Symptoms of inflammatory bowel disease depend on where the inflammation is and how severe it is.

Common symptoms include:

• Diarrhea.
• Belly pain and cramping.
• Blood in the stool.
• Loss of appetite.
• Weight loss without trying.
• Feeling very tired.

Some people notice early signs before a flare-up, such as feeling more tired than usual, changes in bowel habits or a loss of appetite.

When to see a doctor

See a healthcare professional if your bowel habits change or if you have symptoms of IBD. Get care soon if you have:

• Diarrhea that does not stop or signs of dehydration.
• Severe belly pain.
• Blood in the stool that does not go away.
• Fever or signs of infection.
• Weight loss without trying.

The exact cause of inflammatory bowel disease is not known. Diet and stress do not cause IBD, but they may make symptoms worse for some people. Experts think several factors may play a role.

• Immune system. One possible cause is change in the function of the immune system.
• Genes. Several genetic markers have been associated with IBD. Traits passed down in families also seem to play a role, as IBD is more common in people who have family members with the disease. However, most people with IBD don't have this family history.

Risk factors for inflammatory bowel disease include:

• Age. Most people who get IBD are diagnosed before they're 30 years old. But some people don't get the disease until their 50s or 60s.
• Patient population. IBD is more common in white people, but it can occur in anyone. The number of people with IBD is increasing in all races and ethnicities.
• Family history. You're at higher risk if you have a blood relative — such as a parent, sibling or child — with the disease.
• Cigarette smoking. Cigarette smoking is the most important controllable risk factor for severe Crohn's disease.

IBD can affect people at any stage of life, including children and those who are pregnant. Specialized care may be needed in these situations.

Ulcerative colitis and Crohn's disease have some complications in common and others that are specific to each condition. Some complications can happen with both conditions, although some are more common with one type than the other. The risk of complications often depends on how long the disease has been active and how well it is controlled.

Complications found in both conditions may include:

• Colon cancer. Having ulcerative colitis or Crohn's disease that affects most of your colon can increase your risk of colon cancer. Screening for cancer with a colonoscopy usually starts about 8 to 10 years after the IBD diagnosis is made. It may be repeated every 1 to 5 years depending on the findings.

  If you also have primary sclerosing cholangitis (PSC) and colonic disease, colon cancer screening is recommended every year starting at diagnosis. This is due to an elevated risk of colon cancer. Ask a healthcare professional whether you need to have this test done sooner and more frequently.

• Skin, eye and joint inflammation. Certain conditions may occur during IBD flare-ups. They include arthritis, skin lesions and eye inflammation called uveitis.
• Treatment side effects. Certain medicines for IBD are associated with a risk of infections. Some carry a small risk of developing certain cancers. Corticosteroids can be associated with a risk of osteoporosis, high blood pressure and other conditions.
• Primary sclerosing cholangitis, a rare, long-term disease of the liver involving inflammation and scarring within the bile ducts.
• Severe dehydration from diarrhea.

Crohn's disease also may lead to:

• A blockage in the bowel, called an obstruction. Crohn's disease affects the full thickness of the bowel wall. Over time, parts of the bowel can thicken and narrow, which may block the flow of digestive contents. Surgery may be needed to remove the diseased part of the bowel.
• Malnutrition. Diarrhea, belly pain and cramping may make it difficult for you to eat or for your intestine to absorb enough nutrients to keep you nourished. It's also common to develop anemia due to low iron or vitamin B-12 caused by the disease.
• Fistulas. Fistulas are tunnels between body parts that are not usually connected. Fistulas near or around the anal area are the most common kind. In some cases, a fistula may become infected and form a pocket of pus known as an abscess.
• Anal fissure. This is a small tear in the tissue that lines the anus or in the skin around the anus where infections can occur. It's often associated with painful passing of stool and may lead to a fistula around the anus.

Ulcerative colitis also may lead to:

• Toxic megacolon. Ulcerative colitis may cause the colon to rapidly widen and swell, a serious condition known as toxic megacolon. This can increase the risk of a hole in the colon, also called a perforation.

Treatment for inflammatory bowel disease aims to lower inflammation, improve symptoms and help prevent complications. Treatment may include medicines, surgery or both.

The type of treatment recommended depends on several factors, including how severe the disease is, which parts of the digestive tract are affected, and whether complications are present. Treatment plans often change over time based on how the condition responds.

Medicines

Medicines may include:

• 5-aminosalicylates (5-ASA). These anti-inflammatory medicines are often the first step in the treatment of ulcerative colitis, typically for mild to moderate disease. They include mesalamine (Rowasa, others), balsalazide (Colazal) and olsalazine (Dipentum).
• Corticosteroids. Corticosteroids such as prednisone and budesonide (Entocort EC) can help reduce inflammation in the body, but they don't work for everyone. Sometimes, IV corticosteroids are used in the hospital setting. Corticosteroids may be used for a short time to improve symptoms and to help calm the inflammation.
• Immunomodulators. These medicines lower immune system activity that contributes to inflammation. Examples of immunosuppressant medicines include azathioprine (Azasan, Imuran), mercaptopurine (Purinethol, Purixan) and methotrexate (Trexall).
• Small molecules. Janus kinase (JAK) inhibitors are a type of small molecule medicine. They help reduce inflammation by targeting parts of the immune system that cause inflammation in the intestines. JAK inhibitors for IBD include tofacitinib (Xeljanz) and upadacitinib (Rinvoq). Ozanimod (Zeposia) and etrasimod (Velsipity) are another type of small molecule medicine available for IBD.
• Biologics. These target proteins in the body that cause inflammation. Some are given by infusion, and some are given by injection. Examples include infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi). They include certolizumab pegol (Cimzia), vedolizumab (Entyvio) and ustekinumab (Stelara). They also include risankizumab (Skyrizi), mirikizumab (Omvoh) and guselkumab (Tremfya).
• Antibiotics. Antibiotics may be used when infection is a concern. Often-prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl).

Nutritional support

If weight loss is serious, a healthcare professional may suggest special nutrition through a feeding tube or a vein. If there is a narrowing in the bowel, a low-residue diet may be recommended.

Surgery

Surgery may be recommended if medicines and lifestyle changes do not help enough.

• Surgery for ulcerative colitis. This may involve removing the colon and rectum. In some cases, surgeons create an internal pouch so stool can still leave the body through the anus.
• Surgery for Crohn's disease. Surgery may remove a damaged part of the digestive tract, close fistulas, or drain abscesses. Surgery does not cure Crohn's disease, and the disease may come back later. The best approach is to follow surgery with medicine to lessen the risk of recurrence.

Healthy habits may help manage symptoms, but they do not replace medical treatment.

Diet

There is no clear proof that food causes IBD. Still, some foods and drinks may make symptoms worse, especially during a flare-up.

These tips may help:

• Keep a food diary to track what seems to trigger symptoms.
• Eat smaller meals more often.
• Drink plenty of liquids. Water is best.
• Limit dairy products if they make symptoms worse.
• Ask your healthcare team about vitamins or meeting with a dietitian if your diet becomes limited.

Smoking

Smoking raises the risk of Crohn's disease and can make it worse. People with Crohn's disease who smoke are more likely to have relapses and need medicines and repeat surgeries.

Stress

Stress may make symptoms harder to manage for some people. These steps may help:

• Exercise. Even mild exercise can help reduce stress, relieve depression and adjust bowel function. Talk with your healthcare professional about an exercise plan that's right for you.
• Cognitive behavioral therapy. This type of talk therapy can help you manage stress, anxiety and depression by changing unhelpful thought patterns and building coping skills.
• Regular relaxation and breathing exercises. One way to cope with stress is to regularly relax and use techniques such as deep, slow breathing to help you feel calm.

Many people with digestive disorders use some form of complementary or alternative medicine. But there is little research on how safe and effective these treatments are. Talk with your healthcare team before taking these treatments.

IBD doesn't just affect you physically — it takes an emotional toll as well. If signs and symptoms are severe, your life may revolve around a constant need to run to the toilet. Even if your symptoms are mild, you may find it difficult to be out in public. All of these factors can alter your life and may lead to depression. Here are some things you can do:

• Be informed. One of the best ways to better manage your IBD is to find out as much as possible about inflammatory bowel disease. Look for information from reputable sources such as the Crohn's and Colitis Foundation.
• Join a support group. Although support groups aren't for everyone, they can provide valuable information about your condition as well as emotional support. Group members frequently know about the latest medical treatments or integrative therapies. You may also find it reassuring to be among others with IBD.
• Talk with a therapist. Some people find it helpful to consult a mental health professional who's familiar with inflammatory bowel disease and the emotional difficulties it can cause.

Although you may feel discouraged about living with IBD, research is ongoing, and treatment continues to improve.

Symptoms of inflammatory bowel disease may first lead to a visit with your main healthcare team. However, you may then be referred to a professional who specializes in treating digestive disorders, called a gastroenterologist.

Because appointments can be brief, and there's often a lot of information to discuss, it's a good idea to be well prepared. Here's some information to help you get ready and what to expect at your visit.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:

• Your symptoms, including any that seem unrelated to the reason for your appointment.
• Key personal information, including major stresses, recent life changes and family medical history.
• All medications, vitamins or other supplements you take, including the doses.
• Questions to ask your doctor.

Take a family member or friend along, if possible, to help you remember the information you're given.

For inflammatory bowel disease, some basic questions to ask your doctor include:

Symptoms and diagnosis

• What's causing these symptoms?
• Are there other possible causes for my symptoms?
• What kinds of tests do I need?
• Do these tests require any special preparation?
• Is this condition temporary or long lasting?

Treatment and medicines

• What treatments are available, and which do you recommend?
• Are there any alternatives to the primary approach that you're suggesting?
• Are there any medicines that I should avoid?
• What types of side effects can I expect from treatment?
• Is there a generic alternative to the medicine you're prescribing?

Follow-up care and daily life

• What sort of follow-up care do I need?
• How often do I need a colonoscopy?
• I have other health conditions. How can I best manage them together?
• Do I need to change my diet?

Pregnancy and family risk

• Is there a risk to me or my child if I become pregnant?
• If I have IBD and my partner becomes pregnant, is there a risk of pregnancy complications?
• What is the risk of my child having IBD if I have it?

Resources and support

• Are there brochures or other printed material that I can take with me?
• What websites do you recommend?
• Are there support groups for people with IBD and their families?

What to expect from your doctor

Your healthcare team is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. You may be asked about:

Symptoms

• When did your symptoms begin?
• Are your symptoms always there or do they come and go?
• How bad are your symptoms?
• Do you have belly pain?
• Have you had diarrhea? How often?
• Do you awaken from sleep during the night because of diarrhea?
• Do your symptoms affect your ability to work or do other activities?
• Does anything seem to improve your symptoms?
• Is there anything that you've noticed that makes your symptoms worse?

Health history

• Have you lost weight without trying to?
• Have you ever had liver problems, hepatitis or jaundice?
• Have you had problems with your joints, eyes or skin — including rashes and sores — or had sores in your mouth?
• Do you smoke?
• Do you have a family history of inflammatory bowel disease?

Recent exposures

• Have you recently traveled? If so, where?
• Is anyone else in your home sick with diarrhea?

Medicines

• Do you take nonsteroidal anti-inflammatory medicines, for example, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or diclofenac sodium? These medicines also are called NSAIDs.
• Have you recently taken antibiotics?