Bowel down

Crohn’s disease and ulcerative colitis are the two most common forms of inflammatory bowel disease (IBD), affecting over 500,000 people in the UK, usually between the ages 15 and 25. Both conditions have a significant effect on the digestive tract, with colitis triggering inflammation and ulceration on the inner lining of the colon and rectum, while Crohn’s causes the gut wall to become inflamed. 

“Crohn’s and colitis happen when the body’s immune system goes wrong,” says the charity Crohn’s & Colitis UK. “We don’t know why the immune system attacks the body, but it’s probably a mix of genes and the environment.” 

In addition to this, some studies have found that a low intake of fruit and vegetables as well as high consumption of red meat could be factors. 

Symptoms of the two conditions are fairly similar. Those who suffer from Crohn’s disease will experience abdominal pain, diarrhoea, blood in faeces, fatigue, mouth ulcers, loss of appetite, weight loss and anaemia. For colitis, diarrhoea (often with blood or mucus), cramps, loss of appetite, weight loss and anaemia are all common signs. 

“Faecal incontinence or being woken up in the night by the need to defecate are common symptoms of Crohn’s or colitis, but very rare with IBS,” says Dr Marion Sloan, GP and chair of the Primary Care Society of Gastroenterology. “The risk of developing Crohn’s or colitis is three times higher if the patient has a family history, while having other inflammatory conditions, or a history of multiple autoimmune disorders, could also point towards Crohn’s or colitis.”

There is currently no cure for ulcerative colitis or Crohn’s disease, and treatment depends on how severe the symptoms are, and how much of the gut is affected. 

Patients suffering from Crohn’s disease may need to take steroids from time to time. These can help to relieve symptoms by reducing inflammation in the digestive system, but can cause side effects like weight gain, indigestion and sleeping problems. Customers should be advised that steroids can take a few days, even weeks, to start to work, and should not be started or stopped without professional medical advice. 

Aminosalicylates (5-ASAs) are often used to treat those suffering from mild to moderate ulcerative colitis as, like steroids, they help to reduce inflammation and allow damaged tissue to heal. 5-ASAs can be taken orally, as a suppository or through an enema – how they are taken usually depends on the severity of the patient’s condition. Unlike steroids, 5-ASAs rarely have side effects, but customers may experience headaches, stomach pain and a rash. 

Some 20 per cent of people experience constipation regularly, according to the charity Bladder & Bowel UK. While bowel movement frequency varies from person to person, it’s likely to be constipation if an individual has not defecated at least three times in a week, if stools are hard, lumpy and/or dry, or they are straining or in pain. 

“It’s important for people to understand what is their ‘normal’ so they can recognise when they need to seek help,” says Julie Thompson from Guts UK. “Constipation can be caused by lack of fibre, lack of activity or insufficient fluid intake. It could also be the result of medication, especially those containing opioids. It’s also common in people with neurological disease such as Parkinson’s and MS.”

Regular meals and plenty of water every day should make a difference to those suffering from constipation. Increasing fibre intake also helps some people. 

“Aim for a minimum of five portions of fruit and vegetable per day,” says Julie. “Particularly good for constipation are prunes and kiwi. Increase the intake of fibre slowly. Also include wholegrain carbohydrates and drink two litres of fluid a day.” 

Additionally, pharmacy staff can recommend that customers make sure they are regularly exercising to get their digestive system moving. Should symptoms persist, laxatives can be recommended, but these should not be taken frequently. 

Symptoms of diarrhoea include cramping pains, loose stools, headache, vomiting and sometimes fever. Most cases can be treated in the pharmacy. 

“Acute diarrhoea is generally caused by gastroenteritis or food poisoning. This is usually short-lived. Diarrhoea that lasts longer than four weeks should be investigated to identify the cause,” explains Julie. “Some of the common causes of chronic diarrhoea are IBS, food intolerance, inflammatory bowel disease and bowel cancer.” 

Customers should also be referred if they report diarrhoea for 14 days plus, have blood in their faeces, a high fever, severe abdominal pain, are unable to keep fluids down and are dehydrated.

Rehydration is essential because additional fluids are needed to replace those that have been lost. Over the counter oral rehydration sachets can be recommended.

There is no need for sufferers to stop eating, but it might be beneficial to avoid dairy and spicy foods. Small, light meals are best, including carbohydrates to promote fluid and salt absorption. If symptoms persist, anti-diarrhoeals (e.g., loperamide) can be used to shorten an attack.