Bowel Issues – Part 1, by Dr. Bob

Inflammatory Bowel Disease (IBD), is a poorly understood grouping of two separate diseases:  Ulcerative Colitis (UC) and Crohn’s Disease (CD).  Unlike other bowel diseases, both of these conditions have characteristics both in their presentation and pathology that make diagnosis fairly routine.  Both will be reviewed here with recommendations for ongoing management and treatment options in a post-collapse environment.
Ulcerative Colitis patients have recurrent episodes of inflammation of the mucosal layer of the colon.  There are different subtypes of UC based on the location of the inflammation.  Ulcerative Proctitis affects the rectum, or lowest portion of the colon.  If the inflammation is slightly more extensive, the terms Left-sided Colitis, Distal Colitis, or Proctosigmoiditis are often used to describe the disease.  Extensive Colitis involves nearly the entire colon but does not involve the cecum (closest to the small bowel junction) and Pancolitis involves the colon and the cecum.  Each subtype of UC is then characterized as mild, moderate or severe.  Mild disease is usually just the distal colon, with mild pain and sometimes bleeding, and four or fewer stools each day.  Moderate disease may involve more of the colon but it is not Pancolitis, and stools up to 10 daily.  Bleeding can be more severe and even cause anemia, but not transfusions.  Nutrition in both mild and moderate disease is normal.  In severe disease the bleeding can cause anemia which requires transfusions; along with severe abdominal pain, weight loss, malnutrition, low grade fevers, and can even lead to a deadly condition called toxic megacolon.

Treatment for mild and moderate disease is, of course, less involved and less intensive than the treatment for severe disease.  20% of those with Distal Colitis will have complete remission, and the later a patient has onset of their disease, the better their chances at longer and more complete remissions.  Mild and moderate late-onset disease responds better to courses of steroids too.  Often, medications like Azathioprine (Imuran) and salicylates like Sulfasalazine (Azulfidine) will help control symptoms and maintain remission.  Sometimes, more potent chemotherapy drugs are used to control moderate and severe disease, but these will be unavailable WTSHTF.  Steroid courses often help control specific exacerbations of UC, but long-term steroids have significant side effects and other medications like those mentioned above are often used for chronic suppression rather than steroids.

Crohn’s disease is the other IBD of the two.  Crohn’s Disease is usually disease of the small bowel, with only 20% having colon involvement only and the other 80% being small bowel alone or with some colon involvement.  CD is more variable in its presentation than is UC:  fatigue, long-term diarrhea, abdominal cramps, weight loss, low-grade fever, and bleeding are often ongoing and occur for months to years before diagnosis.  The hallmark sign of CD compared to UC is “skipping” or “cobblestoning” on scoping.  Crohn’s Disease has abnormal and normal mucosa right next to each other in patches, whereas Ulcerative Colitis is diffuse.  Otherwise, the two can often be very difficult to tell apart.  CD often causes small ulcerations that can lead to scarring and fistulas, sinus tracts and sometimes perianal skin tags.

Treatment choices for Crohn’s Disease include some of the same medications used to treat UC like salicylates like Sulfasalazine (Azulfidine), steroids and immunomodulators like Azathioprine (Imuran); but also antibiotics, non-systemic steroids like Budesonide (Entocort), and biologic therapies like Infliximab (Remicade) and Adalimumab (Humira).  Why some of these medications work better for CD than they do for UC will likely remain a mystery for many years, if not decades.  But, the fact remains that most of these medications will be unavailable WTSHTF and even now are ridiculously expensive and realistically not within the budget of most of us to even think of stockpiling.

Obviously, the diagnosis of these conditions is not going to be made in TEOTWAWKI.  If you already have or suspect that you may have Ulcerative Colitis or Crohn’s Disease, get your diagnosis and subtype confirmed now and do all you can to control your disease with the grid in place.  Learn about diet theories that help colon health, of which there are many.  Try these diets now and see if they work for you.  Then stick with them and plan your prepping foods accordingly.  If medication is needed to control your condition, you need to have it on hand.  If you currently are on one of the horribly expensive IV medications that controls your symptoms well, think about talking with your doctor about trying cheaper medications so that you can test the control and dosing to prepare for the worst-case scenarios. 

JWR Adds: Dr. Bob is is one of the few consulting physicians in the U.S. who prescribes antibiotics for disaster preparedness as part of his normal scope of practice. His web site is: