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About Crohn's Disease

Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD)

Irritable bowel syndrome (IBS) is often referred to inaccurately as “colitis” and “mucous colitis.” But the suffix “itis” in a medical condition’s name denotes inflammation, which is not a hallmark of IBS. Rather than inflaming the colon, IBS sensitizes the nerves responsible for the contractions (called peristalsis) that propel partially digested food through the organ. As a result, the muscular inner wall overreacts to mild stimuli like milk products and emotional stress and goes into spasm. Irritable bowel syndrome produces cramp-like pains and bouts of diarrhea and/or constipation.

The more serious disorders, Crohn’s disease, and ulcerative colitis are both forms of inflammatory bowel disease. IBD damages the tissue of the small bowel and the large bowel, respectively, through the process of inflammation. As the body’s response to injury, inflammation is characterized by blood-carrying, infection-fighting white blood cells that rush to the site of the injury. Their presence accounts for the painful swelling, warmth, and redness associated with an inflammatory reaction.

Among children, Crohn’s is two times more prevalent than ulcerative colitis. Whereas ulcerative colitis affects only the inner lining of the intestine and is confined to one section, “Crohn’s disease can penetrate the full thickness of the bowel and tends to occur in more than one area,” explains Dr. Alan Lake, a pediatrician and pediatric gastroenterologist at Baltimore’s Johns Hopkins University School of Medicine. In colitis, however, ulcers form where inflammation has destroyed the tissue. The open sores ooze blood, mucus, and pus.

The cause of inflammatory bowel disease has yet to be discovered, although theories abound. Heredity is a factor: 15 to 30 percent of IBD sufferers have a relative with either disorder.

Symptoms that Suggest Irritable Bowel Syndrome may include:

  • Cramp like pain and spasms in the lower abdomen
  • Nausea
  • Bloating and gas
  • Headache
  • Rectal pain
  • Backache
  • Appetite loss
  • Alternating bouts of diarrhea and constipation
  • Fatigue
  • Depression
  • Anxiety
  • Difficulty concentrating

Symptoms that Suggest Inflammatory Bowel Disease may include:

Crohn’s Disease

  • Cramping abdominal pain and tenderness, particularly after meals
  • Nausea
  • Diarrhea
  • General ill feeling
  • Fever
  • Appetite loss possibly leading to weight loss
  • Bloody stool
  • Swelling, pain, stiffness in the knees and ankles
  • Cankerlike sores in the mouth
  • Eye inflammation
  • Irritation or swelling around the rectum
  • Fatigue
  • Depression
  • Anxiety
  • Difficulty concentrating
  • Delayed growth and sexual development in younger teens, due to lack of nutrition

Ulcerative Colitis

  • Pain and cramping in the left side of the abdomen
  • Intermittent episodes of bloody, mucus-like stool
  • Swelling, pain, stiffness in the knees and ankles
  • Canker-like sores in the mouth
  • Fatigue
  • Depression
  • Anxiety
  • Difficulty concentrating
  • Growth retardation in younger teens, due to lack of nutrition

Acute attacks may include:

  • Up to twenty bloody, loose bowel movements a day
  • Urgent need to move bowels
  • Severe cramps and rectal pain
  • Profuse sweating
  • Dehydration
  • Nausea
  • Appetite loss
  • Weight loss
  • Abdominal bloating
  • Fever up to 104 degrees F

You can see that many of the symptoms overlap, making diagnosis complicated at times. In general, says Dr. Lake, “the patient with ulcerative colitis has more bloody bowel movements, and the patient with Crohn’s disease experiences more pain.” He goes on to say that while ulcerative colitis is usually picked up quickly, “with Crohn’s disease, many months can pass between the onset of symptoms and the time of diagnosis. Not only are the symptoms subtle, but they can be minimized by cutting back on eating. So it can be difficult for parents to recognize that something is the matter.

“Frequently, kids are diagnosed because they develop inflammation elsewhere, like the eyes, the mouth, and the rectum. If your child has irritation or swelling around the rectum,” he advises, “never assume that it is hemorrhoids, which is all but unheard of in children. The concern should be that he or she has Crohn’s disease.”

How Irritable Bowel Syndrome is Diagnosed:

Physical examination and thorough medical history, plus one or more of the following procedures:

  • Urinalysis
  • Urine culture
  • Complete blood count
  • Erythrocyte sedimentation rate (sed rate) blood test
  • Stool blood test
  • Sigmoidoscopy

How Inflammatory Bowel Disease is Diagnosed:

Physical examination and thorough medical history, plus one or more of the following procedures:

  • Complete blood count
  • Prothrombin time blood test
  • Erythrocyte sedimentation rate (sed rate) blood test
  • Stool blood test
  • Urinalysis
  • Sigmoidoscopy or colonoscopy
  • Upper gastrointestinal (GI) series (also known as a barium swallow)

Still, other laboratory tests may be ordered.

How Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) is Treated

All of these chronic conditions are incurable but treatable, meaning that steps can be taken on several fronts to reduce the frequency and severity of symptoms.

  • Changes in diet: Boys and girls with IBS or IBD are able to eat relatively normally when the disease is in remission, which is much of the time. During flareups, though, they need to be conscientious about avoiding certain foods. Your pediatrician will work with a nutritionist or a GI specialist to tailor an eating plan for your youngster.
  • In irritable bowel syndrome, adding roughage to the diet may be all that’s necessary to ease cramping and soften hardened stool or eliminate diarrhea. However, high-fiber foods induce the opposite effect in a teen with Crohn’s disease or ulcerative colitis, who should stick to easy-to-digest low-residue items like broth, gelatin, skinless poultry, fish, rice, eggs, and pasta. Fried foods and dairy are also taboo when the disease is active.
  • Memo to Mom and Dad: Help spare your son or daughter some of the unwelcome consequences of IBD by serving five or six small meals a day instead of the customary big three.
  • Drug therapy: If diet alone doesn’t bring relief from an irritable bowel, occasionally a pediatrician will prescribe an antispasmodic agent to slow down its activity. Medication is usually indicated in Crohn’s disease or ulcerative colitis, where the favored drugs include corticosteroids such as prednisone (“the cornerstone of treatment,” according to Dr. Lake), and the 5-ASA agents sulfasalazine, olsalazine, and mesalamine. Should these fail to stem the inflammation, your pediatrician might prescribe one of the following immunomodulators: azathioprine, cyclosporine, methotrexate or 6-mercaptopurine. They work by altering the body’s immune response. An IBD patient’s medicine cabinet often contains antibiotics and antidiarrheal medicines as well.
  • Dietary supplements: From a child’s perspective, one of the most upsetting effects of inflammatory bowel disease is its suppression of growth and sexual maturity. Large doses of prednisone can decelerate physical development; accordingly, pediatricians lower the dose or gradually take young people off the drug once it has controlled the inflammation.
  • The main cause of poor growth, however, is insufficient nutrition. Adolescents with IBD sometimes fall into the habit of skimping on breakfast and lunch in order to avoid repeated trips to the bathroom while at school. As a result, they may be lacking in calories, nutrients, vitamins, and minerals. Protein is especially crucial for growth.
  • Your pediatrician will monitor your child’s eating patterns. Most nutritional deficiencies can be corrected by tinkering with the diet. If necessary, though, she can prescribe oral supplements and/or high-calorie liquid formulas.
  • Surgery: Cases of inflammatory bowel disease that resist drug therapy or develop complications may require an operation to remove part or all of the colon. This route is rarely taken during the teen years.
  • Mental health care: Emotional stress does not cause IBS or IBD, but it can aggravate either condition. Therefore, patients may benefit a great deal from seeing a mental health professional who can teach them stress-reduction techniques such as progressive muscle relaxation and progressive guided imagery. As with other chronic ailments, inflammatory bowel disease can be frustrating for teenagers. Flareups often leave them more dependent on their parents than they want to be and make them feel different from their friends. They may feel as though their body has betrayed them. If you suspect that your son or daughter is having a hard time coping, ask your pediatrician for a referral to a suitable counselor.

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About Crohn's Disease

Still Tired liveing with crohns

When my Crohn’s disease is active, my fatigue can be debilitating. Sometimes I’m forced to stop answering phone calls because I literally don’t have the energy to construct sentences. I don’t allow myself to drive because it doesn’t feel safe. I’m basically unable to do anything except the bare minimum, and when I come out on the other side I feel like I’ve been in the deepest fog.

How can I be so tired?

After experiencing fatigue like this on and off for quite a while, I began to wonder how I could possibly be SO tired. I was ‘sleeping’ ten to twelve hours a night and taking a nap during the day. What more could my body possibly want? I wasn’t working. I wasn’t moving much. In fact, I wasn’t using any more strength than necessary, and yet, it still felt like too much.

Anyone with IBD knows that when you’re sick, it often feels like more than just stool emptying from your bowels. It feels like life is emptying out too.

Fatigue and mental health

I found the fatigue contributed to my anxiety and depression, affecting my mental health too. It seemed like I was trapped in this awful cycle and all I could do is come up for air between episodes.

During that time, I took prescription sleep medication, I worked with a sleep doctor, and underwent multiple normal sleep studies. I even followed suggestions on reducing screen time, creating sleep hygiene and more, but no matter what, I felt exhausted all of the time.

Sleep versus rest

This was when I learned the difference between being asleep, and getting rest. Being in bed, tossing and turning, waking up during the night – they all impact our ability to achieve deep sleep cycles characterized by faster breathing, a faster pulse, and rapid eye movements, or REM. There were times that my body may have been unconscious, but it most certainly wasn’t at rest.

It became clear to me that I had to learn how to dedicate time to conscious rest when I was awake. To be honest, this felt awkward and like something I was embarrassed about. Have you ever sat down to do something like this?

Changes I made

There were three changes I made that over time have significantly impacted my levels of fatigue, and I’d really like to offer them as suggestions to anyone who is struggling.

  1. Scrolling through social media, even while laying in bed, doesn’t count as resting. When you brain is actively thinking about things you want, need, or are missing out on, it impacts your body’s ability to rest. Schedule in some breaks to put your phone down.
  2. Guided imagery and meditation are real things that relax your mind AND your body. I rely on the Calm app, but there are others out there as well which offer you these services right from your phone. Quieting your brain quiets your body in a real, lasting way.
  3. Aromatherapy – certain scents are tied to physical relaxation. Whether you purchase a linen spray, light a candle, burn incense or diffuse essential oils, or take a bath with bubbles or salts or bombs, aromatherapy draws upon the healing powers of the leaves, flowers, stems, bark, roots or petals of plants to stimulate the natural healing action of both your body and your mind.
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About Crohn's Disease

Tips on Asking for Support During Crohn’s or UC Flares

If you’re living with inflammatory bowel disease, you know that your life, health, abilities, and capabilities can change dramatically in a short period of time. From my experience, no matter how much I plan for the next flare, there are always things I wish I had done, I need but don’t have, or I would really benefit from help.

Asking for help during a Crohn’s or UC flare

I’ve thought a lot about this and about how it feels hard to ask for help. I don’t usually know what to ask for directly so I often keep quiet, and I never know who exactly I should reach out to in the event that I need (or want!) physical things or tangible assistance.

I wanted to share with you some thoughts I’ve put together after a lot of trial and error. To be honest, it’s SO MUCH better for my mental health and my stress levels as my symptoms increase to know that I know how to best ask for support and that I’m not alone in my trials, especially when this disease can feel so isolating.

Things that are helpful when dealing with a flare

In no particular order, here are some things that have worked for me:

  1. Keep a list in your phone of a few people who are local that you trust, and that might be able to do you a favor when you don’t feel well. Depending on your needs, this might mean stopping at the store, dropping off a cooked meal, picking up a prescription, taking you to a doctors appointment, sitting with you in the ER or visiting you at home or in the hospital.
  2. Then, add to the bottom of that list, a few people who might not necessarily be nearby, but who understand your heart. People you can call or facetime or text when you want to cry or vent or be distracted. One important note here: don’t leave out your other friends with IBD! I’ve often avoided telling them that I was doing poorly because I knew they had struggles of their own, and in retrospect, they wished they’d been able to be there for me. They understood my plight directly and agreed they’d tell me if whatever I was telling them or asking them in terms of support felt like too much at any given time.
  3. Think about your necessities during a flare: what foods or meal replacements you can tolerate, what clothes and basic household items that you both need and that would make you more comfortable, and anything that might cheer you up.
  4. If you have a roommate, live with family, have a spouse, children or pets, think about if they can help and/or have needs of their own while you are down and out.
  5. In the event that a friend or family member reaches out and asks what they can do for you, or what they can bring you or send to you, I’ve found politely declining over and over is a loss for both myself and the other person. They genuinely want to help, and I honestly could use it. I have found it to be easiest to have direct and tangible items I can ask for – such as groceries, prepared meals (or meal delivery), conversation to take my mind off of things or company when I don’t have the energy to talk.

Living with inflammatory bowel disease is hard enough, there’s absolutely no reason to decline help or support simply because you don’t know how to ask, or don’t want to inconvenience someone who has already offered.

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About Crohn's Disease

Inflammatory Bowel Disease

What is Inflammatory Bowel Disease (IBD)
Inflammatory Bowel Disease is a group of chronic lifelong conditions affecting the digestive tract. It includes both Ulcerative Colitis (UC) and Crohn’s Disease (CD) which are similar but affect different parts of the intestine. UC affects the inner lining of the large intestine while CD can affect any part of the digestive tract from the mouth to the anus. You can read further information on IBD in this patient information leaflet

Clinical features of Inflammatory Bowel Disease
The main features of IBD are bloody diarrhoea associated with frequency, urgency and abdominal cramps.  In severe attacks patients may suffer weight loss and anorexia.

In addition patients may have symptoms from outside the digestive tract including:

•         Arthritis (large joints)
•         ankylosing spondylitis
•         erythema nodosum
•         pyoderma gangrenosum
•         iritis and episcleritis (inflammation of the eyeball)
•         primary sclerosing cholangitis (75% pts have IBD, Geonzon –Gonzales 2006)

How common is IBD?

•         15,000 people in Ireland have IBD
•         Incidence in Ireland – 6,000 UC
                                        – 3,000 CD

What causes IBD?
The cause of IBD is unknown but is thought to include:   Genetic susceptibility
A familial tendency 
Environmental factors -smokingstress

non-steroidal anti-inflammatory drugs  

history of appendectomy

history of infection with mycobacteria  

activation of the immune system

possibly diet but not proven

•         Infective agents
•         Seasonal changes
•         Stress – implicated in aetiology of disease  (Mawdsley & Rampton 2005)

Treatment of IBD
Treatment for IBD is often simple and includes both local and oral medications, often the condition can be managed in the community by the patient’s General Practitioner after consultation with a Specialist. Regular review by a specialist is recommended for complex therapies and disease. Surgery may be required in difficult cases.

Mary Kennedy is the IBD Clinical Nurse Specialist at TUH. The IBD nurse is often your first point of contact if you require any advice regarding your disease. She provides a rapid point of access for IBD patients, in particular she can provide support, advice and information on your inflammatory bowel condition. Also, she will play an active role in disease and drug education and management. Treatments such as Infliximab (Remicade) and Adalimumab (Humira) are administered by the IBD Nurse.

An advice line is run by the IBD Nurse and the contact number is 01 414 3855.

TUH Gut Therapy Programme for IBS
The chronic diarrhoea pathway aims to provide patients with diarrhoea symptoms of Irritable Bowel Syndrome (IBS) with fast access to the most appropriate investigations and management of their condition. Patients aged over 45 with chronic diarrhoea of more than one month duration will be automatically be triaged for a colonoscopy. If this and blood tests are normal they subsequently attend the dietitian led gut therapy clinic.

Patients aged under 45 with chronic diarrhoea of more than one month duration with red flag symptoms such as bleeding, weight loss, anaemia and family history of bowel cancer or IBD will also be automatically be triaged for a colonoscopy. If this and blood tests are normal they subsequently attend the dietitian led gut therapy clinic. 

Patients under 45 who do not have red flag features will have blood and stool tests done. If these are normal they attend the dietitian led gut therapy clinic, if an abnormality is detected they have a colonoscopy and are managed as appropriate after that.

Its most notable attribute is its effect on wound management and healing. Manuka honey also has antibacterial, antiviral and anti-inflammatory properties that may help treat numerous ailments, including irritable bowel syndrome, gastric ulcers, periodontal disease and upper respiratory infections.

Honey is well known for its anti-inflammatory and antioxidant capacities, which may be useful for the prevention of chronic inflammatory process like atherosclerosis, diabetes mellitus and cardiovascular diseases. The antibacterial, anti- inflammatory and antioxidant properties of honey

What is the fastest way to get rid of inflammation in the body?Follow these six tips for reducing inflammation in your body:

  1. Load up on anti-inflammatory foods. …
  2. Cut back or eliminate inflammatory foods. …
  3. Control blood sugar. …
  4. Make time to exercise. …
  5. Lose weight. …
  6. Manage stress.

Does b12 reduce inflammation?Vitamin B6, folate (B9), and B12 can lower your levels of homocysteine, an amino acid that’s linked to a greater risk for heart disease and rheumatoid arthritis. But we can’t say for sure that lowering homocysteine will also lower your risk for disease. The same is true for C-reactive protein, a sign of inflammation.

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