| What is inflammatory bowel disease? |
An estimated more than 1 million Americans have ulcerative colitis or Crohn’s disease, the two most common forms of inflammatory bowel disease (IBD). These conditions, which can be painful and debilitating, cause chronic inflammation of the digestive tract.
Ulcerative colitis and Crohn’s disease are very similar — so similar, in fact, that they're often mistaken for one another. Both inflame the lining of your digestive tract, and both can cause severe bouts of watery diarrhea and abdominal pain. But Crohn’s disease can occur anywhere in your digestive tract, often spreading deep into the layers of affected tissues. Ulcerative colitis, on the other hand, usually affects only the innermost lining (mucosa) of your large intestine (colon) and rectum.
No one knows exactly what causes IBD, although your immune response and certain genetic and environmental factors may play a role.
Currently, there’s no known cure for either ulcerative colitis or Crohn’s disease. But the news is encouraging. Researchers recently identified a gene that, when defective, can trigger Crohn’s disease in some people. This discovery may lead to more effective treatments in the future.
For now, several therapies are available that may dramatically reduce your symptoms and even bring about a long-term remission.
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| Signs and symptoms |
Ulcerative colitis and Crohn’s disease share many common symptoms. These symptoms, which may develop gradually or come on suddenly, include:
- Chronic diarrhea. Inflammation causes cells in the affected areas of your intestine to
secrete large amounts of water and salt. Because normal intestinal absorption is impaired, your colon
can’t absorb this excess fluid, and you develop diarrhea. In addition, your intestines may contract
more than normal, which can also contribute to loose bowels.
- Abdominal pain and cramping. The walls of your intestines may become inflamed and swollen
and eventually may thicken with scar tissue. This blocks the movement of waste through your digestive
tract and may cause pain, cramping or vomiting.
- Blood in your stool. Food moving through your digestive tract can cause inflamed tissue to
bleed. But your intestines may also bleed on their own. You might notice bright red blood in the
toilet bowl or darker blood mixed with your stool. You can also have bleeding you don't see (occult
blood).
- Fatigue. Excessive blood loss may cause anemia and make you feel extremely tired. If you
have Crohn’s disease, inflammation in your small intestine may make it hard for you to absorb enough
nutrients to maintain your energy levels.
- Reduced appetite. Sometimes, abdominal pain and cramping and the inflammatory reaction in
the wall of your bowel may interfere with your ability or desire to eat.
- Weight loss. You’re especially likely to lose weight if your small intestine is inflamed
and you’re not able to digest or absorb much of what you eat.
- Fever. This symptom is common in severe cases of IBD.
If you have ulcerative colitis, you’ll likely have inflammation only in the innermost lining of your colon and rectum. The affected areas will be continuous, with no patches of normal tissue. You may also develop small bleeding ulcers.
Symptoms of both diseases may range from mild to severe. If you have a mild case of Crohn’s disease, you’ll likely have no more than four diarrheal bowel movements a day, little or no abdominal pain, and be able to maintain a normal weight. But if your case is severe, you may have six or more diarrheal bowel movements a day along with severe abdominal pain, weight loss, fever and other complications.
Symptoms of mild ulcerative colitis include no more than four episodes of diarrhea a day, occasional blood in your stool and few, if any, complications. In more severe cases you may have six or more episodes of diarrhea a day, frequent blood in your stool, fever and other complications.
In general, though, the course of IBD varies greatly. You may remain completely without symptoms after the initial one or two episodes of the disease. Or you may have recurrent episodes of abdominal pain, diarrhea, and sometimes fever or bleeding.
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| Causes |
No one is quite sure what causes IBD, although there’s a general consensus as to what doesn’t cause it. Researchers no longer believe that stress is the main culprit, although stress can often aggravate symptoms. Instead, current thinking focuses on the following possibilities:
- Immune system. Some scientists think IBD may be caused by an unknown virus or bacterium.
The digestive tract becomes inflamed when the body’s immune system tries to fight off the invading
microorganism. It’s also possible that inflammation may stem from the virus or bacterium itself.
- Heredity. Fifteen percent to 20 percent of people with ulcerative colitis or Crohn’s have a
parent, sibling or child who also has the disease. Scientists are searching for a gene that might make
you susceptible to IBD.
- Environment. Because IBD occurs more often among people living in cities and industrial nations, it’s possible that environmental factors, including a diet high in fat or refined foods, may play a role.
| Risk factors |
Crohn’s disease and ulcerative colitis can strike at any age, but you’re most likely to develop IBD when you’re young. Thirty percent of people with the disease are ages 10 through 19, and most are between the ages of 15 and 35. The average age at diagnosis is 27.
An equal number of men and women have IBD. Although whites have the highest risk of the disease, it can strike any ethnic group. If you’re Jewish and of European descent, you’re five times more likely to have IBD than other whites.
You’re also at higher risk if you have a close relative, such as a parent, sibling or child, with the disease. If both your parents have IBD, there’s a 50 percent chance you’ll also develop the disease.
If you live in an urban area or in an industrialized country, you’re more likely to develop either Crohn’s disease or ulcerative colitis.
| When to seek medical advice |
See your doctor if you experience a change in your bowel habits that lasts longer than 10 days or if you have any of the symptoms of IBD, such as abdominal pain, blood in your stool, ongoing bouts of diarrhea that don't respond to over-the-counter (OTC) medications or an unexplained fever lasting more than 1 or 2 days.
Although Crohn’s disease and ulcerative colitis usually aren’t fatal, they are serious diseases and may require surgery. In some cases, they may cause life-threatening complications.
| Screening and diagnosis |
Your doctor will likely diagnose IBD only after ruling out all other possible causes for your symptoms, including irritable bowel syndrome (IBS), diverticulitis and colorectal cancer. To help confirm a diagnosis of ulcerative colitis or Crohn’s disease, you may have one or more of the following tests or procedures:
- Blood tests. Your doctor may suggest blood tests to check for anemia or signs of infection.
Two newer tests that look for the presence of certain antibodies can sometimes help diagnose
inflammatory bowel disease, but these tests are accurate in only about 80 percent of cases.
- Barium enema. This diagnostic test allows your doctor to evaluate your entire large
intestine with an X-ray. Barium, a contrast dye, is placed into your bowel in an enema form.
Sometimes, air is also added. The barium fills and coats the lining of the bowel, creating a clear
silhouette of your rectum, colon and a portion of your small intestine. This test typically takes
about 20 minutes and can be somewhat uncomfortable.
- Flexible sigmoidoscopy. In this procedure, your doctor uses a slender, flexible, lighted
tube to examine the sigmoid, the last 2 feet of your colon. The test usually just takes a few minutes.
It’s somewhat uncomfortable, and there’s a slight risk of perforating the colon wall. It may also miss
problems higher up in your colon or in your small intestine.
- Colonoscopy. This is the most sensitive test for diagnosing Crohn’s disease or ulcerative colitis. It allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis. Sometimes a tissue sample can help confirm a diagnosis. If there are clusters of inflammatory cells called granulomas, for instance, it’s likely you have Crohn’s disease, since granulomas don’t occur with ulcerative colitis. A colonoscopy takes about a half-hour. You may be given a mild sedative to make you more comfortable. Risks of this procedure include perforation of the colon wall and bleeding. Occasionally, Crohn's disease affects only the small bowel and not the colon. If your doctor suspects this, he or she may perform a small bowel barium X-ray instead of colonoscopy.
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| Complications |
Both Crohn’s disease and ulcerative colitis can cause a number of complications, some of which can be quite serious.
Crohn’s disease
Crohn’s disease may result in your developing one or more of the following:
- Ulcers. Chronic inflammation can lead to open sores (ulcers) anywhere in the digestive
tract, including the mouth or anus. It’s possible to have many ulcers scattered throughout the
digestive tract, but most Crohn’s-related ulcers form in the lower part of the small intestine
(terminal ileum) or the colon or rectum.
- Fistulas. Sometimes ulcers can extend completely through the intestinal wall creating a
fistula, an abnormal connection between different parts of the intestine or the intestine and the
skin. When internal fistulas develop, food may bypass areas of the bowel that are necessary for
absorption. External fistulas can cause continuous drainage of bowel contents to your skin. In some
cases, fistulas may become infected (abscess), a problem that can be life-threatening if left
untreated.
- Obstruction. Crohn’s disease affects the entire thickness of the intestinal wall. Over
time, parts of the bowel can thicken and narrow, which may block the flow of digestive contents
through the small intestine. Some cases require surgery to remove the diseased portion of the bowel.
- Anal fissure. This is a crack, or cleft, in the anus or in the skin around the anus where
infections can occur.It's often associated with painful bowel movements.
- Malnutrition. Diarrhea, abdominal pain and cramping may make it difficult for you to eat or
for your intestine to absorb enough nutrients to keep you well-nourished.
- Other health problems. Crohn’s disease may cause problems in other parts of the body as well as in the intestines. Among these are arthritis, inflammation of the eyes or skin, kidney stones and, occasionally, inflammation of the bile ducts.
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Ulcerative colitis
The most serious acute complication of ulcerative colitis is toxic megacolon. This occurs when your colon becomes paralyzed, preventing you from having a bowel movement or passing gas. Symptoms include abdominal pain and swelling, fever and weakness. You might also become disoriented or groggy. If toxic megacolon isn’t treated, your colon may rupture, causing peritonitis, a life-threatening condition requiring emergency surgery. Having ulcerative colitis also makes it more likely you'll develop liver or bile duct disease, as well as skin, joint and eye inflammation.
IBD and colon cancer
Finally, both ulcerative colitis and Crohn's disease increase your risk of colon cancer. If you have ulcerative colitis, your risk is greatest if you've had the disease for at least 8 to 10 years and it has spread through your entire colon. You're less likely to develop cancer if only a small part of your colon is diseased.
The same is true for Crohn's disease. The longer you've had the disease and the larger the area affected, the greater your risk of colon cancer. But because Crohn’s doesn't usually affect the entire colon, cancer is less common in people with Crohn’s than in those with ulcerative colitis.
Nevertheless, if you've had any type of inflammatory bowel disease for 8 or more years, have a test for colon cancer at least once every 2 years. The most effective test is colonoscopy.
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| Treatment |
The goal of medical treatment is to reduce the inflammation that triggers symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission. Treatment for IBD usually involves either drug therapy or surgery.
Doctors use several categories of drugs that control inflammation in different ways. But drugs that work well for some people may not work for others, so it may take time to find a medication that helps you. In addition, because some drugs have serious side effects, you’ll need to weigh the benefits and risks of any treatment.
Anti-inflammatory drugs
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:
- Sulfasalazine (Azulfadine). This drug has been used to treat Crohn’s disease and ulcerative
colitis for nearly 60 years. Although it can be effective in reducing symptoms of either disease, it
has a number of side effects, including loss of appetite, nausea, vomiting, skin rashes and headache.
- Mesalamine (Asacol, Rowasa) and olsalazine (Dipentum). These medications tend to have fewer
side effects than sulfasalazine. You take them in tablet form or use them rectally in the form of
enemas or suppositories. You administer the enemas every night for 4 to 8 weeks, or until the lining
of your intestines has healed. Mesalamine enemas can relieve symptoms in more than 80 percent of
people with ulcerative colitis in the lower colon and rectum.
- Balsalazide (Colazal). This is the first new drug in 10 years to be approved for use in
ulcerative colitis. It’s another formulation of mesalamine, the compound found in drugs such as Asacol
and Rowasa. Colazal delivers anti-inflammatory medication directly to the colon. The drug is similar
to sulfasalazine, but uses a less toxic carrier and may produce fewer side. In clinical trials, the
most common side effects were headache and abdominal pain.
- Corticosteroids. Steroids can help reduce inflammation anywhere in the body, but they have numerous side effects, including a puffy face, excessive facial hair, night sweats, insomnia and hyperactivity. More serious side effects include high blood pressure, diabetes, osteoporosis, cataracts and an increased susceptibility to infections. Long-term use of these drugs in children can cause stunted growth. Doctors generally use corticosteroids only if you have moderate to severe IBD that doesn’t respond to other treatment. They may be better tolerated in enema form.
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Immune system suppressors
These drugs also reduce inflammation, but they target your immune system rather than treating inflammation itself. Because these drugs can be quite effective in treating IBD, scientists theorize that damage to digestive tissues is caused by your body’s immune response to an invading virus or bacteria or even to your own tissue. By suppressing this response, inflammation is also reduced. Immunosuppressant drugs include:
- Azathioprine (Imuran) and 6-mercaptopurine (6-MP). These are the most widely used
immunosuppressants for treatment of inflammatory bowel disease. Although it can take up to 3 months
for these medications to begin to work, they help reduce symptoms of IBD in general and can heal
fistulas from Crohn’s disease.
- Infliximab (Remicade). This drug is specifically for people with Crohn’s disease. It works
by neutralizing a protein produced by your immune system known as tumor necrosis factor (TNF).
Infliximab finds TNF in your bloodstream and removes it before it causes inflammation in your
intestines. But Remicade can also increase the risk of serious infection. The drug has been linked to
84 cases of tuberculosis (TB), 14 of which have been fatal. If you’re currently taking Remicade, talk
to your doctor.
- Methotrexate (Rheumatrex, Folex). This drug, which is normally used to treat cancer, is
sometimes used for people with IBD who don’t respond well to other medications. Short-term side
effects include nausea. Long-term use can lead to scarring of the liver.
- Cyclosporine (Neoral, Sandimmune). This potent drug is normally reserved for people who don't respond well to other medications. It's used to heal fistulas from Crohn's disease and may also improve symptoms of ulcerative colitis.
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Antibiotics
Although antibiotics generally have no effect on ulcerative colitis, they can heal fistulas and abscesses in some people with Crohn’s disease. Typical antibiotics include:
- Metronidazole (Flagyl). Once the most commonly used antibiotics for Crohn’s disease,
metronidazole can cause serious side effects, including numbness and tingling in your hands and feet
and, occasionally, muscle pain or weakness. These symptoms tend to disappear slowly, and in some cases
may never go away. Other side effects include nausea, headache, yeast infection and loss of appetite.
- Ciprofloxacin (Cipro). This drug, which improves symptoms in some people with Crohn’s disease, is now generally preferred to metronidazole. Ciprofloxacin may cause hypersensitivity to light and can stunt growth when given to children.
In clinical trials, nicotine skin patches (the same kind smokers use) seem to provide short-term relief from flare-ups of ulcerative colitis. In fact, the patches appear to eliminate symptoms in 4 out of 10 people. But they’re only effective in the short term — symptoms generally return in as little as 4 weeks.
How nicotine works isn't exactly clear. Researchers think it may protect your colon by thickening and increasing the mucus that covers the lining where inflammation typically occurs.
Other medications
In addition to controlling inflammation, some medications may help relieve your symptoms. Depending on how severe your IBS is, your doctor may recommend one or more of the following:
- Antidiarrheals. A fiber supplement such as psyllium powder, Metamucil or Citrucel can help
relieve symptoms of mild to moderate diarrhea by "bulking up" your stool. For more severe diarrhea,
loperamide (Imodium) may be effective. Use narcotics with great caution, however, because they
increase the risk of toxic megacolon.
- Laxatives. In some cases, swelling may cause your intestines to narrow, leading to
constipation. But talk to your doctor before taking any laxatives. Even those sold over the counter
may be too harsh for your system.
- Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others).
Don't use nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin) or
naproxen sodium (Aleve). These are likely to make your symptoms worse. In fact, studies have shown
that people with ulcerative colitis who took NSAIDs doubled their risk of emergency treatment for
digestive problems.
- Iron supplements. If you have chronic intestinal bleeding, you may develop iron deficiency
anemia. Taking iron supplements may help restore your iron levels to normal and reduce this type of
anemia once your bleeding has stopped or diminished.
- Vitamin B-12 injections. Vitamin B-12 helps prevent anemia, promotes normal growth and development and is essential for the digestion and assimilation of food. It's absorbed in the terminal ileum, a part of the small intestine often affected by Crohn's disease. If inflammation of your terminal ileum is interfering with your ability to absorb this vitamin, you may need monthly B-12 shots for life. You'll also need lifelong B-12 injections if your terminal ileum has been removed during surgery.
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New treatments
Several new treatments that one day may effectively relieve symptoms with fewer side effects are in various stages of research.
One of the more intriguing treatments being studied is the use of human growth hormone (HGH) in combination with a high-protein diet to treat Crohn's disease. In a clinical trial, people treated with HGH saw a reduction in their symptoms after 1 month. The benefits continued for the rest of the trial. This improvement reduced the need for steroids and immunosuppressant drugs. Side effects, which included swelling and headaches, disappeared after about 4 weeks. More research will be needed to confirm these findings in other trials and determine the long-term benefits and risks of HGH therapy for people with Crohn’s disease.
Drugs that block a protein produced by your immune system known as tumor necrosis factor (TNF) are also being tested for the treatment of Crohn's disease. These include:
- CDP-571. Antibody-based products such as CDP-571 typically contain mouse protein, which can
cause allergic reactions and other complications in humans. This antibody contains less mouse protein
than the drug infliximab (Remicade) and therefore has the potential to cause fewer side effects.
- Etanercept (Enbrel). This genetically engineered protein has receptors that bind up TNF.
- Thalidomide. Although this drug is best known for once causing severe birth defects, it appears effective in the treatment of Crohn's disease.
Finally, one of the first gene-based drugs to emerge as a result of the latest genetic research may be keratinocyte growth factor-2, a medication aimed at stimulating the growth of healthy tissue in people with ulcerative colitis and chronic wounds such as bed sores.
Surgery
If diet and lifestyle changes, drug therapy or other treatments don't relieve your symptoms, your doctor may recommend surgery to remove a damaged portion of your digestive tract or to close fistulas or remove scar tissue.
In cases of Crohn's disease, surgery can buy years of remission at best. At the least, it may provide a temporary improvement in your symptoms. During surgery, your surgeon removes a damaged portion of your digestive tract and then reconnects the healthy sections. He or she may also close fistulas or remove scar tissue.
A recent Mayo Clinic study suggests that laparoscopic surgery using small incisions can lead to improved outcomes and shorter hospital stays for some people with Crohn’s disease.
Even so, the benefits of surgery for Crohn’s are only temporary. The disease often recurs, frequently near the reconnected tissue, and sometimes elsewhere in the digestive tract.
On the other hand, if you have ulcerative colitis, surgery can often eliminate the disease. But that usually means removing the entire colon and rectum (proctocolectomy). In the past, following this surgery you would wear a small bag over an opening in your abdomen to collect waste. But a procedure that has been used for about 20 years — ileoanal anastomosis — eliminates the need to wear a bag. Instead, your surgeon constructs a pouch from the end of your small intestine. The pouch is then attached directly to your anus. This allows you to expel waste normally, although you may have as many as five to seven watery bowel movements a day because you no longer have your colon to absorb water.
| Self-care |
Sometimes you may feel helpless when facing Crohn's disease or ulcerative colitis. But simple changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.
Diet
There’s no firm evidence that what you eat actually causes IBD. But certain foods and beverages can aggravate your symptoms, especially during a flare-up in your condition. Some people with ulcerative colitis or Crohn's disease need to restrict their diet all of the time, others just some of the time. For a few people, diet seems to make little difference.
It's a good idea to try eliminating from your diet anything that seems to make your symptoms worse. Here are some suggestions that may help:
- Limit dairy products. Like many people with IBD, you may find that symptoms such as
diarrhea, abdominal pain and gas improve when you limit or eliminate diary products. You may be
lactose intolerant — that is, your body can't digest the milk sugar (lactose) in dairy foods. If so,
try substituting yogurt or low-lactose cheeses such as Swiss and cheddar for milk. Or use an enzyme
product such as Lactaid or Dairy Ease to help break down lactose. In some cases, though, you may need
to eliminate dairy foods completely. If you need help, a registered dietitian can help you design a
healthy diet that's low in lactose.
- Try low-fat foods. If you have Crohn's disease of the small intestine, you may not be able
to digest or absorb fat. Instead, fat passes through your intestine, making your diarrhea worse. Foods
that may be especially troublesome include butter, margarine, peanut butter, nuts, mayonnaise,
avocados, cream, ice cream, fried foods, chocolate and red meat.
- Experiment with fiber. For most people, high-fiber foods such as fresh fruits and
vegetables and whole grains are the foundation of a healthy diet. But if you have IBD, fiber may make
diarrhea, pain and gas worse. If raw fruits and vegetables bother you, try steaming, baking or stewing
them. You may also find that you can tolerate some fruits and vegetables but not others. In general,
you may have more problems with foods in the cabbage family, such as broccoli and cauliflower, and
with very crunchy foods such as raw apples and carrots.
- Experiment with protein. There's some evidence that eating a diet high in protein, such as
lean meats, chicken, fish and eggs, can help relieve symptoms of IBD.
- Avoid problem foods. Eliminate any other foods that seem to make your symptoms worse. These
may include "gassy" foods such as beans, cabbage and broccoli, raw fruit juices and fruits —
especially citrus fruits — spicy food, popcorn, alcohol, caffeine, and foods and drinks that contain
caffeine such as chocolate and soda.
- Eat small meals. You may find you feel better eating 5 or 6 small meals rather than 2 or 3
larger ones.
- Drink plenty of liquids. Try to drink at least 8 to 10 glasses of fluids a day. Water is
best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea
worse, while carbonated drinks frequently produce gas.
- Ask about multivitamins. Because IBD can interfere with your ability to absorb nutrients
and because your diet may be limited, you'll likely need to take a multivitamin and mineral
supplement.
- Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.
Although stress doesn't cause IBD, it can make your symptoms much worse and may trigger flare-ups. Stressful events can range from minor annoyances to a move, job loss or the death of a loved one.
When you're under stress, your normal digestive process changes. Your stomach empties more slowly and secretes more acids. Stress can also speed or slow the passage of waste through your intestines. It may also cause changes in intestinal tissue itself.
Although it's not always possible to avoid stress, you can learn ways to help manage it. Some of these include:
- Exercise. Even mild exercise can help reduce stress, relieve depression and normalize bowel
function. Talk to your doctor about an exercise plan that's right for you.
- Biofeedback. This stress-reduction technique helps you reduce muscle tension and slow your
heart rate with the help of a machine. You’re then taught how to produce these changes yourself. The
goal is to help you enter a relaxed state so that you can cope more easily with stress. Biofeedback is
usually taught in hospitals and medical centers.
- Regular exercise, yoga, massage or meditation. These can all be effective ways to relieve
stress. You can take classes in yoga and meditation or practice at home using books or tapes.
- Progressive relaxation exercises. These help you relax every muscle in your body, one by
one. Start by tightening the muscles in your feet, then concentrate on slowly letting all the tension
go. Next, tighten and relax your calves. Continue until every muscle in your body, including those in
your eyes and scalp, is completely relaxed.
- Deep breathing. Most adults breathe from their chests. But you become calmer when you
breathe from your diaphragm — the muscle that separates your chest from your abdomen. When you inhale,
allow your belly to expand with air; when you exhale, your belly naturally contracts. Deep breathing
can also help relax your abdominal muscles, which may lead to more normal bowel activity.
- Hypnosis. Studies show that hypnosis may reduce abdominal pain and bloating. A trained
professional teaches you how to enter a relaxed state and then guides you as you imagine your
intestinal muscles becoming smooth and calm.
- Other techniques. Set aside at least 20 minutes a day for any activity you find relaxing listening to music, reading, playing computer games or just soaking in a warm bath.
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| Coping skills |
Crohn's disease and ulcerative colitis don't just affect you physically — they take an emotional toll as well. If symptoms are severe, your life may revolve around a constant need to run to the bathroom. In some cases, you may barely be able to leave the house. When you do, you might worry about an accident, and this anxiety only makes your symptoms worse.
Even if your symptoms are mild, gas and abdominal pain can make it difficult to be out in public. You also may feel hampered by dietary restrictions or embarrassed by the nature of your disease. All of these factors — isolation, embarrassment and anxiety — can severely alter your life. Sometimes they may lead to depression.
One of the best ways to feel more in control is to find out as much as possible about IBD. In addition to talking to your doctor, look for information in books and on the Internet. You might find it especially helpful to talk to people who share your condition. Organizations such as the Crohn's and Colitis Foundation of America (CCFA) have chapters set up across the country. Your doctor, nurse or dietitian can locate the chapter nearest you, or you can contact the organization directly. In many parts of the country, local newspapers also publish the times and locations of various support group meetings.If possible, take your family with you to meetings. The more they know about your disease, the better able they'll be to understand what you're going through.
Although support groups aren't for everyone, they can provide valuable information about your condition as well as emotional support. Group members frequently know about the latest medical treatments or integrative therapies. You may also find it reassuring to be among people who understand what you're going through.
Some people find it helpful to consult a psychologist or psychiatrist who's familiar with inflammatory bowel disease and the emotional difficulties it can cause. Although living with ulcerative colitis or Crohn's disease can be discouraging, the outlook is definitely brighter than it was even a few years ago.
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| Complementary and alternative medicine |
More and more people are interested in nontraditional approaches to healing, especially when standard treatments produce intolerable side effects or aren’t able to provide a cure. To address this growing interest, the National Institutes of Health established the National Center for Complementary and Alternative Medicine (NCCAM) in 1992. The Center’s mission is to explore nontraditional therapies in a scientifically rigorous way. In general, alternative medicine refers to therapies that may be used instead of conventional treatments. Complementary or integrative medicine, on the other hand, usually means therapies used in conjunction with traditional treatments. Complementary therapies may include acupuncture or acupressure, massage, music or art therapy, guided imagery, yoga, tai chi, and hypnosis. These definitions are very fluid, however. Sometimes acupuncture might be used exclusively to treat a colon problem, for instance.
Most alternative and complementary therapies don’t simply address a problem with the body. Instead, they focus on the entire person — body, mind and spirit. As a result, they can be especially effective at reducing stress, alleviating the side effects of conventional treatments and improving quality of life.
A study published in the May 1998 issue of American Journal of Gastroenterology reported that 51 percent of people with either Crohn’s disease or ulcerative colitis had used some form of alternative or complementary therapy. Most of these people cited side effects and ineffectiveness of conventional therapies as their primary reason for seeking alternative care. Improving quality of life and being treated as a whole person rather than as a disease were also major motivations.
NCCAM’s findings are available on their Web site. You can also talk to information specialists at the Center’s Clearinghouse by 888-644-6226 between 8:30 a.m. and 5 p.m. Eastern time.
— January 22, 2002 —