Understanding Inflammatory Bowel Disease

Treatment depends on the type of IBD, the areas of the gut involved, and the severity of the disease. Treatment often starts with milder therapies and moves to stronger ones only if needed.

Non-Surgical Management

This is usually the first-line therapy for IBD. Several options are available, including these:

• Anti-inflammatory drugs: Given orally or rectally, these work by locally reducing inflammation in the gut lining. They are most effective in mild to moderate ulcerative colitis and some mild Crohn’s cases if disease is limited to the colon. For moderate to severe flares of IBD, corticosteroids are commonly used to quickly calm a flare by suppressing the immune response.
• Immune system suppressors: These target the underlying immune response causing the inflammation. These drugs don’t provide instant relief but can help prevent the immune attacks on the gut when taken long-term.
• Antibiotics: These are used to manage complications like infections, but are not used as primary long-term treatment for IBD itself.
• Lifestyle and dietary management: Avoiding trigger foods and adjusting fibre intake can help manage the chronic diarrhoea associated with IBD.

Surgical Treatments

Surgery is needed when certain complications arise or the disease does not respond to more conservative medical therapy. The options include these:

• Colectomy: Partial colectomy is the removal of the colon and rectum. After removal of the colon, the surgeon may create an ileal pouch to store waste internally or create a stoma (an opening on the abdomen) for stool to exit into a disposable bag. In some cases, the entire colon is removed (total colectomy), often for those with severe ulcerative colitis.
• Bowel resection: The surgeon removes the diseased segment of intestine and then connects the healthy ends back together in a process called anastomosis.
• Strictureplasty: This procedure widens the narrowed section by surgically opening and reshaping it, all without removing any part of the bowel. This is typically done for patients with multiple strictures or those who have already had large sections of bowel removed. This is because the procedure tries to preserve intestinal length.
• Fistula and abscess surgery: Crohn’s disease near the anus often causes fistulas that tunnel from inside the rectum to the skin around the anus. This surgical procedure is done to drain the abscess of such fistulas and remove the fistula tract, which can prevent further abscess formation.

Your doctor will discuss the expected recovery time after the surgery, which is typically several weeks. You will also learn if you need additional procedures (like the creation of a temporary stoma) or further treatments after surgery.

Recovery and Prognosis for IBD

The recovery varies by type of treatment. Patients who have undergone surgery typically spend about 1-2 weeks in the hospital and several weeks at home regaining strength. If you have a temporary stoma, you will learn stoma care before going home.

Consistency with treatment is key to a good prognosis for IBD. It tends to be a relapsing-remitting illness. 

Individuals who adhere to their maintenance medications are much less likely to see relapses. Those who have regular follow-ups or check-ins with their gastroenterologist or colorectal specialist also benefit from improved management. 

Periodic blood tests, stool tests, and even scheduled colonoscopies can be useful as well. The last test can help check for early signs of colorectal cancer, which IBD patients are at higher risk for.

For surgical treatment, the prognosis is generally good:

• Ulcerative colitis patients who undergo colectomy are essentially free from colitis flares as the disease no longer affects them without the colon.
• Surgery for Crohn’s disease patients can significantly improve symptoms and resolve complications. However, Crohn’s can recur, so ongoing medication is often recommended to reduce recurrence risk.