IBD Explained (Crohn’s vs. Ulcerative Colitis): Symptoms, Diagnosis, and Treatment Options
If you’ve been told you might have inflammatory bowel disease (IBD) or if you’re still searching for answers about ongoing digestive symptoms, understanding the difference between Crohn’s disease and ulcerative colitis is a good place to start. Both are forms of IBD. However, they behave differently, require different approaches to diagnosis, and don’t always respond to the same treatment.
At Bergen Medical Associates, our gastroenterology team works with patients across northern New Jersey. We accurately diagnose IBD and build individualized treatment plans that fit your diagnosis. Here’s what you need to know.
Key Takeaways
- Crohn’s disease and ulcerative colitis are both forms of IBD, but they affect different parts of the gastrointestinal tract and carry distinct risks.
- Common symptoms include diarrhea, abdominal pain, blood in the stool, fatigue, and unintended weight loss.
- With the right care, most patients can achieve remission and maintain a good quality of life. Treatment options range from anti-inflammatory medication to biologics and surgery in some cases.
- At Bergen Medical Associates, our GI specialists can help you get an accurate diagnosis and a plan that fits your situation.
What Are the Key Differences Between Crohn’s and Ulcerative Colitis?
Although Crohn’s disease and ulcerative colitis are both forms of IBD, they affect the body in distinct ways.
Where Inflammation Occurs
Crohn’s disease can develop anywhere along the digestive tract, from the mouth to the anus. It most commonly affects the end of the small intestine and the beginning of the colon. Inflammation often appears in patches, with healthy tissue between affected areas.
Conversely, ulcerative colitis affects only the large intestine (colon) and rectum. The inflammation is continuous rather than patchy and begins in the rectum before extending upward through the colon.
How Symptoms Differ
Both conditions can cause diarrhea, abdominal discomfort, and digestive symptoms. However, some symptoms are more common in one condition than the other.
People with Crohn’s may experience:
- Cramping abdominal pain
- Chronic diarrhea
- Weight loss
- Nutritional deficiencies
- Fistulas (abnormal connections between organs) or abscesses (pus buildups)
If you have ulcerative colitis, you may have bloody diarrhea or rectal bleeding, an urgency to have bowel movements or frequent bowel movements, and rectal discomfort. Because the symptoms can overlap, you need to be thoroughly examined by a physician to be correctly diagnosed.
Additionally, ongoing inflammation can lead to complications if left untreated. Crohn’s disease may cause bowel narrowing, fistulas or abscesses, or malnutrition. Ulcerative colitis may increase the risk of severe colon inflammation or enlargement, significant bleeding, and colon cancer over time.
What Are Common Symptoms of IBD?
IBD symptoms can range from mild to severe and often come in waves of flares and remission. Some people experience symptoms for months before receiving a diagnosis. Knowing what to look for can help you get evaluated sooner.
You may notice an increase in digestive symptoms, such as frequent diarrhea, which can sometimes have blood or mucus, an urgent need to have a bowel movement, abdominal cramping and pain, and incomplete evacuation or rectal bleeding.
IBD can also impact your overall health and symptoms outside the gut, also known as extraintestinal manifestations. Patients commonly experience the following:
- Fatigue that doesn’t improve with rest
- Unintended weight loss and reduced appetite
- Anemia from blood loss or poor nutrient absorption
- Skin rashes or sores, red bumps under the skin (erythema nodosum) or ulcers on the skin (pyoderma gangrenosum)
- Joint pain or swelling, especially in the knees, ankles, and wrists
- Eye inflammation
- Mouth sores
These extraintestinal symptoms often flare alongside digestive symptoms, but not always. If you’re experiencing any combination of the above, you should talk to your doctor.
How Is IBD Diagnosed?
There’s no single test that can confirm IBD on its own, so multiple tools are often used together. Diagnosing IBD involves gathering information from symptoms, medical history, physical examination, and diagnostic testing. There are several steps your doctor will take to rule out other conditions and determine whether you have Crohn’s or ulcerative colitis and how severe it is.
- Laboratory tests: Lab tests are usually the first step. A complete blood count (CBC) can detect anemia or signs of infection. If you have active IBD, you’ll usually have elevated inflammatory markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
- Stool tests: These are often combined with blood tests. Fecal calprotectin and lactoferrin help detect intestinal inflammation without invasive procedures. They can also help your doctor monitor your disease activity over time.
- Colonoscopy with biopsy: This imaging technique allows your gastroenterologist to directly view the lining of your colon and terminal ileum (the section of the small intestine that connects to the large intestine). They can identify areas of inflammation and take tissue samples. These biopsies can help distinguish Crohn’s from colitis and rule out other conditions such as infection or microscopic colitis.
- Imaging studies: If your doctor suspects you have Crohn’s disease, they may order further imaging studies. Computed tomography (CT) enterography and magnetic resonance (MR) enterography provide detailed images of the small intestine. These scans can identify areas where the bowel is narrowed, fistulas, abscesses, and how much of the bowel wall is involved.
Once your doctor confirms your diagnosis, they’ll assess how severe it is to guide your treatment options and form a plan.
What Are Your Treatment Options for IBD?
IBD treatment focuses on reducing inflammation, relieving symptoms, preventing complications, and maintaining remission. The right plan for you depends on which condition you have, its severity, and how your body responds. Possible treatment options include:
- Anti-inflammatories and steroids: Aminosalicylates (5-ASAs) like mesalamine are typically used for mild to moderate ulcerative colitis. They reduce inflammation directly in the colon lining. Corticosteroids like prednisone are used for short-term flare control. However, because of their side effects, most doctors don’t recommend them long-term.
- Immunomodulators and biologics: For moderate to severe disease, immunomodulators like azathioprine help suppress the immune response that causes inflammation. Biologic therapies, including Tumor Necrosis Factor (TNF) inhibitors, integrin antagonists, and IL-12/23 inhibitors, work by targeting specific proteins involved in the inflammatory process. Biologics have significantly improved outcomes for patients with IBD, which is why they are now a main course of treatment.
- Nutrition and lifestyle support: While diet doesn’t cause IBD, it can affect how severe your symptoms are. Working with a registered dietitian can help you identify trigger foods and prevent nutritional deficiencies. Some patients benefit from specific carbohydrate diets or low-residue diets during flares. Quitting smoking, reducing stress, and staying active can also help manage your symptoms.
When Is Surgery Needed for IBD?
Many people can effectively manage their IBD with medication. However, sometimes, you may need surgery.
Your doctor may consider surgery when:
- Medications are no longer effective
- You develop severe complications, such as bowel obstruction, fistulas, or abscesses
- You have an increased cancer risk
For ulcerative colitis, surgically removing the colon (colectomy) can be curative. For Crohn’s, surgery can address complications, but the disease can return in other areas of the digestive tract. Most patients with Crohn’s will require at least one surgery in their lifetime. Your gastroenterologist will monitor your response to treatment over time and adjust your plan as needed.
What Is It Like Living with IBD?
IBD is a lifelong condition, but that doesn’t mean it needs to control your life. While it can be challenging, advances in diagnosis and treatment have made it possible for many people to control their symptoms and maintain a high quality of life.
The primary goals of treatment are:
- Reducing inflammation
- Achieving remission
- Preventing future flares
- Preserving quality of life
Your care team will help you recognize early warning signs of a flare. They will also adjust your treatment plan as needed during these flares.
Regular follow-up care is an important part of managing IBD. Routine lab work helps track inflammation levels and monitor for medication side effects. Patients with chronic ulcerative colitis or Crohn’s disease in the colon also need to be periodically screened for colon cancer. If you’re on immunosuppressants, you’ll need to be up to date on your vaccines.
Living with a chronic condition can take a toll on your mental health. Anxiety and depression are more common in patients with IBD than in the general population, and stress can worsen GI symptoms. Many people living with IBD benefit from counseling and peer support groups.
You don’t have to manage IBD alone. Working with a care team that understands your condition can help give you the tools you need to live well.
When Should You See a GI Specialist?
You should never ignore digestive symptoms, especially when they persist or interfere with your daily life. Schedule an appointment with your doctor if you have:
- Diarrhea that persists for more than a few days or that keeps coming back
- Blood in your stool or on the toilet paper
- Abdominal pain or cramping that interferes with your life
- Unintended weight loss
- Unexplained fatigue
- A family history of IBD, Crohn’s disease, or colorectal cancer
Getting diagnosed early helps you get treated sooner, and earlier treatment often leads to better long-term outcomes. If your symptoms are affecting your quality of life, that’s enough reason to make an appointment.
Get Comprehensive IBD Care Near You in New Jersey
Inflammatory bowel disease is complex, but the right team can help make it more manageable. At Bergen Medical Associates, our board-certified gastroenterologists take a personalized approach to diagnosing and treating Crohn’s disease and ulcerative colitis. We offer on-site diagnostic services, advanced treatment options, and coordinated care across our numerous locations.
We’ve been serving patients throughout northern New Jersey for more than 25 years, and we understand what it takes to not only accurately diagnose patients but also provide compassionate, ongoing support. Whether you’re newly diagnosed, seeking a second opinion, or managing a flare, we’re here to help. Contact us today to schedule an appointment. We have locations in Emerson, Montvale, Northvale, Paramus, and Ridgewood, NJ, making it easy to find treatment near you.
Frequently Asked Questions About IBD, Crohn’s Disease, and Ulcerative Colitis
Is IBD the same as IBS?
No. While their symptoms might be similar, irritable bowel syndrome (IBS) doesn’t cause inflammation. IBD does cause inflammation.
Can IBD be cured?
Ulcerative colitis can be cured surgically through the removal of the colon. Crohn’s disease has no cure, but it can be managed with medication. With the right treatment plan, most patients can achieve and stay in remission.
What causes IBD?
We’re not entirely sure. Research points to a combination of genetics, immune system dysfunction, and environmental triggers. However, we do know that stress and diet don’t cause IBD, but they can influence your symptoms.
Does IBD increase my risk of colon cancer?
It can. Routine colonoscopies are an important part of long-term IBD care. Gastroenterology specialists will determine an appropriate screening timeline based on your history.
How do I know if my symptoms are from IBD or something else?
Most GI conditions have overlapping symptoms. The only way to know for certain is with a thorough examination, including lab work, stool testing, and a colonoscopy.
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