Crohn's and colitis

Get help straight away if

These are uncommon, but they need same-day care — go to an emergency department, do not wait for an appointment.

• Severe abdominal pain with fever, a swollen tense abdomen, or being unable to pass stool or windGo to an emergency department.

Contact us promptly if

Not an emergency, but worth being seen sooner rather than waiting it out.

• Significant or persistent rectal bleeding
• Many stools a day, or being woken at night to open your bowelsNight-time symptoms in particular suggest active inflammation rather than an irritable bowel.
• Losing weight without trying

What usually happens

Feeling well does not mean the inflammation has stopped. The bowel can be actively inflamed while symptoms are mild, and untreated inflammation causes the damage that leads to surgery years later — which is why treatment continues through the good spells.

That is also why stopping treatment when you feel fine is the commonest route back to a flare. If side effects or cost are the reason, say so — there are usually alternatives.

It is not caused by diet or by stress, though both can affect how you feel. Diets that promise to cure it are worth being sceptical about; diets that help you manage symptoms are worth discussing.

Bowel symptoms are embarrassing to describe and describing them precisely is genuinely useful. Frequency, blood, urgency and night-time waking are the details that change decisions.

Many people with IBD are on treatment that suppresses the immune system, which changes how infections and vaccinations are handled — worth raising before you need it.

At your appointment

We will ask about frequency, blood, urgency, night-time symptoms, pain and weight — the specifics, because they distinguish active disease from a settled gut behaving irritably.

Blood tests and a stool test for inflammation are often used to check whether the bowel is inflamed even when you feel reasonably well.

Care is usually shared with gastroenterology; we handle a great deal between specialist visits, including flares, monitoring and vaccinations.

We will make sure you know what to do at the start of a flare, rather than waiting for the next appointment.

Worth asking

• —Is my disease actually quiet at the moment, or just quiet symptomatically?
• —What should I do at the first sign of a flare?
• —Does my treatment affect which vaccines I should have?
• —Is there anything about diet that would genuinely help me?