Ulcerative Colitis Blog

In response to a recent blog, Lee wrote in with a question about how to approach a family member or friend about a possible diagnosis of UC. While there are certainly individual differences based upon the dynamics of each relationship, some things we have found helpful in these situations are:

1) Express that the reason you are broaching the topic is primarily out of your care and concern for the individual. For example, starting off by saying "I've noticed that you haven't really been feeling very well lately and I'm genuinely concerned about you." Some people find having a digestive illness embarrassing and difficult to talk about. Discussing symptoms of bloody diarrhea and gas is not as easy as talking about a backache or twisted knee. Others, who have been healthy for most of their lives, try to deny the symptoms for some time in the hope they will go away. Yet, the disruption to a person's quality of life and emotional health from gastrointestinal problems can be substantial. By bringing up the topic, you are demonstrating an openness and understanding.

2) Provide appropriate support. In Lee's situation, it sounds as if she is concerned a family member is exhibiting symptoms of UC and should seek medical attention. It may be helpful to mention to the individual that you happened to come across some information about a condition that seems to fit his symptoms, and would be happy to share it with him to see what his thoughts are. Providing a resource for the person you are concerned about may help him acknowledge and start understanding that perhaps something could be wrong.

3) Encourage the person to discuss these issues with a health care professional. Symptoms of UC (bloody diarrhea, constipation, abdominal pain, gas, bloating) can also be seen in irritable bowel syndrome, infectious diarrhea, proctitis secondary to sexually transmitted diseases, celiac disease, food allergy, and other forms of colitis. As such, it is important that the individual has an appropriate evaluation to determine the source of symptoms.

There are a lot of acronyms used in the medical field which can cause confusion for patients and practioners alike. A common question people have is, "What's the difference between IBD and IBS and is it possible to have both at the same time?"

First, a few definitions:

IBD = inflammatory bowel disease, encompasses a spectrum of disorders of the intestine including Crohn's disease, ulcerative colitis, and indeterminate colitis. The root of all of these disorders is a dysregulation of inflammation in the body, commonly targeted to the gut. The inflammation of IBD causes damage to the lining of the intestine resulting in an ulcerated appearance to the tissue on colonoscopy.

IBS = irritable bowel syndrome (popularly known as "spastic colon"), is a gastrointestinal disorder caused by hypersensitivity of the nerves which line the intestines. Our guts are always in motion, moving in waves of muscular contractions to help digest food (peristalsis). For most individuals, the normal movements of the gut are imperceptible. In IBS, there is a dysregulation of the how sensations are felt by the nerves in the gut causing people to feel uncomfortable even with normal peristalsis. In contrast to IBD, the lining of the intestine on colonoscopy looks normal. It is the abnormal nerves impulses that cause symptoms.

How are IBD and IBS similar?
The main similarity between IBD and IBS is that patients with either of these conditions can have very similar symptoms. Symptoms that are associated with both IBD and IBS include: abdominal pain, diarrhea, constipation, urgency, bowel frequency, bloating, nausea, and changes in appetite. Another similarity is that in a subset of patients, IBD or IBS can be triggered by a gastrointestinal infection.

How are IBD and IBS different?
IBD and IBS differ in terms of the underlying cause of the disease process, some symptomatology, laboratory tests, and treatment. As mentioned above, IBD is caused by inflammation in the intestine, whereas symptoms of IBS are cause by hypersensitivity of the nerves in the gut. Furthermore, there are some symptoms which are found in IBD that are not typically seen in IBS, including: bloody stool, weight loss, fever, oral ulcers, skin rashes, joint pains. In order to distinguish between the two, physicians rely on patient histories as well as lab tests and endoscopic results. In IBD, lab tests can indicate inflammation in the blood and stool; in IBS, these lab tests are usually normal. As noated above, inflammation of the lining of the intestine is typically seen on colonoscopy in IBD, whereas, the lining of the intestine looks normal in IBS. Finally, the treatments for the two conditions are vastly different.

Is it possible to have both IBD and IBS at the same time?
While the majority of IBD and IBS patients carry one diagnosis exclusively, it does appear that a small subset of individuals can have both. Often times this occurs in the setting of IBD when a patient has flare symptoms but turns out to have normal lab values and endoscopic tests. For these individuals, some of the medicines that treat spasms in IBS may be helpful.