Preventive Care Hacks for Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) impacts 5 million people worldwide (1.6 million in the U.S.). For unclear reasons, the numbers have been increasing for more than 50 years. There are two main types – Crohn’s disease and ulcerative colitis. The cause of IBD remains elusive. Current theories include an interplay between genetics, a malfunctioning immune system, and the gut microbiome. Preventive care hacks can help you better manage inflammatory bowel disease.

Inflammatory Bowel Disease

As the name implies, IBD involves inflammation of the GI tract. Symptoms may vary from mild and infrequent to severe and frequent. They can include diarrhea, abdominal pain and cramping, anemia, weight loss, blood in the stool, and fatigue.

Complications include an increased risk of colon cancer, blood clots, C difficile infection, infertility, a higher rate of preterm births and low birth weight babies in women whose disease is active during pregnancy, bowel obstruction, malnutrition, strictures (a scarred narrowing of the bowel), anal fissures (small tear in the tissue that lines the anus or the skin around the anus), fistulas (a connection between different parts of the body), and bowel perforation (a hole in the intestine).

While Crohn’s disease can affect any part of the entire GI tract, from the mouth to the anus, ulcerative colitis is limited to the colon and rectum. Both conditions can manifest in other parts of the body including the skin, eyes, bones, gallbladder/biliary system, liver, and joints. 

Some people are at greater risk of IBD, including the following: being of the white race (and even higher for those of Ashkenazi Jewish descent), family history of IBD, cigarette smoking (Crohn’s disease), living in an industrialized country (and even greater if you live in a northern climate).

Immunizations and cancer screenings are important for everyone, but extra steps are needed in those with inflammatory bowel disease. If you have IBD, you have higher risks for certain conditions, some related to IBD itself and others due to the treatment you may be on, many of which cause suppression of your immune system.

Patients with IBD are at higher risk for certain cancers, and medications such as steroids, 6-MP, and biologics (e.g., infliximab and adalimumab) may impact your ability to fight infections.

Increased risks

Conditions for which IBD patients are at higher risk include:

• flu/complications of the flu
• shingles
• pneumococcal pneumonia
• HPV (human papilloma virus)
• abnormal PAP smear
• cervical cancer
• skin cancer
• colon cancer
• prostate cancer
• osteoporosis

What special precautions may be necessary with IBD?

Patients with IBD may need more frequent screening for certain cancers, and screening may also need to start at an earlier age for others. They also should not receive live virus when immunizations are given and may need a higher dose than the general population.

For example, guidelines suggest:

• high-dose flu vaccine
• if possible, vaccinate against pneumococcal pneumonia prior to starting treatment for IBD
• annual PAP smears
• condition-specific schedule for screening colonoscopy

The Crohn’s and Colitis Foundation has developed a health maintenance checklist for adult patients with IBD.

How can you optimize your preventive care?

Inflammatory bowel disease is complicated, and there is much yet to be learned regarding its cause(s), diagnosis, and management. Remember preventive care is much more than just immunizations and cancer screenings!

Acquire health literacy, self-advocacy, and health system navigation skills.

These are some preventive care hacks for IBD:

• It is important that you work with your PCP and gastroenterologist (and for the two of them to work together) to determine the best preventive care pathway based on your specific situation.

• Actively engage and ask questions, e.g., when should I be screened, what’s different for me because of my IBD?

• Follow up and get a copy of any testing, e.g., labs, x-rays/CT/MRI, biopsy results.

• Healthy eating is important to your health and well-being. For some patients, having IBD may mean the need for vigilance to avoid certain vitamin deficiencies and malnutrition as well as special ways to get nutrition from time to time. A registered dietitian can help provide guidance and collaborate to design a plan that addresses your special needs and fits within your daily routine.

• Your emotional and mental health is important to your well-being. It is not uncommon for patients with a chronic disease to have depression and/or anxiety for a variety of reasons. IBD is no different.
  
  Although stress does not cause IBD, it may increase the likelihood of a flare and make symptoms more severe. Be sure to share with your healthcare practitioners if you are feeling stressed/overwhelmed, anxious, or depressed or just feeling blue. Use a stress toolkit and take proactive action to be less stressed.

• IBD may sometimes impact your ability to engage in physical activity for a variety of reasons. However, it is still important to make movement a priority for both your physical and mental health.

• Sleep allows the body to rest and the brain to declutter. If you have IBD, sleep may be more challenging at times, e.g., during a flare. And sleep disturbances may negatively impact your immune system. Take steps to make it easier to get high-quality sleep of sufficient duration.

Are you planting the seeds today for the shade you will need in the future?

“Someone’s sitting in the shade today because someone planted a tree a long time ago.”

~ Warren Buffett

Preventive care matters. Your health is priceless!