Inflammatory bowel disease

Also called Crohn's disease, Ulcerative colitis, IBD

The immune system attacking the gut. Not IBS, not a food intolerance, and not something anybody caused.

What it is

Around 1 in 123 people in the UK have inflammatory bowel disease. Roughly half of them wait more than a year for a diagnosis, and a good many are told first that it is stress or irritable bowel syndrome.

Two main forms. Crohn's disease can inflame anywhere from mouth to anus, through the full thickness of the bowel wall. Ulcerative colitis affects the large bowel only, and only the lining. Both are autoimmune, both relapse and remit, and neither is caused by diet or by worrying.

The distinction from IBS matters enormously: IBD causes visible inflammation and tissue damage, and it needs immune-suppressing treatment rather than reassurance.

Signs you might notice

Diarrhoea lasting weeks, often with blood or mucus.

Abdominal pain and urgency. Waking at night to open bowels, which is a useful pointer away from IBS.

Weight loss, fever, and profound fatigue.

Mouth ulcers, sore eyes, joint pain and skin rashes, because this is a whole-body condition.

Anaemia that keeps returning.

How it can affect day-to-day life

The toilet question dominates daily life more than anything clinical. Planning journeys around facilities, urgency with almost no warning, and the humiliation of being refused access to a staff toilet.

Fatigue is consistently rated by patients as the worst symptom and consistently under-treated by clinicians.

Steroids get used as a crutch. They work fast, and they carry real long-term harm, so repeated courses are a signal that the underlying treatment needs escalating rather than a sign of good control.

Supporting someone well

Take the maintenance medication in remission. Stopping when well is the commonest cause of a flare.

Get a Can't Wait card and a RADAR key. Small things, enormous difference to whether somebody leaves the house.

Treat fatigue as a symptom worth investigating: check iron, B12 and inflammation rather than accepting it.

Ask for a named IBD nurse and a flare plan, so a flare gets treated in days rather than after a four-week wait.

Do not suggest diets. Elimination diets without dietetic supervision cause malnutrition and do not treat inflammation.

In a service or a school, put toilet access in writing rather than leaving it to whoever is on duty.

Where to get help

Ask a GP for a faecal calprotectin test, which distinguishes inflammation from IBS, and for a gastroenterology referral.

Crohn's and Colitis UK run a helpline and produce the Can't Wait card.

Severe pain with a distended abdomen, high fever, or heavy rectal bleeding needs urgent assessment.