Crohn’s Disease and ulcerative colitis - Inflammatory Bowel Disease (IBD)

These are two conditions which can give similar symptoms and which usually start between the ages of 15-35.

Ulcerative Colitis (incidence 1:600)
This is confined to the colon and rectum (the large bowel). Sometimes the rectum alone is involved. Inflammation and ulceration of the lining of the bowel cause urgent diarrhoea which can be very frequent. Bleeding from the rectum with mucus in the stool is a common feature. Sufferers also complain of abdominal pain and tiredness. There is a risk of developing bowel cancer later in life so regular follow up is essential.

Crohns Disease (incidence 1:1000)
This causes frequent, urgent diarrhoea, sometimes with blood. Abdominal pain, tiredness and weight loss are common. Crohns disease usually affects the small intestine, but may be more widespread through the gastrointestinal system. It can present itself in a greater variety of ways than ulcerative colitis, for example it could start with fissures around the anus.

Both conditions tend to ‘relapse and remit’. ie there are times of being very well with no symptoms and times when the condition flares up. Symptoms can vary, but the usual course is for individuals to suffer intermittently rather than to have symptoms continuously.

Both conditions require anti-inflammatory drug treatments, but there are some differences between the two in the choice of drugs. Steroids are often needed either locally in the rectum, or orally to treat acute attacks. Frequently relapsing cases will need immunosuppressive treatments such as azathioprine.

Irritable bowel syndrome (IBS) is NOT a precursor of these inflammatory bowel diseases. There are no pathological, inflammatory changes in the bowel in IBS. However, episodes of IBS can occur during the remission of IBD. It is important not to follow the usual advice of a high fibre diet during an episode of IBS if you suffer from inflammatory bowel disease, when a low residue diet is more appropriate.

Further information

This article published on
25 November 2005

Next review date 11/1/2013


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