Other conditions connected to IBD

Anaemia 

Anaemia is very common in people with IBD and about one in three will have the condition. Anaemia is a lack of red blood cells, which means there is less blood to carry oxygen around the body. This commonly leads to tiredness and sometimes dizziness, headaches, cold hands or feet, pale skin, and shortness of breath. Symptoms for this condition can be hard to pinpoint so it’s easier to check with a quick blood test. 

Causes of anaemia include: 

• Low iron which may happen because of inflammation in your intestines interfering with your body’s ability to use or absorb iron and/or blood loss from intestinal bleeding 

• Poor absorption of vitamins and minerals, like vitamin B12 (folate) 

• Use of certain medications 

To treat anaemia, people are often given iron tablets but the side effects can be hard on the bowel. If your body cannot tolerate iron tablets, then you may need intravenous (through the veins) iron. 

Bones 

Many people with Crohn’s and colitis have lower than average bone density (strength). Even though there is a natural loss of bone density as people grow older, people with IBD are at risk at any age. Testing your bone density is an important part of managing IBD. 

Risk Factors 

Demographics that increase your risk of bone disease: 

• Increasing age 
• Female gender 
• Low body mass index (BMI) 
• Smoker 
• Alcohol drinker 

Corticosteroids – This anti-inflammatory medication gets in the way of your body absorbing an important mineral for bone health, calcium, and slows down bone growth. Long-term use of high-dose steroids increases your risk of developing osteoporosis (weak bones). 

Inflammation – Crohn’s and colitis changes the gut environment in many ways. One part of the inflammatory response involves an increase in the proteins called cytokines. Cytokines may interfere with bone health – the greater the presence of the cytokines the more likely it is to develop osteoporosis. 

Vitamin D deficiency – Vitamin D is needed to absorb calcium which is important for bone health. Vitamin D is absorbed in the small bowel and inflammation or surgery in that area can interfere with absorption. Not enough sun exposure can also contribute to low levels of vitamin D. 

What you can do to protect your bones 

• Reduce steroid use (with the help of your doctor) 
• Regular bone density scans (every two years) 
• Watch how much alcohol you drink 
• Stop smoking 
• Exercise 
• Include calcium-rich foods in your diet (e.g., dairy and leafy green vegetables) 
• Talk with your doctor about calcium and vitamin D supplements 

Arthritis and joint pain 

Arthritis is the inflammation of the joints and is the most common complication of IBD outside of the gut. People often think arthritis only affects those who are advanced in age but young people with IBD can also to be affected. 

Arthritis causes joint pain, swelling of joints and reduced flexibility. People with arthritis may also have stiff joints (arthralgia). It can be hard to know if the arthritis is connected to IBD but the arthritis symptoms often get better after the gut is treated. 

There are a few different types of arthritis that affect people with IBD: 

Peripheral arthritis – affects the large joints of the arms e.g., elbows, wrists, knees and ankles. 

Axial arthritis (spondylitis) – affects the lower spine and joints at the bottom of the back. 

Ankylosing spondylitis – is a more serious form of spinal arthritis. It is uncommon, only affecting between 2% and 3% of people with IBD. 

In the general population, people with arthritis may use nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling of the joints. For people with IBD this may not be a good option because NSAIDs can sometimes irritate the gut lining. Some people with IBD will be able to use NSAIDs but medication should always be discussed with your doctor first. 

Alternatives to NSAIDs are corticosteroids but usually doctors will focus on treating the inflammation in the gut. After the inflammation comes down, joint pain usually improves. 

Skin 

Skin complications may be caused by IBD or by the medications used to treat the disease. Some common skin conditions connected to IBD are: 

Erythema nodosum – tender red bumps usually appear on the shins or ankles and sometimes on the arms. It usually appears alongside a flare-up and disappears once the IBD has been treated. Affects 2%-10% of people with IBD. 

Pyoderma gangrenosum – starts as small blisters on the shins or ankles that then grow into large wounds. Wounds will heal after symptoms of IBD are under control. Until then, antibiotics and medical ointments will be used to treat the skin condition. 

Skin tags – small flaps of skin often found around the anus. Skin tags are common in Crohn’s disease and can become inflamed and irritated when faecal matter gets caught on them. Making an extra effort to stay clean will reduce discomfort. Surgical removal of skin tags is avoided because of the risk of permanent damage to the anus. 

Aphthous stomatitis (canker sores) – small mouth ulcers. They usually appear during a severe flare-up of IBD and disappear once the disease is under control. Until then, medicinal mouthwashes can be used to give relief. 

Some uncommon skin conditions connected to IBD are: 

Sweets syndrome – involves a fever and red skin wounds, usually on the upper body. It is usually treated with steroids. 

Acrodermatitis enteropathica – a flaky rash that usually appears on the face, hands, feet and around the genitals (perineum). It is often caused by zinc deficiency. 

Pyoderma vegetans – blisters, plaques (raised patches covered with a white layer of dead skin), or patches around the groin and under the arms. When the IBD is treated the condition will improve. 

Vasculitis – raised, reddened areas that can sometimes be ulcerous. When the IBD is treated the condition will improve. 

Epidermolysis bullosa acquista – blisters on the knees, elbows, hands and feet. 

Vitiligo – loss of skin colour in patches  

Psoriasis – scaly, itchy skin  

Clubbing – skin beneath the nails becomes thickened 

Skin cancer – developing skin cancer is more likely in people with IBD who are using immunosuppressive medications. It can be helpful to make using sunscreen a habit and have annual skin checks by your doctor or dermatologist. 

Medication side effects – sometimes a skin condition is not caused by IBD but by the medications used to treat it. Your doctor may choose to treat the skin condition or find an alternative medication. 

Eyes 

Most eye conditions connected with IBD are treatable and won’t lead to loss of vision if treated. If you notice any eye inflammation it is important to talk about it with your doctor as soon as possible. 

Uveitis – the most common eye complication for people with IBD. The inflammation of the eye affects the uvea (middle layer of the eye wall). Symptoms of uveitis are eye pain, blurred vision, sensitivity to light and redness of the eye. If left untreated uveitis can lead to glaucoma and possible vision loss. 

Keratopathy – an abnormality of the cornea (clear, protective layer of the eye). It affects people with Crohn’s disease but does not cause pain or impair vision, so it usually does not need to be treated. 

Episcleritis – inflammation of the episclera (outer coating of the white of the eye). Symptoms of episcleritis are pain and tenderness. It is usually treated with steroid eye drops but the condition may improve after your IBD improves. 

Dry eyes – may be caused by low vitamin A. Dry eyes can lead to an eye infection and the need for antibiotics. Treatment may involve artificial tears or vitamin A supplements. 

Kidneys 

The job of the kidneys is to clean the body’s blood and remove waste through urine. They are found in the centre of the back just below the ribcage. Serious kidney complications are rare in IBD but there are a few milder conditions. 

Kidney stones – Crohn’s disease interferes with the small intestines’ ability to absorb fat. This can lead to a kidney stone called oxalate. You are more likely to develop kidney stones if you’ve had many small bowel resections. Symptoms include sharp pain, nausea, vomiting and blood in the urine. Treatment involves drinking more water and switching to a diet that is high in juices and vegetables. The kidney stones can also be removed surgically or with an endoscope. 

Hydronephrosis – an obstruction of one of the ureters (tubes connecting the kidney to the bladder). In Crohn’s disease, the small intestine can become swollen and put pressure on a ureter. The blockage can damage the kidney and will require surgical treatment. Symptoms include a dull pain where the kidneys are as well as blood and pus in the urine. 

Amyloidosis – the abnormal gathering of a protein (amyloid) in various organs, in this case, the kidneys. It is a rare disorder only seen in people with long-term and severe IBD. There are no symptoms early on in the disorder but diagnosis can be confirmed with a biopsy (tissue sample). There are medications that can slow down the progress of the disease. 

Glomerulonephritis – an abnormality in the glomerulus (cluster of blood vessels in the kidney) where a sore develops that interferes with the kidneys’ ability to clean the blood. In extreme cases, a kidney transplant may be needed. 

Medications – can sometime cause kidney complications. Once you stop taking the medication causing the problem, kidney function usually goes back to normal. Make sure to ask your doctor about your kidney health and if they think they need monitoring. 

Liver 

Your liver is found in the upper right part of your belly (abdomen). It has many functions but one of its main jobs is to process food nutrients. The liver also produces cholesterol, acids and bile salts that get stored in the gallbladder before being used to break down fats. Sometimes people with IBD will develop an inflamed liver. Most liver damage is reversible if treated. 

Fatty liver disease (hepatic steatosis) – extra fat gets deposited in the liver, pushing out normal liver cells. It is reversible and no treatment is usually necessary but patients are encouraged to lose weight and control their blood cholesterol levels. 

Hepatitis – a generic term for inflammation of the liver. It can be caused by some medications used to treat IBD. If the medications you are on increase your risk of hepatitis your doctor will give you regular blood tests to check for this condition.  

IBD can also directly cause inflammation of the liver and this is called autoimmune hepatitis. It is treated in a similar way to IBD and if left untreated, autoimmune hepatitis can lead to liver scarring (cirrhosis) and permanent liver damage. 

Gallstones – The gallbladder normally holds liquid bile until it is needed for digestion. However, bile can harden to form stones within the gallbladder. If gallstones try to leave the gallbladder and block the ducts, pain, nausea, and vomiting occur. Gallbladder removal eliminates this problem. 

Primary sclerosing cholangitis (PSC) – inflammation of the bile duct system of the liver. PSC is seen in about 3% of patients with ulcerative colitis, and less in Crohn’s disease.  

Bile ducts transport bile from the liver to the upper small intestine. Scarring of the bile ducts and eventually the liver is caused by the inflammation. When this occurs, the bile cannot flow normally. Bile buildup leads to itching and jaundice, and if there is enough damage, fatigue can occur.  

To control the bile build-up, stents are usually placed within the bile ducts to keep the bile flowing. Complications of PSC include infection of the bile (cholangitis) and cancer of the bile duct system (cholangiocarcinoma).  

If the liver is damaged too much, cirrhosis can occur and liver transplantation can be considered. Another complication in patients with PSC is an increased risk for colon cancer. Therefore, it is important for patients with PSC to speak to their doctor about undergoing annual colonoscopies. 

Read more about Complications of IBD and Fatigue.