it is important to rule out food sensitivities as the cause of the problem. Emotional stress can also make things worse. Your doctor can usually diagnose IBS based on your symptoms, and can rule out other causes with laboratory and X-ray tests, as needed.
The treatment of IBS is based on the individual’s symptoms. Lifestyle changes should be made to avoid triggers such as food or stress. These changes may also include diet, counseling, and some medications. In this condition, high fiber is recommended to treat both diarrhea and constipation. It is also important to drink at least 6-8 glasses of water per day. Your doctor may also prescribe medications to ease the abdominal pain. Antidiarrheal medications, as well as laxatives are not recommended except for severe symptoms, but it is best to follow the recommendations your doctor gives you. It is often difficult for people to accept that there is no specific cause for their symptoms, but it is important to remember that this is still a chronic condition that requires continual management through lifestyle and diet.
If you are concerned about symptoms you have been experiencing, or if you have questions about IBD or IBS, we would be happy to help. At Austin Gastroenterology, we understand the importance of your digestive health. Call us at an office near you to set up an appointment: North Office (512) 244-2273, Central Office (512) 454-4588, and South Office (512) 448-4588. If you are an existing patient, you can request an appointment online.
