Inflammatory bowel disease (IBD): symptoms, treatment and diet

The NHS says treatment for IBD depends on your symptoms. If you are very unwell you may need to be treated in hospital. Treatment aims to settle a flare-up and reduce the chance of it coming back. You will usually be looked after by a specialist team that includes a gastroenterologist, with regular check-ups and tests.

The NHS pages for Crohn's disease and ulcerative colitis list the main groups of medicine. Your own plan depends on which condition you have, how much of the gut is affected and how severe your symptoms are, so you will probably need different treatments over time.

• Medicines to reduce inflammation in the gut, such as steroids (usually for a short time to treat a flare-up), mesalazine or sulfasalazine.

• Medicines that reduce the activity of the immune system (immunosuppressants), such as azathioprine or mercaptopurine.

• Biological therapy, which targets specific proteins that cause inflammation, such as adalimumab or infliximab.

• Medicines for particular symptoms, such as painkillers, laxatives or medicines to stop diarrhoea, and supplements such as calcium or vitamin B12.

• A special liquid diet (enteral nutrition) instead of medicines, which the NHS says may be recommended for children or for people who cannot take steroids.

• Surgery, if symptoms are severe or medicines are not working.

IBD is an umbrella term, not a single disease. In IBD the lining of the gut becomes inflamed (swollen) and can develop ulcers. Guts UK describes it as a group of digestive conditions characterised by chronic inflammation in the gut, and says symptoms can differ for each person because IBD can affect different parts of the digestive system.

The NHS lists three main types. Crohn's disease and ulcerative colitis are the best known; microscopic colitis is less often discussed and, Guts UK says, is thought to be under-diagnosed.

The NHS lists the main symptoms of IBD as diarrhoea that lasts longer than 4 weeks, tummy pain, blood or mucus (clear slime) in your poo, bleeding from your bottom, feeling tired all the time and losing weight without trying.

Symptoms often come and go. Both NHS condition pages describe periods of remission, with few or no symptoms, followed by flare-ups that can last from a few days to several months.

• Crohn's disease can also cause constipation, pain in or around the anus, loss of appetite, and in children, not growing as expected or delayed puberty.

• Ulcerative colitis can cause needing to poo frequently, urgently or during the night, feeling you need to poo even when your bowel is empty, and bloating.

• During a flare-up, symptoms can appear elsewhere in the body, including swollen or painful joints, red or sore eyes, mouth ulcers, a high temperature and skin changes.

• Flare-ups may be triggered by stress, infections, changes in medicines, taking NSAIDs such as ibuprofen or aspirin, or certain foods; sometimes there is no obvious trigger.

There is no single IBD diet. The NHS says that Crohn's disease can make it harder for the body to absorb nutrients, so a healthy, balanced diet is important, but it also says there is no clear evidence that a special diet or particular foods help. Some people find that certain foods affect symptoms such as diarrhoea, bloating or constipation, and this is different for everyone.

The NHS suggests keeping a diary of what you eat, any changes in your medicines and stress, to see whether certain things seem to affect your symptoms. It advises against making big changes to your diet without advice from your healthcare team, and your team can refer you to a dietitian.

For ulcerative colitis the NHS also suggests drinking plenty of fluids if you have diarrhoea, eating a balanced diet and keeping alcohol to no more than 14 units a week, because alcohol can irritate the digestive system.

There is no single test. The NHS says that if a GP thinks you could have Crohn's disease they may arrange blood tests and a poo sample, and you will be referred to a specialist in hospital for more tests to confirm the diagnosis.

Hospital tests can include a colonoscopy, endoscopy or gastroscopy (a thin tube with a camera passed through the throat or bottom), a small tissue sample (biopsy) and scans such as MRI, CT or ultrasound. The NHS says it often takes time to get a diagnosis because symptoms vary and can look like other conditions, including IBS, diverticular disease and coeliac disease.

The NHS says Crohn's disease symptoms most commonly start in teenagers and younger adults, and that in children it can cause poor growth or delayed puberty. Guts UK says Crohn's disease is most often diagnosed before the age of 30 and ulcerative colitis between 15 and 25.

For ulcerative colitis, the NHS lists delayed puberty or stunted growth in children as a possible complication. A child with ongoing bowel symptoms or poor growth should be seen by a GP. The NHS says an enteral nutrition liquid diet may be recommended for children instead of medicines.

The NHS says you can usually have a healthy pregnancy if you have Crohn's disease, but that symptoms that are not well controlled can make it harder to get pregnant or cause problems in pregnancy. It advises speaking to a specialist if you want to try for a baby or find out you are pregnant.

Some medicines used for Crohn's disease are not suitable in pregnancy, so treatment may need to change, and some medicines can also affect male fertility. Do not stop any medicine without advice from your IBD team.

Use the NHS advice below as a guide. If you already have an IBD team, the NHS says you can also contact your care team during a severe flare-up.

• Call 999 or go to A&E for severe tummy pain, bleeding non-stop from your bottom, a lot of blood or large blood clots when you poo, or vomiting blood or poo, or sick that looks like coffee grounds or soil. The NHS says not to drive yourself.

• Ask for an urgent GP appointment or call NHS 111 for very bad or bloody diarrhoea, black or dark red poo, a high temperature or feeling hot, cold or shivery, a fast heartbeat, or being unable to fart or poo.

• See a GP for diarrhoea lasting more than 7 days, tummy pain or bloating that does not go away or keeps coming back, blood or mucus in your poo, or weight loss you cannot explain.

The NHS says complications of Crohn's disease can be serious but that the right treatment reduces the risk. They include a fistula (an abnormal tunnel from the bowel to another body part), an anal fissure, a narrowed section of gut (stricture), a hole in the bowel wall and, in people at high risk, bowel cancer, for which colonoscopies may be offered.

For ulcerative colitis the NHS lists anaemia, weak bones (osteoporosis), depression and anxiety, not getting enough vitamins and minerals, and a higher risk of bowel cancer, for which you will be offered regular bowel cancer screening. The NHS also advises going to those screening appointments and having the vaccinations you are offered, as some IBD medicines make infections more likely.

On the NHS, IBD is usually suspected in primary care, with blood and poo tests, and then confirmed by a hospital gastroenterology team. Long-term care is shared between that team and your GP.

Private gastroenterology services can offer assessment, colonoscopy and scans, and some people use them to shorten waiting times for tests. Whichever route you use, ask who will coordinate your long-term monitoring, how flare-ups will be handled and how your results will be shared with your GP.