This is the sixth and last part of our mini-series about the condition based on our patient booklet “Fast Facts for Patient and Their Supporters: Inflammatory Bowel Disease”.

Does IBD Affect Fertility or Pregnancy?

Fertility

• Female fertility is not significantly affected by IBD if the condition is well controlled.
• Theoretically, oral contraceptive tablets may not be fully absorbed if Crohn’s disease affects the small intestine. If you are a woman with Crohn’s disease who wishes to avoid pregnancy, it is important that you discuss your contraceptive options with your doctor.
• There is a risk of infertility in women who have had pelvic surgery, such as the creation of an ileoanal pouch after removal of the colon. Women should consider deferring pouch surgery until they have completed their family.
• Male fertility can be reduced by sulfasalazine because it may reduce the sperm count. This is reversible.

How Does IBD Affect Pregnancy and Vice Versa?

• Pregnancy does not adversely affect IBD and, if IBD is well controlled, it does not adversely affect the chances of a successful pregnancy.
• If the IBD is uncontrolled at conception, there is an increased risk of spontaneous abortion, premature delivery and stillbirth.
• Ideally, women should work with their doctor to try to achieve remission before conceiving. The wellbeing of the mother is the single most important influence on the outcome of pregnancy.
• Pregnant women should talk to their doctor about the drugs they are taking and whether there are any risks to the unborn baby. However, the health benefits to the mother of safe drug control usually outweigh the theoretical risks to the unborn child.

What about Delivery?

Vaginal delivery is usually safe and preferred. However, if you have active Crohn’s disease in the anal region, Caesarean section should be considered. In all cases, it is wise to discuss the best strategy for delivery with both your gastroenterologist and obstetrician.

What Is the Risk of My Baby Getting IBD?

This is difficult to determine precisely in most cases. However, the lifetime risk for your baby is low and usually less than 5%. This means that there is a very high likelihood that your baby will never get IBD.

IBD in Children

Childhood IBD

IBD begins in childhood or adolescence in about a quarter of patients. Genetic rather than environmental influences are likely to be stronger when IBD occurs in childhood, particularly in preschoolers.

Unusual presentations are more common in children.

Characteristics of IBD in Children

• More extensive disease than in adults
• May result in short stature
• Delays puberty
• Causes inflammation outside the gut (e.g. skin rashes, mouth ulcers)

Treatment

Children are not, of course, small adults; the treatment of IBD in childhood must consider that the patient is still growing and maturing, physically and emotionally.

Diagnostic Radiation

Diagnostic radiation, particularly from CT scans, should be limited because of an increased sensitivity to radiation in young people.

Drugs

Early use of immunomodulatory drugs, including biological therapies such as anti-TNFa, can reduce the use of corticosteroids and offset the danger of stunted growth. Reluctance to use such drugs in young patients is often unfounded; there is no added risk with their use in children over that in adults.

Diet

Nutrition requires extra attention in children. Weight and height should be carefully monitored. Indeed, a liquid formula diet is often more important than drug therapy in children.

In some cases, it may be necessary to provide nutrition by a fine-bore tube passed through the nose and down the throat into the stomach.

IBD in the Elderly

IBD is common in older people, because most patients with IBD live a full life. In addition to those who grow old with their IBD, some patients develop IBD for the first time in later life.

IBD is often mild in older people, but coincidental disorders may get confused with IBD, delaying the diagnosis or complicating it.

The IBD is sometimes confused with other disorders.

Other Possibilities for Symptoms in Older People

• Infectious colitis
• Ischemic colitis (due to poor blood supply)
• Diverticular disease
• Drug-induced injury
• Bowel cancer

Type of Disease

The inflammation in older people tends to occur in the lower parts (distal) of the gastrointestinal tract, with disease of the large bowel (colon) in patients with Crohn’s disease and more rectal involvement in those with ulcerative colitis.

Weight loss, bleeding and fever may be more prominent, and although it may seem strange, constipation often occurs.

Treatment

It is important to spot the adverse effects of drugs quickly in the elderly. The use of multiple drugs for IBD and other disorders that people get as they age adds to the risk of drug toxicity and drug interactions.

Information based on Fast Facts for Patients and their Supporters: Inflammatory Bowel Disease (Karger, 2019).