What is IBD?

Inflammatory Bowel Disease (IBD) refers to two diseases, Crohn’s Disease (CD) and Ulcerative Colitis (UC). Both CD and UC are chronic, and cause pathological changes and inflammation of the intestinal tract (large and small bowel). Over 70,000 individuals in Australia have IBD (prevalence rate around 90-300 per 100,000) and of those, 33,000 have UC, while 28,000 have CD.

The primary distinction between CD and UC is that CD results in full thickness inflammation (a immune system response to localised tissue injury. Inflammation aims to ‘seal off’ damaged tissue from non-damaged tissue and begin to either reduce or destroy the damaged tissue of the bowel tissues, and can also involve all of the digestive tract from the mouth to the anus. The most common area affected by CD is the ileum, the lower section of the small intestine. In contrast to CD, UC is primarily associated with the inflammation of the inner lining of the colon and rectum (the large bowel).

IBD often starts in adolescence or young adulthood but it may begin at any time, even in old age. It is a chronic condition that flares up from time to time. Sometimes the symptoms are related to specific stressful events or to routine everyday stress. For example, travel can affect IBD because it disrupts normal eating and sleeping habits. IBD can have a significant impact on the life of a sufferer. Normal functioning can be considerably disrupted by symptoms; travel, work habits, or socialising can be limited due to a desire to remain close to a bathroom. Sometimes there is no apparent reason for an increase in symptoms (with the exception of increased destruction of the bowel structures).

Due to the nature of the inflammation, both CD and UC result in diarrhea containing mucus, pus, and blood at times, nausea, severe abdominal pain (especially during bowel motions), fever/chills, weight loss, anorexia, and constipation. Other symptoms include, arthritis (pain in joints) and joint problems, skin problems (such as rashes, erythema), mouth ulcers, jaundice (causes the skin to become yellow in colour), and inflamed eyes, and sleep disturbances. Further more serious complications associated with IBD, include carcinoma of the colon and pyroderma gagrenosum (ulcers on the legs, hands, etc).

While the severity of the diseases are different for each person, many individuals with CD and UC will experience periods of remission which range in length from weeks to years. Despite this, many individuals with IBD will face at least one surgery to remove sections of necrotised (damaged) bowel. Around two-thirds to three-quarters of individuals with CD require at least one surgery to remove sections of bowel; often multiple surgical procedures are required throughout an individual’s life to reduce the symptoms and inflammation.

Around sixty percent of all CD cases require a colectomy, a surgical procedure whereby the entire colon is removed. In these cases, these individuals require an external plastic bag (i.e., colostomy bag), to collect waste. Despite these surgeries, CD may continue to inflame and destroy the remaining bowel tissue resulting in continuing symptoms.

To date, the cause of UC and CD is unknown although it has been identified that IBD is associated with a range of contributing factors, including genetic and aspects of immunological functioning such as autoimmune process (as found in arthritis) and viral/bacterial infection or immunological changes. Several environmental factors have also been identified to influence the IBD progress and severity, these include; smoking, diet, social status, stress, intestinal permeability, and history of appendectomy.

The ongoing personal cost of living with IBD is significant, not only economically, but psychologically. Like all other chronic illnesses, IBD activity is strongly related to psychological symptoms, including distress/anxiety (e.g., feeling wound up, inability to relax, feelings of panic and worry) and depression (e.g., loss of interest in enjoyable activities, feeling sad and unhappy, slowed down, lacking energy). Psychologists and doctors have found consistent relationships between IBD and a range of concerns including diminished energy, impaired sense of control (due to an unknown disease course), impaired body image, increased isolation and fear, and feeling ‘dirty’.

Rates of reported psychological symptoms, such as anxiety and depression in IBD cohorts are higher (up to 50%) than in comparison to other chronic disease illness groups. In comparison to healthy controls (and other illness groups such as IBS and colon cancer), individuals with more severe IBD report more psychiatric distress. Not surprisingly, IBD sufferers also report reduced self-esteem, increased body image concerns and sexual problems.