What is IBD and How do PTs Manage It?

What is IBD?  Inflammatory bowel disease (IBD) is often confused with the functional disorder Irritable Bowel Syndrome (IBS). IBD is an autoimmune disease primarily impacting the gastrointestinal  tract.  IBD contains three subtypes: Crohns disease (which can impact any GI tissue from the mouth to the anus), Ulcerative Colitis (which affects the colon and rectum exclusively) and Indeterminate Colitis (which indicates difficulty with diagnostic clarity).  IBD has a genetic component, although it is believed that an environmental trigger turns on the gene. People are more likely to be diagnosed between 15 – 30 years of age or between 50-80 years of age and there is equal distribution between genders.  Over the past decade, it has been detected in the younger population without a clear explanation.  

Diagnosis is made via intestinal biopsy that is obtained via colonoscopy.   IBD is a relapsing-remitting illness with a wide range of symptom severity among those impacted and there are a host of extraintestinal symptoms that a patient with this disease may or may not experience. Hallmark symptoms include diarrhea, fecal urgency, abdominal pain, bloating, weight loss/difficulty gaining weight, nausea and frequent low-grade fevers.  Because the intestinal lining is often inflamed, red blood cell functions are frequently impacted, which in turn brings about fatigue.  IBD may influence joints, eyes, skin, hepatobiliary function, hematopoietic coagulation, pulmonary function and often compromises nutrient absorption.  Impaired nutrient absorption can contribute to growth delay in children and impaired bone density in any individual with this disease.  PT’s treating this population should be aware of what may be a sign and/or symptom of IBD, including musculoskeletal system impairments, and differentiate that which may be explainable by other diseases with a similar presentation.

There is a spectrum of medications utilized to treat IBD and most of them include at least one side effect.   In addition to the disease impacts, PTs treating this population should be aware of potential medication side effects as part of their medical screening process. 

Pain can be a significant problem for the patient with IBD and perhaps the most relevant role PT can play in managing this population lies in our expertise in screening the musculoskeletal system from other sources of pain.  Education and empowerment surrounding self-pain management are key issues to improving function for people with IBD.

Just as screening for joint complaints informs clinical decision making, PT’s should screen patients with IBD for pelvic floor dysfunction.  These patients are frequently NOT referred to PT for functional pelvic floor disorders, although they often present with impaired bowel, bladder and/or sexual function.  Due to chronic bowel urgency, many patients with IBD present with overactive pelvic floor musculature and dyssynergia.  Many of these functional impairments are fully treatable with PT. 

To learn about the role of the physical therapist in managing IBD, we invite you to explore our on-demand course The Role of the Physical Therapist in Managing Inflammatory Bowel Disease (IBD) where instructors, Christine Morgan, PT, DPT, Board-Certified Sports Clinical Specialist and Nancy Cullinane, PT, MHS, Board-Certified Women’s Health Clinical Specialist will provide you with an overview of IBD and the multiple systems that may be impacted by both the disease and medications utilized in treating it.

Authors: Christine Morgan, PT, DPT, Board-Certified Sports Clinical Specialist

Nancy Cullinane, PT, MHS, Board-Certified Women’s Health Clinical Specialist