Inflammatory Bowel Disease

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Crohn’s Disease vs Ulcerative Colitis

Two major inflammatory conditions that affect the bowels are Crohn’s disease and ulcerative colitis. Together, they are known as inflammatory bowel disease (IBD). IBD is classically thought to be autoimmune; in other words, the result of the body’s immune system attacking itself. Recent evidence may point to the immune system attacking, not just itself, but the normal bacteria and other microbes in the gut.

Inflammatory bowel disease was once thought to originate from dietary and stress issues. These are now considered aggravating factors rather than the cause.

People with Crohn’s disease or ulcerative colitis are a diagnostic challenge to the medic, as they present with pelvic pain that may mimic other GI conditions such as diverticulitis or appendicitis. The first signs of IBD normally appear in teenagers or young adults.


Crohn’s disease is characterized by inflammation that can affect any part of the GI tract. It most commonly affects the end of the small bowel (ileum) and the beginning of the colon. This is called “ileocolitis.” Other areas include the stomach, jejunum, duodenum, ileum, and large intestine.

Crohn’s can affect the entire thickness of the bowel wall. In some patients, intestinal inflammation may “skip” some locations, leaving normal spots between patches of inflamed tissue.

Symptoms of Crohn’s disease vary dependent on the areas affected. The condition may “flare” up for weeks or months and, then, improve. They include:

•          Abdominal pain and cramping.

•          Nausea and vomiting.

•          Persistent diarrhea or, sometimes, constipation.

•          Bleeding from the rectum.

•          Sudden and severe urges to have a bowel movement.

•          Feeling like there isn’t complete evacuation of the bowels.

•          Loss of appetite and weight loss

Crohn’s disease is problematic off the grid, as it is commonly treated with prescription steroids, but may require surgery in the most severe cases. Both options are off the table in survival scenarios. Off the grid, acetaminophen for pain, antidiarrhea meds like loperamide, and a soft, bland diet may help. Probiotics such as kefir, yogurt, miso, or supplements may help decrease flareups, although further study is required.

If inflammation leads to bacterial infection with fever, Metronidazole, ciprofloxacin, and ampicillin are antibiotic options. Some of these are available in certain veterinary equivalents such as Aqua-Zole and Aqua-Cipro. It should be noted that ciprofloxacin can cause serious long-term side effects, such as tendon rupture, nerve damage, and more.


Ulcerative colitis is a chronic inflammation of the large intestine, usually the rectal area. Like Crohn’s disease, it is a type of inflammatory bowel disease (IBD) and is thought to be autoimmune in nature. Ulcerative colitis is often first diagnosed in adolescence and early adulthood, but sometimes begins in older age groups.

In ulcerative colitis, inflammation of the inner lining of the colon leads to symptoms, such as:

•          Intermittent abdominal pain, often left-sided.

•          Diarrhea, often more than four times a day; may be mixed with mucus and blood.

•          Abdominal pain, often left-sided.

•          Rectal bleeding and pain.

•          Constipation despite frequent urges to have a bowel movement.

•          Fecal incontinence.

•          Fever and fatigue.

•          Weight loss.

Flare-ups of bloody diarrhea and pain may last for weeks, followed by a period of relative improvement. Over-the-counter meds like Loperamide 2 mg orally can be given for diarrhea and acetaminophen for pain. Steroids and even immune suppressants are options in normal times.


Although both Crohn’s disease and ulcerative colitis are types of inflammatory bowel disease (IBD), there are differences: Ulcerative colitis is limited to the rectum and large intestine, while Crohn’s disease develops anywhere throughout the entire digestive system (sometimes even causing mouth sores!). As such, someone whose Crohn’s disease affects primarily the stomach may be more likely to have symptoms like nausea and vomiting, something rarely seen in ulcerative colitis.

In Crohn’s disease, healthy areas of intestine can be seen between areas of inflammation. Ulcerative colitis causes the colon to appear more uniformly and continuously inflamed. Ulcerative colitis only affects the innermost lining of the colon while Crohn’s disease can occur in any part or the entirety of the bowel wall.

Both forms of IBD can result in scarring if severe. Scars often occur in the form of abnormal narrowing of the intestines called “strictures”  that can cause obstruction.


Both Crohn’s disease and ulcerative colitis may possibly be made less severe with dietary changes. Patients may have difficulty digesting uncooked produce, unpeeled fruit, and vegetables with high fiber content like cauliflower and broccoli. Fatty foods and dairy products can also worsen symptoms. If possible, stick with frequent, small meals of non-spicy cooked vegetables and lean meats and fish. Also, avoid high-sugar content foods, alcohol, and caffeine.

Some consider intermittent fasting (IF) as an option. Intermittent fasting is a diet pattern in which a person eats only during a certain number of hours and fasts for the rest of the day. The most common way to accomplish this is to fast immediately following dinner through part of the next day.

Ohers suggest time-restricted fasting (TRF), where the person eats only during certain hours of the day. Although some early research suggests a benefit to those with IBD, weight loss, vitamin D and iron deficiency, and lack of nutrients make it a controversial strategy. In normal times, IF and TRF regimens are best monitored by a registered dietician.

Probiotics and prebiotics have also been recommended as helpful, but may vary in their effectiveness. Probiotics are harmless microbes that you can consume. They are found in certain foods and supplements, and work like the good bacteria in your gut. Yogurt is a probiotic, but not recommended for IBD due to its dairy content. Other foods include:

  • Sauerkraut
  • Kombucha
  • Kefir
  • Kimchi

Prebiotics are food for probiotics and for intestinal bacteria. Adding prebiotics to your diet might improve the function of your normal intestinal bacteria. Using prebiotics along with probiotics might make the probiotics more effective.

  • Honey
  • Whole grains
  • Bananas
  • Onions
  • Garlic
  • Artichokes

Some believe that the anti-inflammatory Omega-3 fatty acids found in fish oil may help those suffering from Crohn’s disease. One study suggests that remissions last longer in people taking fish oil than a placebo. Avoid high doses, however, as it can cause bleeding problems.


There are herbal therapies claimed to ease the symptoms of irritable bowel disease. These include:

  • aloe vera juice
  • slippery elm bark
  • chamomile
  • peppermint

Some natural therapies may not mix well with certain prescription meds. Discuss these with your physician before a disaster strikes to see if they are safe to use.


Stress and anxiety don’t cause inflammatory bowel disease, but they can certainly impact health and aggravate GI symptoms. Exercise may help reduce tension by focusing on pleasurable activities like biking, swimming, and walking. Yoga, meditation, and mindfulness techniques may make a difference.

Some notice improvement with diaphragmatic breathing. In this technique, you sit or lie in a comfortable position and place one hand on the abdomen. Inhale through the nose for four seconds, hold for another two, then exhale slowly through your mouth for six seconds. Repeat.

Another technique called progressive muscle relaxation or PMR, involves tensing and relaxing different muscle groups to relieve tension that can make stress and pain worse. Starting with both hands, make fists and hold them tightly for 10 seconds, followed by relaxation for 20 seconds.

With each movement, focus on the sensations of relaxation coming into your body. You may feel warmth and a sense of well-being and peace. Hold each position for 7 to 10 seconds, then relax your muscles for about 20 seconds. Tense and relax each muscle group twice before moving on to the next part of the body. Repeat and, then, tense and relax muscle in both lower arms, upper arms, shoulders and neck, abdomen, legs, and so on in order.

Without advanced technology and medications, inflammatory bowel disease may be difficult for the survival medic to treat. We must do the best we can, with what we have, in times of trouble.

Joe Alton MD

Dr, Alton

Find out more about IBD and 200 other medical issues in long-term disaster settings in our greatly expanded 4th Edition of The Survival Medicine Handbook! And don’t forget our entire line of quality FSA/HSA-eligible medical kits and supplies at You’ll be glad you did.

Hey, don’t forget to check out our entire line of quality medical kits and individual supplies at Also, our Book Excellence Award-winning 700-page SURVIVAL MEDICINE HANDBOOK: THE ESSENTIAL GUIDE FOR WHEN HELP IS NOT ON THE WAY is now available in black and white on Amazon and in color and color spiral-bound versions at

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