Crohn’s Disease and Ulcerative Colitis are the two main forms of IBD (Inflammatory Bowel Disease). These conditions affect the digestive system, causing inflammation which in turn can lead to a variety of symptoms including abdominal pains and the need for frequent bowel movements.

Even though the conditions are often spoken about together and share many similarities, they are in fact two separate syndromes.

Here we’ll look at them both and consider their:

• Differences
• Causes
• Diagnoses
• Types and symptoms
• Treatments

What's the difference between Crohn’s and Colitis?

First things first: what exactly are the two syndromes and what differentiates them?

Crohn’s Disease

Crohn’s is a lifelong condition which can affect any part of the digestive system: from the mouth to the anus. It is a condition that impacts everyone differently and can be severe or mild depending on the person and, depending on where exactly in your gut Crohn's is, the symptoms will vary. In fact, it is so person-specific that an individual may enjoy many years without any noticeable symptoms whilst others could have more frequent flare ups.

The main symptoms can include:

• Diarrhoea (sometimes mixed with blood, pus or mucus),
• Stomach aches,
• Fatigue (typically because of the impact of the other symptoms)
• Loss of appetite
• Weight loss (caused by both/either the loss of appetite or the inflammation of the gut limiting the amount of nutrients absorbed)
• Feverishness
• Mouth ulcers
• Anaemia (a reduction in red blood cells can manifest from a combination of the above and lead you back into a cycle of fatigue)

Ulcerative Colitis

Colitis, unlike Crohn’s, only affects the large intestine, not the rest of the digestive system. The symptoms are similar to those listed above for Crohn's, as are the severity levels and development over time. However, Colitis can come and go in flare-ups which can sometimes cause other symptoms or conditions such as arthritis which Crohn’s does not cause.

What are the causes of Crohn’s and Colitis?

Research into both conditions has been extensive though there remains much more work to be done in order to fully understand them. This means that the causes of them both cannot yet be determined with 100% certainty, although recent developments with regards to genetics has lead to a number of key observations and beliefs.

Crohn’s Disease

Researchers believe that Crohn’s could be the result of a number of different factors, including:

• Viruses
• Diet
• Bacteria
• Smoking
• Certain medications
• Stress

Ulcerative Colitis

Likewise, researchers see the above as likely contributing factors to the development of Colitis too, but they are also consider the following to be instrumental in it:

• Genes
• An unusual reaction in the immune system
• An environmental trigger (such as those outlined above).

How are Crohn’s and Colitis Diagnosed?

In both cases the typical journey towards diagnosis begins with the development of diarrhoea that may be coupled with bleeding or abdominal pains. If you are young, or have a family history of the conditions, then your doctor may more readily lean towards a prognosis of Crohn’s or Colitis.

If this is the case then you will need to go through a variety of tests and physical examinations to help confirm a diagnosis.

What are the main types of Crohn’s and Colitis?

The Main Types of Crohn’s

As Crohn’s can impact different parts of the gut, and can sometimes affect multiple parts, there are a handful of different types:

Terminal ileal and ileocaecal

The ileum is the final part of the small intestine and, when this is the affected area, this type of Crohn’s may be called either ileal or ‘terminal ileal’ Crohn’s. If it extends to the start of the large bowel then the term used is ileocaecal Crohn’s. This is a particularly common type of Crohn’s where usual symptoms include pain in the lower right side of the abdomen (most notably after eating), diarrhoea and loss of weight. If there is any bleeding, it will likely not be observable in your stools although they may look black and, should you have a blood test, it could show you to be anaemic.

Ileitis and jejunoileitis

This type of Crohn’s relates directly to the small bowel with ileitis and jejunoileitis referring to specific areas in it. With this type of Crohn’s abdominal pains and diarrhoea are common, as is nutrient deficiency. This type is more common in children and younger people.

Crohn’s Colitis

This is when the colon (large intestine) is affected although it is different to Ulcerative Colitis. The typical symptom is bloody/mucousy diarrhoea. As the colon is inflamed it will not be able to hold as much waste and therefore more frequent bowel movements are probable.

Gastroduodenal

Much less common than the above, this is where Crohn’s occurs in the upper gut (i.e. oesophagus, stomach, duodenum) and can in fact occur simultaneously to other types. The common symptoms here include pain similar to that of indigestion, nausea, weight loss, reduced appetite and anaemia.

Perianal

This is where the anus is affected. It is a common type and can be the precursor to further intestinal symptoms. The symptoms involved include:

• Fissures - tears/splits in the anal canal that cause pain and bleeding during bowel movements.
• Fistulas - narrow passageways between the gut and the skin or another organ.
• Abscesses - painful, swollen areas of pus around the anus. Can lead cause fever or lead to fistulas.
• Skin tags - small growths that form around the anus
• Haemorrhoids/piles - swollen blood vessels in/around the anus.

Orofacial granulomatosis

More commonly known as Oral Crohn’s, this is where the mouth is affected. It is a rare condition though will more likely develop in children than adults. It can be a result of deficiencies in iron, vitamin B12 and folate and typically causes mouth fissures and swollen lips.

The Main Types of Ulcerative Colitis

Unlike Crohn’s, the types of ulcerative colitis are categorised by how much of the large intestine is impacted and there are 3 mains types: proctitis, left- sided/distal colitis, and total/pancolitis.

Proctitis

This type of colitis is where only the rectum is inflamed and the main symptom is passing fresh blood or bloody mucus irrespective of the type of stool passed (diarrhoea, normal, constipation). The rectal inflammation may also make the sufferer feel the need to engage a movement despite the bowel being empty (this is called tenesmus).

Some sufferers may also experience proctosigmoiditis - the form of colitis that affects the sigmoid colon. The symptoms are the same as the above, though constipation is far less likely.

Left-sided/ Distal Colitis

Here, the distal colon (rectum and descending colon) is affected. Symptoms include:

• Bloody/mucousy diarrhoea
• Abdominal pain on the left-side
• Urgency to make a movement
• Tenesmus

Total/ Pancolitis

This is where the entire colon is affected and can cause:

• Frequent, bloody/mucousy/pus-y diarrhoea
• Abdominal cramps
• Tenesmus
• Weight loss
• Fever 

If most of the colon is inflamed this is referred to as Extensive Colitis, though the symptoms remain the same.

What is the Impact of Ulcerative Colitis and Crohn’s?

Any underlying medical condition will impact our lives, but with careful and considered management, the impact can be mitigated as much as possible. Ulcerative Colitis and Crohn’s can be approached with careful and considered planning too. However, it is always important to remember that everyone is different and the severity of their condition will be equally variable and so every experience is different.

The Impact of Crohn’s

Depending on the severity of the condition as well as whether it is currently in an active or quiet phase, the impact on someone's life will be different.

Crohn’s can be treated with medication. For those with mild/infrequent symptoms this type of treatment can often mean their lives are not affected much at all.

Typically sufferers will experience cycles of flare ups and bouts of remission allowing them to lead generally normal lives.

However, there is a contingent of sufferers who unfortunately will experience more frequent, perhaps even continuous, symptoms despite their medications or surgeries. For these individuals their lifestyles must be adapted to much larger degrees.

Living with Crohn’s invariably means relatively regular visits to the GP or a hospital-based IBD team. Embracing this and developing a good relationship with them will help immeasurably.

The condition may also have an emotional, as well as physical, impact on your wellbeing so building a strong support network around you will help to make a considerable difference to your experience.

The Crohn’s and Colitis UK, the leading UK charity focused on supporting those affected by these conditions to achieve a better quality of life, provides many great resources, including a handbook, focused on offering practical support and guidance for making lifestyle adaptations.

The Impact of Ulcerative Colitis

Individuals with Ulcerative Colitis may also experience varying degrees of severity as well as different levels of everyday impact depending on the phase the condition is currently in.

Some sufferers may only ever experience mild discomfort and infrequent instances of diarrhoea and abdominal pains. However, others may have far more distressing experiences meaning far bigger changes to their lifestyle.

In line with the above, Crohn’s and Colitis UK also provides a number of resources of lifestyle management in regards to Ulcerative Colitis, as well as guidance for employers, university students and even for the friends and families of sufferers, to help them support their loved one.

What Treatments are Used For Ulcerative Colitis and Crohn’s?

Medication

Pharmaceutical options are available for the treatment of both Crohn’s and Ulcerative Colitis. These medications intend to help reduce inflammation and provide a moderate degree of control over the conditions.

Crohn’s

Medicated treatments for Crohn’s may mean ongoing, or long-term, courses or, for some, it may mean periodic, short courses, depending on the severity and type of Crohn’s had.

The drugs help to reduce the symptoms and ultimately achieve and maintain remission once the condition is under control.

There are a number of drug-types used for the treatment of Crohn’s:

• Aminosalicylates [these reduce the inflammation of the intestinal lining]
• Corticosteroids [these block the substances that trigger the allergic reaction that leads to inflammation]
• Immunosuppressants [suppress the immune system and therefore the amount of inflammation]
• Biological drugs

For those interested, a full overview of the above can be found here.

Ulcerative Colitis

Medicinal treatments for Ulcerative Colitis are used in a similar way to those used in the treatment of Crohn’s. The largest difference, in principle, is the length of time they are required for. In most instances treatment is long-term although if your physician advises you, after being free of symptoms for several years as well as an endoscopy showing good/significantly improved health, it may be possible to stop the treatment.

The typical range of drugs used to treat Ulcerative Colitis include:

• Aminosalicylates
• Corticosteroids
• Immunosuppressants
• Biological

Diet

For some people, a 2-8 week nutrient-rich, liquid diet may be prescribed. This is particularly useful for children (although this enteral nutrition can also be given to adults) to ensure they continually receive the nutrients they need for growth and overall well-being. During this period no solid or ’normal’ foods may be consumed.

Another benefit of this treatment is that it may reduce the need for additional steroids which will mean the gut has a chance to properly rest and enter a state of healing. In the majority of cases where the liquid diet is prescribed, a dietician will be highly involved.

Surgery

Surgery is not a first option for the treatment of Crohn’s or Colitis and, fortunately, developments in drug treatments have made surgery less common than ever before.

However, it remains an important consideration for those for whom other treatments have not proven to be effective at significantly mitigating the impact of the condition on their life and well-being. However, surgery is by no means less impactful and the results, such as a stoma (a bag attached to the stomach into which digestive waste is emptied rather than via the anus), are lifelong and have to be weighed up by both the patient and their team against other management options.

For further reading, Crohn’s and Colitis UK offer a detailed and comprehensive summary of surgery for Crohn’s or Colitis.

Conclusion

Crohn’s and Colitis both have the power to really influence significant lifestyle changes for those who suffer from particularly severe cases. However, with the right medication and treatments the impact either condition has on your life can be reduced.

A MedicAlert membership can help provide further peace of mind throughout your daily life should you find yourself in need of emergency care. We support everyone with underlying medical conditions ranging from cancer and epilepsy to rare conditions.

As treatments such as steroids, immunosuppressants and biological medications are often prescribed for long-term use, it is important that medical personnel know they are being taken. Having these listed on your medical jewellery and highlighted on your medical record, will be vital in emergency situations.

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