Your Gut

Diagnosing and managing inflammatory bowel disease

This information is for anyone with axial spondyloarthritis (axial SpA) including people with ankylosing spondylitis (AS)

7% of people with axial SpA (AS) also develop inflammatory bowel disease

If you develop symptoms which might indicate inflammatory bowel disease (IBD) you should be referred by your GP or rheumatologist to a gastroenterologist for tests, diagnosis and ongoing management.

Main symptoms of IBD

  • Diarrhoea. This is sometimes mixed with blood, mucus and pus
  • Cramping pains in the abdomen. These can be very severe and often occur before passing a stool
  • Tiredness and fatigue
  • Feeling generally unwell. Some people may feel feverish
  • Loss of appetite and loss of weight. Weight loss can be due to the body not absorbing nutrients from the food you eat because of the inflammation in the gut
  • Anaemia (a reduced number of red blood cells). You are more likely to develop anaemia if you are losing a lot of blood and are not eating
  • Mouth ulcers

There are two main types of inflammatory bowel disease: Crohn’s disease and ulcerative colitis.

Crohn’s disease

Crohn’s disease is a long term condition that causes inflammation of the digestive system. The inflammation can affect any part of the digestive system, from the mouth to the back passage, but most commonly occurs in the last section of the small intestine (ileum) or the large intestine (colon).

Symptoms vary depending on which part of the digestive system is inflamed but common symptoms include:

  • Recurring diarrhoea
  • Abdominal pain and cramping, which is usually worse after eating
  • Fatigue
  • Weight loss
  • Blood and mucus in the faeces

There may weeks or months where you have very mild or no symptoms (known as remission), followed by times where the symptoms flare.

There is currently no cure for Crohn’s disease. However, medication is available that can be used to treat the symptoms and prevent them from returning.

 Ulcerative colitis

Ulcerative colitis is a long term condition where the colon becomes inflamed. In more severe cases, painful ulcers may form on the lining of the colon. These ulcers can bleed and produce mucus and pus.

Symptoms of ulcerative colitis include:

  • Diarrhoea which may be mixed with mucus, pus or blood
  • Abdominal pain
  • Pain when passing stools
  • Frequent need to go to the toilet
  • Weight loss

Symptoms of ulcerative colitis can range from mild to severe. The condition is very unpredictable. Symptoms can flare up and then disappear for months or even years.

Help and support

Crohn’s and Colitis UK is a charity that provides help and support for people with IBD.

Their helpline number is 0300 222 5700 (Monday, Tuesday, Wednesday and Friday 9am-5pm, and Thursdays 9am-1pm). You can also contact them by email:

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