Treatment Approaches for IBD

OK – you have read about all the things that can happen if you are diagnosed with IBD. Now let’s talk about some of the ways in which your health care team will work with you to control your symptoms. Let’s briefly review the medication you may be prescribed, your diet, types of surgery that might be performed if you need it and the importance of a balanced lifestyle. For more detailed information, please read our brochures on each of these topics. And of course, talk with your doctor, nurse, pharmacist or registered dietitian for information that is relevant to your individual situation.

1. Medication Be aware that all medications, prescription or otherwise, have side-effects. Adjusting your medication to maximize benefits while limiting side-effects will be a balancing act that is unique to you and your condition. You and your physician must work together to find the best possible combination that optimize your health and well-being.

In general, medications fall into one of two very broad categories: drugs that are used to reduce inflammation (and may therefore reduce some of your symptoms) and those that are aimed only at symptom-reduction and do not affect the inflammation in your gut.

a) Drugs for Reducing Inflammation:
Examples of the types of drugs available to combat inflammation include:

• Sulfasalazine and 5-Aminosalicylates (5-ASA): limit the production of certain chemicals that trigger inflammation
• Steroids: reduce inflammation
• Immunomodulators: alter how the body mounts an inflammatory response
• Biologicals: target and block molecules involved in inflammation
• Antibiotics: do not counteract inflammation directly, but decrease infection that can cause and result from severe inflammation

b) Drugs for Managing Symptoms:
Note that many of these drugs are available “off the shelf” in your pharmacy. You should NOT self-prescribe; talk with your doctor first.

• Antidiarrheals: do not take these during a flare-up as they may cause other complications! Check with your doctor
• Antispasmodics: relax muscles in the wall of the GI tract to reduce cramping
• Bulk formers for stool: soak up water in the stool, thereby firming it up and lessening looseness as well as frequency
• Bile Salt Binders: prevent irritation of the gut by capturing bile salts
• Stool softeners: for softening feces to ease bowel movements if you have hemorrhoids or anal fissures; talk with your doctor before trying these!
• Analgesics: for pain reduction
• Non-steroidal anti-inflammatory drugs: for pain control in joints (but note that some people find these drugs aggravate their abdominal pain and diarrhea)
• Acid-reducing drugs: for “heartburn”
• Vitamins and minerals: may be needed as supplements

For more details on your medications, please read our booklet, "Prescription for Health".

2. Diet and Nutrition Everyone needs to have a well-balanced diet for good health, vigour and healing. People with IBD in particular, must eat well in order to avoid problems like malnutrition and dehydration. See our booklet called, "Food For Thought" for detailed information and tips as well as Canada’s Food Guide for getting information on a well-balanced diet. Talk to a registered dietitian for help on a food lifestyle that is best for you.

For now, you should know that your diet does not cause a flare-up, but it may exacerbate (increase) your symptoms if you eat “trigger” foods. Trigger foods are those which aggravate your gut and are individual to you. Identifying those foods which are triggers for YOU is an important part of your day-to-day strategy in living well with IBD.

Conversely, you should also identify what are your “safe” foods. These are foods which are unique to you and do not appear to bother your digestive tract. Examples of foods that appear to be “safe” for many people include white rice, white bread, bananas, applesauce and toast. If you need an acronym to remember some of these safe foods, think about “BRAT” – bananas (or bread), rice, applesauce and toast.

Sometimes people with IBD need to go on specialized feeding regimes known as:

• Total Enteral Nutrition (TEN) – a feeding tube is passed through the nose into the esophagus and down into the stomach. A liquid nutritional supplement is delivered through the feeding tube, usually at night. TEN is used in addition to regular eating to ensure that the individual is getting adequate nutrition every day
• Total Parenteral Nutrition (TPN) – Nutrients are delivered directly to the bloodstream via a special intravenous line. In this way, the gut is bypassed totally, giving it the opportunity to rest completely.

3. Surgery Approximately 70% of people with CD and 40% of those with UC will require surgery at some point in their lives. Surgery should not be regarded as a last resort in the treatment of IBD; it is another treatment option for the management of CD and UC. Take a tour through our booklet on  "Surgery and IBD" for more details. Surgery for Ulcerative Colitis Removal of the large intestine and rectum (colectomy) effectively removes ulcerative colitis from your body with the result that you are “cured” of UC.

Because the rectum is gone and thus the passage for feces has been removed, your surgeon may have also created an ileostomy (the small bowel is cut and brought to the exterior of your body). An ileostomy uses a bag (otherwise known as an ostomy appliance) attached to the skin of your abdomen for the elimination of feces.

In some cases, surgeons can convert an ileostomy to an ileal pouch anal anastomosis (IPAA). For those people who are eligible for this surgery, the IPAA offers a high degree of satisfaction because a pouch for collecting feces is made inside your body and stool continues to be expelled through the anus rather than into an ostomy bag.

Surgery for Crohn’s Disease
Because CD can involve any part of the GI tract, surgical treatments can be many and varied. If you have acquired an abscess, stricture or obstruction, a resection (removal of all or part of a section of the gut) may be required to repair the problem. In some cases, a strictureplasty can be done to open up a narrowed segment of the intestine. As with UC, a colectomy and ilesostomy are possible surgeries.

The IPAA is not usually performed on patients with CD because unlike UC, the disease can recur after the procedure is done. This necessitates further surgery and potentially the removal of the internal pouch.

In addition to bowel-specific surgery, patients with CD can also have surgery to treat problems associated with complications of the disease. For example, if you have developed a fistula, there are procedures available to reduce the pain and pus.

Laparoscopic Surgery
Laparoscopic surgery, otherwise known as “minimally invasive” is performed through small incisions in your abdomen and with the aid of special instruments and a camera. Advocates for this specialized surgery have found that it is less traumatic for the patient and speeds up healing time while decreasing post-operative pain. However, some IBD patients do not do well with laparoscopic surgery due to the amount of internal scarring (adhesions) inside the abdomen or because the disease is so extensive that a wider field of view is needed than that offered by the scope. Your surgeon is the best person to make this decision based on your individual history and situation.

4. Leading a Balanced Lifestyle
At the end of the day, you are the person who must deal with IBD and you are the one in charge of your body and your attitude. Leading a balanced lifestyle is vitally important for success in surviving and thriving with CD or UC.

a) Exercise IBD may drain you of energy and the temptation to give up exercise is very strong. Instead of doing high energy, high demanding activity, try some gentle things like walking, swimming, playing with your dog, yoga or tai chi. The point is – keep moving. When you are in remission, you can go back to your previous activities, making sure you approach them sensibly; stay aware and mindful of your body and be kind to yourself.

b) Fun, Humour and Gratitude

The journey you are engaged in is not only one of a physical nature, but also one of a psychological challenge. Like all major expeditions in this life, winners are determined by their attitude, not just their aptitude. A sense of humour and a zest for fun will fuel that positive attitude, so find every reason to laugh and enjoy the good things in your life. It may not seem like you have much to be grateful for right now, but spend some conscious time deliberating on what they are and you will be pleasantly surprised at how many blessings you have.

c) Emotional overload
Sometimes the psychological impact of IBD gets to be too much. On top of the physical symptoms, feelings of uncertainty, embarrassment, aversion to being dependent on others, guilt and self-doubt can weigh you down. Be aware of how you are feeling and how these emotions are affecting your quality of life. If depression seems to have taken up residence in your emotional house, seek the help of your physician as there are treatments available to help you through it. Seek the support of family and friends – let them be there for you just as you would be for them.

And remember – YOU are not your disease. IBD is a part of your life, but YOU are not your diagnosis. You are so much more than that. d) Stress Stress does not cause IBD, but for some, it does appear to aggravate symptoms. This is not true for everyone however so it really does depend on you. If you do find that stress bothers your gut, some of the tips above will help you to cope. In addition, try things like meditation, relaxation techniques, avoid caffeine and live your life by the Serenity Prayer: “Grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference.”

e) Ongoing Education
One of the best things you can do is find a network of other people who have IBD, and with them, embark on an exploration of education. Learn as much as you can about your disease and pick up tips about coping strategies.

One great way to do this is to join your local chapter of the Crohn’s and Colitis Foundation of Canada (CCFC) where like-minded people come together to learn, have fun and support one another.