Crohn's disease and ulcerative colitis

What IBD is

Inflammatory bowel disease, or IBD, is the name for conditions where the immune system causes long-term inflammation and ulcers in the gut. The two main types are Crohn's disease and ulcerative colitis. IBD is not the same as irritable bowel syndrome (IBS).

The exact cause isn't known. It seems to be a mix of genes, the immune system, gut bacteria and things around us. Smoking makes Crohn's worse.

IBD can start at any age, but it is most often diagnosed in teenagers and young adults. Research funded by Crohn's & Colitis UK found more than 1 in 123 people in the UK live with Crohn's or colitis, which is over half a million people.

There is no cure yet, but treatment can keep many people well for long periods.

Types of IBD

Doctors describe IBD by which condition you have and which part of the gut is affected.

Crohn's disease

Can affect any part of the gut, from the mouth to the bottom, often in patches. Inflammation can go through the whole bowel wall. It most often affects the end of the small bowel (the ileum).

Ulcerative colitis

Affects only the large bowel (colon) and rectum, in one continuous stretch from the rectum upwards. It affects the inner lining of the bowel. At least 1 in 233 people in the UK have it.

Proctitis

A type of colitis that affects only the rectum. It often causes urgency and bleeding, sometimes with constipation.

Left-sided colitis

Colitis that affects the rectum and the left side of the colon. Pain is often in the lower left of the tummy.

Extensive colitis or pancolitis

Colitis that affects most or all of the colon. Flares can be more severe.

Perianal Crohn's

Crohn's around the bottom. It can cause painful abscesses and fistulas, which are tunnels between the bowel and the skin or other organs.

IBD unclassified

Sometimes it isn't clear whether someone has Crohn's or colitis. This is called IBD unclassified (IBDU). Treatment is similar.

Symptoms and flares

Symptoms depend on the type of IBD and where it is. Common symptoms include:

IBD usually comes and goes. Times when symptoms are under control are called remission. Times when they come back are called flares.

Months or years

Remission

Few or no symptoms. Tiredness and some pain can carry on. Keep taking your maintenance medicine.
Days

Early signs

More frequent or looser poo, blood, cramps or tiredness. Contact your IBD team early.
Days to months

Flare

Urgent diarrhoea, pain, bleeding, weight loss and exhaustion. Treatment is stepped up.
Weeks

Recovery

Symptoms settle as treatment works. Energy can take longer to return.

Timings are typical ranges, not exact rules. Infections, stopping medicines, stress and anti-inflammatory painkillers can all set off a flare.

Joint pain and IBD

Joint problems are the most common symptom of IBD outside the gut. Crohn's & Colitis UK says up to 46 in every 100 people with Crohn's or colitis may have them.

Joint pain without swelling

Called arthralgia. The joints ache but aren't inflamed. It can sometimes be a side effect of medicines, or happen when steroids are reduced.

Type 1 arthritis

Affects fewer than 5 joints, usually large ones like knees and ankles. It tends to flare with your gut, and usually settles within weeks as the gut gets better.

Type 2 arthritis

Affects 5 or more joints, often the small joints of the hands. It doesn't follow your gut symptoms and can last months or years.

Axial spondyloarthritis

Long-term pain and stiffness in the lower back and buttocks, often worse in the morning or after rest. It can cause lasting damage if not treated, so tell your doctor about back pain.

Treatment includes controlling gut inflammation, physiotherapy and exercise, steroid injections into a joint, and some of the same medicines used for IBD, such as anti-TNF biologics. A rheumatologist can help, ideally working with your IBD team.

Be careful with anti-inflammatory painkillers

Anti-inflammatory painkillers (NSAIDs) such as ibuprofen, naproxen and diclofenac can set off an IBD flare. Only take them if your IBD team says it is OK. Gels and creams rubbed on the skin carry less risk. Paracetamol is usually safer for pain.

When to get urgent help

A severe flare can become an emergency. Acute severe colitis needs hospital treatment, often within hours.

Call 999 or go to A&E if you have

severe tummy pain
bleeding from your bottom that won't stop, or large blood clots
vomit with blood in it, or that looks like coffee grounds
a swollen, hard tummy and can't poo or pass wind
collapsed, or feel faint and very unwell

Call NHS 111 or your IBD helpline today if

you have severe bloody diarrhoea, or many bloody poos a day
you have a high temperature
your heart is beating fast
you are being sick and can't keep fluids or medicines down
you have a painful swelling near your bottom

Contact your GP or IBD team if

you think you are starting a flare
you have joint, eye or skin problems
you have side effects from your medicines
you are losing weight without trying
you have had diarrhoea for more than a few days

A red or painful eye with blurred vision also needs to be seen urgently. It can be a sign of eye inflammation linked to IBD.

Diagnosis and referral

Your GP will ask about your symptoms and may arrange:

Blood tests to look for inflammation, anaemia and infection.
A poo test to rule out infection, and a test called faecal calprotectin that shows inflammation in the gut. It helps tell IBD apart from IBS.

If IBD is suspected, your GP will refer you to a gastroenterologist. The specialist may arrange:

A colonoscopy or sigmoidoscopy: a thin tube with a camera looks inside the bowel. Small samples (biopsies) are taken to confirm the diagnosis.
A gastroscopy to look at the upper gut, if needed.
Scans such as MRI, CT or ultrasound, especially to check the small bowel in Crohn's.

Within 4 weeks

NICE's quality standard says people with suspected IBD should see a specialist within 4 weeks of referral, and sooner if symptoms are severe. Crohn's & Colitis UK says 1 in 4 people still wait more than a year for a diagnosis.

Treatments and medicines

Treatment has two aims: to bring a flare under control (inducing remission), and to keep you well (maintaining remission). Medicines are usually started by your hospital IBD team. Some are then prescribed by your GP.

Aminosalicylates (5-ASAs)

Prescription, mainly for colitis

Mesalazine and sulfasalazine, as tablets, granules, suppositories or enemas. For mild or moderate colitis, NICE suggests trying them for about 4 weeks before adding another treatment. They are often taken long term to prevent flares.

Steroids

Prescription, short courses for flares

Prednisolone, budesonide or hydrocortisone. Tablets usually help within 1 to 4 weeks, and a drip in hospital works within days. A course often lasts about 8 weeks. They aren't used to keep you well long term because of side effects. Carry your steroid card.

Immunosuppressants

Started by your IBD team

Azathioprine, mercaptopurine and methotrexate. They calm the immune system to keep you in remission. They can take 3 months or more to work. You will need regular blood tests.

Biologics

Hospital specialist, by injection or drip

These target parts of the immune system. They include anti-TNF medicines (infliximab, adalimumab, golimumab), vedolizumab, ustekinumab, and newer IL-23 blockers such as risankizumab, mirikizumab and guselkumab. Many people can inject at home. Your team will check whether they are working after a few months.

Targeted tablets

Hospital specialist

JAK inhibitors (tofacitinib, filgotinib, upadacitinib) and S1P modulators (ozanimod, etrasimod) are tablets that calm the immune response. Which ones you can have depends on your type of IBD.

Liquid diet

With a specialist dietitian

A special liquid-only diet (exclusive enteral nutrition) can settle Crohn's, especially in children and young people, usually for several weeks.

Symptom relief

GP, pharmacy or IBD team

Paracetamol, antispasmodics for cramps, and iron or vitamin supplements. Anti-diarrhoea medicines should only be used if your team says so, as they can be dangerous in a severe flare.

If you are admitted to hospital with acute severe colitis, you will usually be given steroids through a drip. NICE says that if you haven't improved after about 72 hours, doctors should consider a rescue medicine or surgery.

Surgery and recovery

Surgery may be needed if medicines aren't working, if the bowel is narrowed or blocked, or for fistulas and abscesses. For colitis, removing the colon can be a cure for the gut disease. For Crohn's, surgery can work well, but Crohn's can come back in another part of the gut.

Operation	What it involves and typical recovery
Bowel resection (Crohn's)	The damaged part of the bowel is removed and the healthy ends joined. Usually several days in hospital and several weeks to recover.
Stricture widening (Crohn's)	A narrowed section is widened, either in surgery or with a balloon during an endoscopy.
Fistula and abscess surgery	Draining abscesses and placing a soft thread (seton) so a fistula can drain.
Colectomy with ileostomy	The colon is removed and the small bowel brought out through the tummy into a stoma bag. Often 3 to 10 days in hospital, then about 6 to 8 weeks to get back to usual activities, and no heavy lifting for 3 months.
Ileo-anal pouch (J-pouch, colitis)	An internal pouch is made from the small bowel, so you can pass poo normally. It is usually done in 2 or 3 operations over several months.

Most people can drive about 6 weeks after a major bowel operation. You can usually go back to work when you feel well enough and can look after your stoma, if you have one. A stoma nurse will support you. Many people say they feel much better once they have recovered.

Self-help

During a flare

Contact your IBD team early. Many have an advice line
Drink plenty of fluids so you don't get dehydrated
Eat small, plain meals if you can
Use a heat pad for cramps
Keep a kit: spare underwear, wipes, medicines and your Can't Wait card

Staying well

Keep taking your medicines, even when you feel well
If you smoke, get help to stop. It makes Crohn's worse
Ask to see a dietitian before cutting out foods
Keep active, at a level that suits you
Get help for fatigue, low mood or anxiety

Getting the best care

Keep a symptom diary. Note how often you go, any blood, pain, joint symptoms, food and medicines. Bring it to appointments.
Know your IBD team. Ask for the IBD nurse advice line number and save it in your phone.
Have a flare plan. Ask your team what to do and who to call when a flare starts.
Carry a Can't Wait card and a RADAR key. The card explains you need a toilet urgently. The key opens over 9,000 locked accessible toilets. Crohn's & Colitis UK members can get both.
Carry your steroid card if you take steroids, and a list of your medicines.
Mention joint, eye and skin problems. They are part of IBD, and you may need a referral to a rheumatologist or other specialist.
Ask for a second opinion if treatment isn't working or you feel you aren't being listened to.

IBD and work

Crohn's and colitis aren't automatically classed as a disability, but they often count under the Equality Act 2010 (the Disability Discrimination Act in Northern Ireland). This applies if your condition has more than a minor effect on daily life and has lasted, or is likely to last, at least 12 months. Conditions that come and go count. The law looks at how you would be without treatment.

If it does, and your employer knows or should know about it, they must make reasonable adjustments. Adjustments might include:

A desk close to the toilet
Toilet breaks whenever you need them
A fixed desk instead of hot-desking
Flexible hours or a later start
Working from home during flares
Parking close to the building
Time off for appointments and infusions
A phased return after surgery or a flare
Private facilities for stoma care
A supportive chair for back or joint pain

Access to Work is a government grant that can pay for equipment, travel to work and other support. For advice on your rights, contact Acas or Citizens Advice. Crohn's & Colitis UK has guides for employees and employers.

Benefits

If you can't work for a while, you may get Statutory Sick Pay from your employer. Depending on how IBD affects you, you may also be able to get Personal Independence Payment (PIP), or Adult Disability Payment in Scotland, Universal Credit or Employment and Support Allowance. Turn2us and Citizens Advice can help you check.

How The Beyond Pain Foundation can help

If NHS waits are too long, or the help you need isn't available to you on the NHS, we may be able to fund:

A private consultation with a gastroenterologist or rheumatologist
Physiotherapy for IBD-related joint or back pain
Sessions with a specialist IBD dietitian
A pain management programme
Workplace or home equipment, such as a supportive chair, a sit-stand desk or a home working setup so you can work near a toilet
Travel to specialist appointments

We can't pay for everyday living costs, or for treatment you have already paid for. Prices vary, so always get a written quote to include with your application.

Apply for funding Check the requirements

Support and sources

Crohn's & Colitis UK

Information and support charity

Helpline 0300 222 5700, Monday to Friday, 10am to 3pm, or email helpline@crohnsandcolitis.org.uk. Members can get a Can't Wait card and a RADAR key.

crohnsandcolitis.org.uk

Bladder & Bowel Community

Practical support

Information on toilet access, including a free RADAR key and Just Can't Wait card through its home delivery service.

bladderandbowel.org

NHS

Health information

Symptoms, treatment and when to get help with Crohn's disease and ulcerative colitis.

nhs.uk/conditions/crohns-disease

Sources for this guide

Last reviewed: October 2026.