Inflammatory bowel disease (IBD) is a group of disorders affecting the digestive tract. It is a disease of your immune system and includes Crohn’s disease, Ulcerative Colitis as well as Indeterminate Colitis, sometimes referred to as microscopic, lymphocytic or collagenous colitis.

IBD can cause prolonged inflammation and can occur throughout the digestive tract, including the mouth, esophagus, stomach, small and large intestine. Inflammation in any of these areas can be painful and disruptive. In rare cases it can be life threatening. Inflammation can also disrupt the body’s ability to digest food, absorb nutrients and eliminate waste. There is no cure for either Crohn’s disease or ulcerative colitis.

IBD is ongoing and life-long although you may have periods of good health (minimal/no symptoms, called remission) and times when your symptoms are more active (relapse or flare). Everyone is different: many people may have few flares, while others may have more severe disease with more frequent or severe symptoms.

The cause of IBD is not currently known, but there are a few theories. It is perhaps thought that IBD is caused by a combination of factors including genetics, abnormal function of the immune system and potential environmental factors such as viruses, bacteria, diet, smoking and stress. It is important for people to remember that there is nothing they have done to cause this disease.

The goals of treatment always include resolving or reducing symptoms and healing the bowel.

Symptoms of IBD can often include, but not limited to, abdominal pain/cramping/bloating, nausea, vomiting, diarrhea or constipation, bloody stools, joint pain, and skin or eye issues.

Reference: https://www.healthline.com/health/inflammatory-bowel-disease

Crohn’s disease causes inflammation anywhere along the digestive tract. This means it can occur anywhere between the mouth to anus, but is usually located in the lower part of the small bowel (terminal ileum) and the upper colon. It usually creates patchy areas of inflammation between healthy portions of the gut, as seen on diagnostic tests like colonoscopy. This patchy presentation generally differentiates Crohn’s from ulcerative colitis. If left untreated or in the case of severe disease, it can penetrate the layers of the bowel wall and create an abscess or fistula. Chronic inflammation can also lead to a stricture or narrowing of the bowel wall.

Crohn’s disease is generally progressive, but can be managed by medications in addition to lifestyle modifications. In severe cases, surgery to remove the diseased area may be required.

Crohn’s symptoms can range from mild to severe and usually develop gradually, but can also come on without warning. Symptoms generally include diarrhea, fever, fatigue, abdominal pain/cramping, bloody stools, and nausea.

Reference: https://crohnsandcolitis.ca/About-Crohn-s-Colitis/What-are-Crohns-and-Colitis

Complications associated with Crohn’s disease may include:

• Stricture: As a result of ongoing inflammation and then healing, the bowel may form scar tissue, which creates a narrowing of the bowel called a stricture. This is a concern because this can cause food or fecal matter to become stuck and cause a blockage or obstruction. Strictures can be treated surgically or via dilation procedure, if they become a problem.
• Obstructive symptoms include severe pain from abdominal cramping, nausea, and often vomiting and/or constipation. The abdomen may become bloated and distended. If you experience an obstructive episode, please contact your gastroenterologist or IBD nurse right away. If you have severe symptoms and to reduce risk of perforation, you should go immediately to the nearest emergency room!
• Perforation: Although rare, a severe blockage can cause perforation or rupture of the bowel wall. This will cause stool to leak and is considered an emergency situation.
• Fistula: As a result of chronic inflammation, these are tunnels that can form through the walls or 3 layers of the intestine. They can connect other sections of the bowel to the skin or even other internal organs. The most common fistula is the perianal fistula that presents in the areas around the anus. Good disease control via medications can help reduce the risk of fistula. Sometimes surgery is necessary.
• Abscess: When fistula is severe, it can find it’s way to the skin and form a pocket where fluid can accumulate or build up. If the fluid becomes infected, this is an abscess. Abscess are very painful and often cause fever, swelling to the area and sometimes drainage. Abscesses are generally treated with antibiotics and often require drainage in the ER.
• Anal Fissure: A small tear in the tissue around the anus where infection may occur, increasing risk of fistula. The most common cause of this is constipation and straining with bowel movements.
• Malnutrition and Dehydration: Diarrhea, abdominal pain, cramping and nausea may make eating unappealing or even painful. In addition to the inflammation present during a flare, nutrient absorption is difficult. It is common to develop low iron as well as B12 and vitamin d deficiency.
• Colon Cancer: Overall, the risk of colon cancer is low, however the risk of colon cancer increases over time. Screening colonoscopy usually begins 8-10 years after IBD diagnosis is made. Routine colonoscopy will continue every 2-3 years.
• Osteoporosis: Long term inflammation, surgery, corticosteroid exposure, inactivity can make it harder for your body to absorb calcium and vitamin D as well as your ability to build more bone.

Ulcerative Colitis (UC) is a chronic, inflammatory, autoimmune disease that causes small ulcerations or sores (think of a cold sore) in the inner lining of the large intestine. Inflammation almost always involves the lower end of the colon, just above the anus in the rectum and extends upward in a continuous manner, to variable distances. When only the lower colon or rectum is involved, this is called ulcerative proctitis. Unlike Crohn’s disease, inflammation is limited to the surface lining of the colon.

Ulcerative colitis is generally managed with medications and lifestyle modifications to treat symptoms while targeting the cause of inflammation.

Symptoms of UC often include blood on the surface of stool and/or in the water, bowel urgency, diarrhea accompanied by abdominal pain/cramping and even constipation. Symptom intensity can be mild to severe. Symptoms should be reported to your gastroenterologist or IBD nurse if they do not resolve in a few days.

Complications associated with Crohn’s disease may include:

• Colon Cancer: Overall, the risk of cancer is low. However, the likelihood of cancer increases after 8-10 years after IBD diagnosis is made. You are more likely to get colorectal cancer if you have severe inflammation in your colon and/or a family history of colon cancer. You will receive routine colonoscopy every 2-3 years.
• Primary Sclerosis Cholangitis (PSC): this is a condition related to the common bile ducts. These are the tubes that carry digestive bile from your liver to small intestine. If this becomes an issue, your gastroenterologist will review in more detail.
• Toxic Megacolon: Although this is rare, it is dangerous. This is caused when gases become trapped and cause the bowel to swell up.
• Perforation: Although rare, inflammation and sores on the bowel lining can develop a hole and leak contents outside of the bowel. This is considered an emergency situation.
• Bleeding: blood loss from active disease can cause iron deficiency/anemia.
• Osteoporosis: Long term inflammation, surgery, corticosteroid exposure, inactivity can make it harder for your body to absorb calcium and vitamin D as well as your ability to build more bone.

Routine testing of blood and stool will be scheduled per your gastroenterologists. Blood tests are generally requested every 2-6 months and will include complete blood count (red blood cells, white blood cells, hemoglobin), iron/ferritin, CRP (general marker for inflammation not specific to IBD), annual Vit D, and B12. Others, may be requested as needed. We ask that you complete these per the lab requisition provided to you and ensure they are up to date for your follow up visits.

Routine fecal calprotectin will be requested every 6 months and as needed.

The amount calprotectin reflects the amount of inflammation (disease activity), the higher the number the more inflammation present. Calprotectin is specific to IBD and correlates well with a colonoscopy. Meaning, if you were to do a FCP around the same time as you had a colonoscopy, the results would both indicate either active disease or not.

With other diseases such as irritable bowel syndrome (IBS), calprotectin levels are normal.

*It is important to remember that you can have inflammation without symptoms and symptoms without inflammation, particularly with Crohn’s disease.

The purpose of FCP is 3-fold:

1. Predict a flare
2. Determine if your symptoms are related to IBD vs IBS/Infection/stress, etc
3. Evaluate response to treatment *important for pharmacare approvals of your biologics or other molecules.

In the event of a positive fecal calprotectin (the higher the value, the more inflammation is present), your doctor may do one or more of the following:

1. Request a colonoscopy to confirm result or repeat fecal calprotectin
2. Add a new medication, increase the dosage or frequency of your current medication

If your FCP is normal (<100) and you are symptomatic, discussion and evaluation related to other causes for your symptoms will be completed.

Colonoscopy is performed by a colonoscope which is a long flexible tube transmitting light. The physician can accurately examine the lining of your rectum and large bowel (colon). The procedure is performed for the investigation of rectal bleeding, abnormalities noted on x-rays of the large bowel (barium enema), change in bowel habits and chronic anemia due to blood loss. Colonoscopy is the most sensitive method of discovering polyps, which represent abnormal growths of tissue.

The physician also has the ability to take pieces of tissue (biopsy) for examination under microscope and can also brush cells from the surface of suspicious areas for examination in the laboratory. Both these procedures are performed by the passage of the instruments through the tube without causing any discomfort.

Polyps can be removed through the colonoscope. A wire loop or snare is passed through the colonoscope and severs the attachment of the polyp from the intestinal wall by means of an electrical current. Polyps are usually removed because they may develop into cancer. A small per centage of polyps may already contain an area of cancer in them. Removal of colon polyps is the best method to prevent and cure colon cancer.

The colon must be completely empty of waste materials; special bowel preparation to suit your needs will be ordered by your physician. No barium study should be performed during 72 hours before the procedure and iron tablets must be discontinued one week before the procedure. If the procedure is being done on an outpatient basis someone will have to drive you home, as you would have received sedation. You should also plan to be absent from work on the day of the procedure.

While you are lying in a comfortable position the colonoscope is inserted into the rectum and gradually advanced through the colon. Examination usually occurs when the instrument is slowly withdrawn after being fully inserted along the length of the colon. Some bowel distension will result in discomfort but the procedure is usually well tolerated and rarely causes pain. Occasionally the bowel is long and tortuous and you will be aware of the physician performing technical maneuvers in an attempt to shorten the bowel to facilitate the passage of the instrument. In a minority of cases, passage of the colonoscope through the entire colon cannot be achieved. A limited exam may be sufficient if the area of suspected abnormality was well-visualized.

AFTER THE PROCEDURE: You will be kept under observation until most of the effects of the medication have worn off. Careful monitoring of the blood pressure and pulse will occur to ensure that bleeding is not occurring following polypectomy. You will also pass gas per rectum following the procedure to get rid of accumulated bowel gas.

COMPLICATIONS: Colonoscopy and polypectomy are safe and are associated with very low risk when performed by physicians who have been specially trained and are experienced in these endoscopic procedures. One possible complication is perforation in which a tear through the wall of the bowel may allow leakage of intestinal fluids. This complication, which is extremely rare, usually requires surgery. If the complication is recognized late, severe infection may occur and it could lead to death. Another complication is bleeding from the site of biopsy or polyp removal. On rare occasions it is brisk and surgery may be required. Patients at risk from heart disease may be monitored during colonoscopy as the stress of the procedure may rarely produce irregular heart rhythms.

Mezavant, Pentasa, Salofalk, Asacol, Octasa, etc.

These medications belong to a class of drugs called aminosalicylates (5-ASA), though it does NOT contain aspirin. It works by decreasing inflammation in the colon. They help to reduce symptoms of active mild to moderate disease such as diarrhea, rectal bleeding, and stomach pain.

5-ASA is “topical”, meaning it releases its action to the bowel wall and is not absorbed systemically. These are not immune suppressive.

If you are prescribed this medication, your gastroenterologist and/or your IBD nurse will review in more detail.

Prednisone, Budesonide, etc.

These medications are effective in treating mild-moderate (budesonide) and moderate-severe (prednisone) symptoms of Ulcerative Colitis or Crohn’s Disease, usually when 5-ASA is not effective or symptoms are severe.  They work by suppressing the overactive immune system which will decrease the inflammatory reaction within the GI tract.

Corticosteroids are used for the short-term treatment of symptoms. When there is a significant improvement in symptoms, the dose of prednisone is slowly reduced to zero (usually over 5-9 weeks). Prednisone is not used for long-term maintenance as it has no effect in preventing further flares and can be associated with negative long-term effects.

If you are prescribed this medication, your gastroenterologist and/or your IBD nurse will review in more detail.

Ciprofloxacin, Metronidazole, etc.

Ciprofloxacin is used generally in combination with metronidazole and it is effective in managing symptoms associated with the extraintestinal manifestations of Crohn’s Disease, including fistulas.

Metronidazole/Flagyl is commonly used in the treatment of Crohn’s Disease, Pouchitis, and C Difficile infections. Flagyl is used as a primary agent or in combination with Ciprofloxacin as it is also effective in managing symptoms associated with the extraintestinal manifestations of Crohn’s Disease, including fistulas.

Antibiotics are typically used for a course of 3 weeks. However, prolonged courses can be used to manage ongoing symptoms.

If you are prescribed this medication, your gastroenterologist and/or your IBD nurse will review in more detail.

During this time, avoid the foods that are “triggers” for you. Triggers are food and drink that can cause increased symptoms such as abdominal cramps, bloating and diarrhea; they are unique to each individual so there is not a specific list that will apply to everyone.  Common triggers may include:

• alcohol,
• sugar,
• caffeine,
• greasy foods,
• dairy products containing lactose and;
• spicy foods.

Once you have identified your triggers, you will want to reduce or even eliminate them from your diet temporarily, until your flare-up has subsided. It is important to realize the dietary triggers may cause increased symptoms without actually causing increased gut inflammation and avoiding them may not cause your flare-up to subside any faster. However, avoiding them may make you feel more comfortable until the flare-up has subsided.

Remember that your trigger foods may not always irritate your gut. If you are in remission, these foods are needed for a healthy, well-balanced diet and you may begin to slowly (1 at a time) re-introduce them into your diet.

Protein needs are higher during a flare. Optimize your intake and aim to have protein with every meal or snack.

During your acute episode, try eating small meals frequently during the day as this will be less taxing on your gut and will be easier for your digestion. Five to six meals a day are ideal. If you can make the midday meals your main meals (rather than the end of day) you may also find that food is better tolerated.

“Safe foods”, like trigger foods, are also unique to each individual. This group of foods is those that cause the least irritation for you and can help you ride out an acute episode by minimizing your gut’s reaction during digestion.

Like trigger foods, you need to identify the foods that you are able to tolerate. In general, many people find that the following foods are safe for them:

• White bread
• Herbal teas
• White rice
• Bananas
• Applesauce
• Eggs
• Meal supplements
• Chicken, turkey and other white meats

When your gut is really bothering you, some people find that the BRAT diet (bananas, white rice, applesauce and toast) is a soothing solution.

Dairy products deserve some extra attention because many IBD sufferers appear to be lactose-intolerant. If you are lactose-intolerant, it means that your body lacks the enzyme lactase and you will have difficulty digesting the lactose found in milk and some dairy products. The result may include bloating, cramping, gas and diarrhea shortly after you eat lactose-containing food and drink.

If your physician believes you are lactose-intolerant, you should stick to lactose-free milk, rice milk, potato or soy milk. A calcium supplement with vitamin D is recommended.

Soluble fibre helps to thicken stool, but be careful and test them in small amounts first.

Rich sources of soluble fibre include:

• bananas
• oranges
• avocadoes
• oatmeal
• barley
• beans
• chickpeas
• ground flaxseeds
• chia seeds
• potatoes without skin
• white rice
• white bread
• creamy nut butters
• pasta

Metamucil, psyllium husk, and partially hydrolyzed guar gum are soluble fibre supplements that can be helpful for some people. However, Metamucil and psyllium husk should be avoided in those with narrowing in their bowel.

When most people think of having Crohn’s or ulcerative colitis, they think diarrhea; however, some people experience various degrees of constipation. Constipation can be defined at the inability to pass stools on a regular basis (at least every 3 days) or perhaps not be able to fully empty one’s bowels. Constipated stools are often hard and/or dry, causing bloating, cramps, and nausea.

Constipation may be caused by a low fiber diet, medications, reduced fluid intake, inflammation or narrowing in the bowel or even the rectum.  Other disease conditions or back injuries can also complicate constipation.

Chronic constipation can cause small tears in the rectum, called fissures. In other case, hemorrhoids may develop and causing rectal itchiness, irritation and bleeding.

Some strategies for managing constipation may include, but not limited to:

• Increased fluid intake- up to 2-3L per day, to tolerance
• Slowly increased fiber (if you are on a low fiber diet or have a stricture, speak to dietitian, IBD nurse or gastroenterologist)
• Eat more chia seeds, prunes, warm prune juice, kiwi fruit, whole grains, other fruits & vegetables, leafy greens, peels and skins (if tolerated), dried fruit, coffee, tea
• Limit fatty foods, dairy, alcohol, processed grains, red meat all of which can make constipation worse
• Avoid straining with bowel movements and do not hold in your stool
• Consider elevating your feet so you are in more of a squatting position while you are on the toilet- get a “squatty potty”
• Magnesium citrate- this may cause diarrhea, speak to your dietitian, IBD nurse or gastroenterologist
• Exercise such as walking, running, yoga
• Manage stress
• Laxaday or Restoralax- these are called osmotics and found over the counter at your pharmacy. They function by drawing water from the bowel wall into the stool making the stool easier to pass. They are tasteless and can easily be added to any drink 1-3x/day, to tolerance. Speak to your gastroenterologist, IBD nurse, or dietitian
• Metamucil can be helpful, but be sure to drink plenty of fluids to avoid worsening of constipation and related symptoms
• Use caution with stool softeners and bowel stimulants as these may create dependency
• Consult with a dietitian
• Consider pelvic floor therapy if constipation is a chronic issue via specialized physiotherapist

IMPORTANT: If during a flare you are losing more fluids than you are taking in, please contact your gastroenterologist or IBD nurse, you may need urgent care for IV hydration. Symptoms of dehydration include dry mouth, concentrated/dark urine, lack of urination, dry mouth, cracked lips, headache, fatigue, light-headedness/dizziness, and/or heart palpitations.

Increase intake of tolerated fluids such as herbal tea, decaf coffee (caffeine is a stimulant), bone broth, Pedialyte or half-strength Gatorade or diluted juice (no pulp).

Your gastroenterologist may recommend vitamin &/or mineral supplementation to help address or prevent nutritional deficiencies. It is recommended that you get all of your needs from eating a well-balanced diet, but this may be difficult for some r/t disease flares, symptoms, surgeries or medications.

It is recommended that you check with your gastroenterologist before taking any supplements, herbs or complementary therapies. Some supplements can cause GI symptoms such as nausea, diarrhea or constipation. Consultation with a dietitian experienced with IBD is also recommended.

Some common supplements recommended for IBD patients may include:

1. Calcium– essential for bones and teeth. Calcium is recommended for all IBD patients particularly if you are on corticosteroids (prednisone, budesonide), have low bone density (osteopenia) or weak bones(osteoporosis). Calcium is most effective taken with vit D3. Recommended daily dose is 1000-1200mg daily, including dietary intake.
2. Vitamin D3– helps your body absorb calcium and is recommended for all IBD patients as it may also support immune function in your gut and control inflammation. Vit D is best taken with calcium and is especially important for those patients on corticosteroids, or you have weak bones or low bone density. Minimum dose recommendation is 2000IU daily, rain or shine!
3. Iron– essential for the prevention of anemia (low red blood cells which are responsible for carrying oxygen throughout the body). Inflammation/disease activity and blood loss from intestinal ulcers can cause iron deficiency. Iron should be taken with vitamin C for better absorption. It is important to have your iron levels tested before taking iron supplements!

B12– deficiency is commonly seen in Crohn’s patients, particularly if you have disease in the small intestine or if you have had surgery to remove all or part of the ileum. Vegetarians are at risk of B12 deficiency. Oral supplementation of 1000mcg B12 daily may be recommended, but some people require monthly B12 injections.

If you have IBD and are a smoker, you may wonder if smoking has an effect on your disease.

The relationship between smoking and IBD is complex. Studies have shown that people who smoke are more likely to develop Crohn’s disease and that smoking increases the severity of disease. In contrast, smoking appears to decrease the severity of disease in “some” people with Ulcerative Colitis. In clinical practice, this is actually true in many cases.

Of course, those patients with longstanding, active IBD who smoke are at increased risk of developing cancer. Smoking cessation is encouraged for all patients. Please discuss this with your family physician.

Don’t let your IBD stop you from travel! Of course, for many patients travel may be challenging, but here are some tips to help make travel more enjoyable.

1. Bring your prescription medication with you and bring enough for the entire trip and maybe a couple extra days, just in case!
2. Obtain a letter from your gastroenterologist if you need to bring any injectable medications with you. Just in case customs asks.
3. Carry your medication on you if you are traveling on a plane.
4. Keep all medications in their original containers so they are easily identified.
5. Know where the bathrooms are: If you are flying, book an aisle seat.
6. Use a bathroom locator app.
7. Travel with toilet supplies, paper, change of clothes as needed.
8. Plan travel between infusion treatments when at all possible.
9. For those on biologic therapy and are travelling out of town or country for a prolonged period of time, please speak to your IBD Nurse and Patient Support Program.

If your disease is not currently in remission, you will likely be advised to avoid extended out-of-country travel. Speak to your IBD Nurse about how best to manage your condition before traveling.

Unfortunately, fatigue is a rather common and complex symptom of inflammatory disease. Reasons for fatigue may include medication side effects, nutritional deficiency, disease activity, pain, sleep disturbances, iron deficiency, anxiety, depression, lack of physical activity and more.

It is important to understand that fatigue may be caused by factors not related to your IBD.

Generally, your gastroenterologist and IBD nurse will initially try to determine if your fatigue is related to inflammation or disease activity.

Living with IBD can certainly take a toll on mental health.  Many people struggle from time to time and experience a range of challenges related to chronic or unpredictable symptoms. This can often lead to worries about flare ups, social stigma, dietary restrictions/eating out, bathroom access and ability to work, to name a few.

It is understood that although stress may not directly cause IBD, stress can make symptoms worse and may even trigger a flare of IBD. Stress can create a complex cycle of flare ups and triggering of symptoms, which ultimately creates more stress creating a vicious cycle.

It is imperative that those experiencing stress/anxiety/depression identify personal triggers as they may relate to their symptoms. By doing so, perhaps strategies for avoiding these triggers or learning to better manage them can be made.

Importantly, our patients are encouraged to seek personal support. This may be a friend, mental health support group or a mental health professional. Many people are worried if they report stress/anxiety/depression to their health care providers or seek guidance from a mental health professional, that they will just be given medication that do not wish to take (medication can make a big difference for some people so we encourage you to keep an open mind).  However, there is data to support effective, non-medication approaches, at least as a first step to managing mental health.

Some other strategies to manage stress may include:

• Nutrition: optimize well balanced dietary intake
• Relaxation Techniques: such as muscle relaxation or belly breathing
• Mindfulness & Meditation
• CBT: cognitive behavioral therapy
• Exercise: 30 minutes of daily, intentional movement whether that is a run, walk or gentle yoga.
• Sleep Habits: create a gentle night-time routine — disconnect from electronics, hot bath, read a book, sleep and wake at the same time each night, avoid caffeine, etc.
• Get Help: Ask your gastroenterologist/IBD nurse or family physician for recommendation on referral or seek support via Crohn’s and Colitis Canada or family physician

Helpful Resources:

https://crohnsandcolitis.ca/About-Crohn-s-Colitis/IBD-Journey/Mental-Health-and-Wellness/Ways-to-Manage

https://www.mindbodymedicineclinic.com/ibd

IBS is a common condition in our IBD patients, as it is in the general population. The Canadian Society of Intestinal Research states that up to 20% of Canadians are living with IBS.

IBS is a long-term condition requiring long-term management of known symptoms. IBS is a disorder of the brain-gut interaction caused by changes in the muscles and nerves that control sensation and movement in the digestive system.

Unlike IBD, IBS does not cause changes in the bowel or increase the risk of colorectal cancer over time. It does not involve the immune system nor cause inflammation in other parts of the body like IBD can.

IBS diagnosis is based on symptoms rather than any specific diagnostic test and by ruling out other conditions such as celiac disease, diverticular disease or IBD.

There are 3 main types of IBS:

1. IBS-C- constipation (the digestive system contracts slowly)
2. IBS-D- diarrhea (the digestive system contracts to quickly)
3. IBS- M- mixed diarrhea and constipation (transit time varies)

It is important to know that what works for one person might not work for another. Also, many people experiencing IBS say that what once worked for symptom management, just does not work anymore. This can be very frustrating, understandably.

The cause of IBS is unknown, though there are many factors playing a role. These may include:

• Muscle contractions in the intestine, referred to as motility. Stronger contractions can cause gas, bloating and diarrhea. Weaker contractions can cause passage of food to slow down (slow motility) resulting in hard, dry stools or constipation.
• Nervous System issues can cause poorly coordinated signals between and intestines causing symptoms.
• Severe infection can cause IBS to develop. This is called gastroenteritis.
• Life-stress- think “brain-gut connection”. When people are stressed physically or emotionally, gut issues are common. This can actually work in reverse, where relentless gut issues cause increased stress, anxiety, or even depression.
• Changes in gut microbiome- this is challenging to manage and many people seek prebiotics and/or probiotics, unfortunately the research is not fully reliable at this time. These may certainly be worth a try if diet and stress management have been ineffective. A trained IBD dietitian or your physician can make recommendations, response continues to be somewhat trial by error, however.
• Triggers- the role of food and stress is not fully understood. However, many people have worse IBS symptoms when they eat or drink certain foods or beverages. The main offenders, but not limited to, seem to be wheat, dairy, onions, garlic, fatty foods, carbonated beverages, caffeine, alcohol, cruciferous vegetables and/or high FODMAP foods. In addition, stress may make symptoms worse, but does not cause IBS.

Symptoms may include:

• Abdominal pain/cramping
• Bloating and or gas
• Straining to have a bowel movement
• Feeling like your rectum is blocked
• Infrequent bowel movements (constipation)
• Diarrhea, especially in the AM or after meals
• Bowel urgency
• Incomplete bowel movements
• Loss of bowel control

Risks associated with IBS:

• Hemorrhoids
• Anal fissures – cracks in the lining of the anus
• Fecal impaction from constipation causing a blockage
• Rectal prolapse
• Lazy bowel syndrome caused from frequent use of laxatives
• Food elimination practices can lead to a diet limited in nutrients causing malnutrition
• Stress and anxiety can impact an individual’s quality of life

Treatment can be challenging as symptoms can change from time to time as can triggers and individual life stressors. Treatment is focused on relieving symptoms so that a person may experience an improved quality of life.

Managing IBS requires daily effort to manage triggers, dietary intake and stress. This is not an easy thing to do.

• Seek advice of trained IBD/IBS dietitian
• Seek mental health support such as mind-body medicine to manage stress- even if you don’t think you are stressed or anxious, this is still a good idea!
• Avoid food triggers, but consider slowly reintroducing healthy, whole food triggers once you feel better. Go slow.
• Eat smaller meals, chew foods well
• Eat at regular times each day, avoid skipping meals, snacking and highly processed foods
• Eat high fiber foods- go slowly, too much fiber too quickly can get held up behind constipated stools causing more pain/bloating/gas
• Psyllium to add bulk to looser stools, oats work, too!
• Osmotic medication to draw water into hard stools- speak to your physician or IBD nurse
• Drink lots of fluids, add 1-2 glasses of water with each meal and aim for 2-3L daily- especially if you are constipated
• Exercise regularly/daily- walking post meals for at least 15 minutes to help with motility and digestion
• Get sleep
• Try a low FODMAP diet
• Pelvic floor training with an experience physical therapist
• Abdominal massage can help relieve constipation by stimulating bowel movements and improving motility- there are many videos on YouTube to help guide you.
• Breathing and relaxation exercises such as diaphragmatic breathing which can help the abdominal wall relax, gentle heat, body position changes
• Your physician may be able to recommend medication in the event that other strategies have been ineffective.

Common Things That May NOT Help:

• Random elimination diets without a plan: this can lead to malnutrition and “food noise” or disordered eating patterns- seek the help of a dietitian
• Too much fiber too fast: this can cause increased gas, bloating and worsening constipation
• Overuse of laxatives for constipation- this can lead to cramping, more bloating and bowel urgency
• Detox teas and cleanses: no evidence for use in IBS. Ingredients may worsen existing symptoms and may disrupt normal bowel function rather than improve it.

When to seek help:

• Unintentional weight loss
• Severe symptoms
• Persistent vomiting
• Sudden bowel changes
• Nighttime symptoms
• Rectal bleeding NOT thought to be associated with the presence of internal or external hemorrhoids

References:

1. https://cdhf.ca/en/digestive-conditions/irritable-bowel-syndrome-ibs/
2. monashfodmap.com
3. mindbodymedicineclinic.com/ibd
4. badgut.org
5. roryrd.com

GERD is a chronic condition, requiring long-term treatment in most cases, that can range from mild to severe. It is a result of disordered valve function between the esophagus and the stomach. Normally, when you swallow food, the valve opens permitting the passage of food to the stomach and then closes to prevent food and stomach secretions from coming back up. When this mechanism fails, food and stomach acids come back up causing symptoms such as heartburn, sore throat, or persistent cough and in some case, difficulty swallowing, to name a few.

Although GERD is not related to IBD, inflammation and slower motility in the gut for some people with IBD can increase the risk of developing reflux disease.

Fortunately, many individuals can successfully manage most cases of GERD with lifestyle and dietary changes and along with the right medication, in some cases.

Symptoms

Although many people experience symptoms of reflux from time to time, perhaps from a large meal, spicy foods, or perhaps caffeine/alcohol/carbonated beverage consumption, symptoms are short lived and are not of concern. However, if symptoms persist, it is advised to speak to your family physician, IBD nurse or gastroenterologist.

Persistent symptoms may include:

• Heartburn
• Chest burning
• Regurgitation- food and acid coming up to your throat/mouth
• Sour or metallic taste
• Sore throat or hoarseness
• Persistent cough or always feeling like you need to clear your throat
• Difficulty swallowing, feeling like food is stuck

Diagnosing

Most of the time, symptoms alone will provide your doctor with the information they need to diagnose GERD. If symptoms do not respond to treatments, further diagnostic testing may be required.

Management

As mentioned above, GERD is a chronic condition, most often requiring ongoing treatment, even after symptoms are under control. Untreated GERD can result in damage to the esophagus, and a pre-cancerous condition called Barrett’s esophagus.

• Smaller, more frequent meals, eat slowly
• Avoid common food triggers such as fatty/fried foods, chocolate, mint. Carbonated beverages, caffeine, onions, garlic, citrus fruits, tomatoes and alcohol.
• Stay upright for 2-3 hours after eating
• Stop late night snacking and avoid eating for up to 4 hours before bedtime
• Raise head of your bed 6-8 inches while sleeping
• Keep a symptom diary and look for “safe foods” rather than bothersome ones
• Stress management- consider mindfulness, cognitive behavior therapy and physical exercise
• Avoid vigorous exercise for at least 1 hour after eating
• Smoking avoidance
• Achieve healthy weight
• Prescription medication when non-medicinal treatments are not helpful
• Review your current medications with your doctor- some medications such as tricyclic antidepressants, anti-inflammatory pain killers (such as aspirin or ibuprofen) or even estrogen can relax the sphincter or irritate the esophagus. This does NOT mean discontinue any prescription medications you are taking without prior consultation with your family doctor or gastroenterologist

References:

https://cdhf.ca/en/digestive-conditions/gerd/

https://www.health.harvard.edu/diseases-and-conditions/gerd-diet-foods-to-avoid-to-reduce-acid-reflux

www.badgut.org