Crohn's and Colitis. Dr. Hillary Steinhart
are likely due to simple conditions that are probably not long-lasting. Although some people feel that the symptoms are suspicious, they may deny the possibility of having a serious chronic disease, especially if they already have a family history of IBD and do not wish to face the possibility that they, too, are going to have to live with this disease. In some cases, the delay in diagnosis may be due to a general lack of knowledge on the part of the individual about what constitutes abnormal or unacceptable symptoms or due to embarrassment that they may feel in discussing their symptoms.
Another feature of IBD that may lead to a delay in diagnosis is the fact that the symptoms may come and go without any treatment, so that someone with IBD may have symptoms that go on for days or weeks and then go away on their own, and the person may feel perfectly healthy again for many weeks or months until the symptoms come back. With this pattern of symptoms, people may dismiss the episodes when they occur, thinking they will go away again on their own, and will often not mention them to their doctor or primary care provider.
Very occasionally, a delay in diagnosis may occur when a physician discounts a patient’s description of symptoms or misses important clinical clues toward making the diagnosis.
For most people, any delay between the time symptoms begin and the time they ask their doctor for advice is due to the gradual change from a state of good health to a state of illness or disease. There are likely very few individuals with IBD who do not eventually undergo evaluation and have a diagnosis of Crohn’s disease or ulcerative colitis confirmed.
Good Health
Crohn’s disease and ulcerative colitis typically develop in people who previously were in good health and who had no prior bowel symptoms or digestive problems.
Common Symptoms
Inflammatory bowel disease — in particular, Crohn’s disease — can present with quite different symptoms from one person to the next, and these symptoms depend upon many different factors.
Some factors are not directly related to the disease. These include usual bowel habits before developing IBD, pain tolerance or threshold, and probably even mood. Although these individual factors may modify the symptom experience, the nature of the inflammation — its severity, extent, and location — is most important in determining the symptoms.
Flare Periods
Crohn’s disease and ulcerative colitis fluctuate in severity, and patients can experience flares and remissions. Symptoms are typically experienced primarily during these flare periods. When the disease is in remission, patients, particularly patients with ulcerative colitis, may have no symptoms whatsoever.
Crohn’s disease and ulcerative colitis tend to share a number of symptoms, such as abdominal pain and diarrhea, but they can be quite different with respect to the prominence of these symptoms and their course over time. The common symptoms of the two disorders and how they manifest are listed below.
Quick Guide to Ulcerative Colitis Symptoms
If you experience any one or combination of the following symptoms, be sure to consult with your doctor.
•Rectal bleeding (blood and mucus in the stool)
•Rectal urgency (frequent trips to the toilet and urgent need to move the bowels that often can’t be delayed)
•Severe abdominal cramps
•Frequent diarrhea
•Increased intestinal gas
•Persistent fatigue
•Weight loss
Ulcerative Colitis Symptoms
Because ulcerative colitis affects only the large intestine, the symptoms are due to inflammation, damage, and ulceration of the lining of the large intestine. The inflammation is usually contained within the most superficial inner linings of the large intestine. This determines the type of symptoms that a patient may experience. Because of these symptoms, patients with ulcerative colitis often feel they have to stay close to a bathroom when their disease is active.
Rectal Bleeding
Blood in the stool occurs regardless of whether the inflammation is restricted to just the bottom end of the large intestine (rectum) or involves the entire large intestine. Mucus is often passed along with blood in the stool, but can sometimes occur on its own. In some cases, blood and mucus may be passed without any stool. Although this bleeding can happen with every bowel movement and can appear quite severe, it almost never results in a sudden fall in the hemoglobin (blood count), and, as a result, the bleeding is almost never an emergency situation. It is, however, an indication of the severity of the underlying inflammation and requires medical attention.
Other common conditions, such as hemorrhoids, can also cause blood with stools, so not all rectal bleeding is due to ulcerative colitis.
Blood in the Stool
The most obvious and consistent manifestation of ulcerative colitis is the presence of blood in the stool. This occurs in almost every individual with ulcerative colitis. In fact, if someone with IBD has never had blood in the stools, it is quite possible that the condition is Crohn’s disease rather than ulcerative colitis. Crohn’s disease is not always associated with blood in the stool.
Rectal Urgency
Inflammation of the rectum always occurs in ulcerative colitis and affects the normal ability to hold stool and gas. Patients with ulcerative colitis may experience frequent and very strong urges to move the bowels whenever there is the smallest amount of stool, blood, mucus, or gas in the rectum. This urgency is often accompanied by strong lower abdominal cramping that is probably due to contraction or spasm of the rectum and sigmoid colon.
When patients experience this type of urgency and are not close to a bathroom, they may not be able to control the urge long enough and may be incontinent. This loss of control can sometimes be the most troubling symptom for patients with ulcerative colitis. In many cases, individuals with active ulcerative colitis will plan their activities so that they always have easy and quick access to a bathroom.
The increased bowel activity usually occurs in the early-morning hours and soon after eating. As a result, patients will avoid going out in the morning until after bowel movements subside, or they will avoid eating before going out of the house. When the ulcerative colitis is more severe, the bowel activity may continue throughout the night and will make the patient wake up several times to go to the bathroom.
Unrelenting Pain
Between flares, patients usually do not feel any pain. If a patient with ulcerative colitis reports constant, unrelenting abdominal pain, it suggests the possibility of another diagnosis or a complication, such as bowel perforation. Be sure to consult with your doctor if abdominal pain has this characteristic.
False Urges
False urges are another troubling symptom that many patients with active ulcerative colitis experience. When the rectum becomes distended with gas or stool, it sends a signal to the brain indicating a need to move one’s bowels. When the rectum is inflamed, it becomes irritable and will send these signals to the brain with only the smallest amount of distension or even without any distension at all.
In that case, a person will feel a strong urge to move the bowels and will rush to the bathroom, only to find that nothing comes out or, at most, just a small amount of blood and mucus. As a result, people with ulcerative colitis may have to make countless trips to the bathroom every day, even though they may pass stool only a handful of times.
Typically, when stool is passed, it comes in only small amounts each time. Because patients will pass what is recognized as stool only very infrequently, they will sometimes feel as if they are constipated. When only the rectum is inflamed, the inflammation and spasm may actually