Inflammatory bowel disease, or IBD, can begin at any age, but for older adults, changing bowel habits are often chalked up to “just getting older” or mistaken for something else entirely.
“People tend to think of inflammatory bowel disease as something that only affects younger generations,” said Ericka Howard, MD, gastroenterologist on the medical staff at Methodist Richardson Medical Center. “But we actually see a second influx of new diagnoses between the ages of 60 and 80.”
That misconception can lead to years of unnecessary suffering. Studies show diagnosis in older adults may be delayed by as much as six years compared with younger patients, and up to 60% of older adults with IBD are initially misdiagnosed.
“If you’re noticing chronic diarrhea, abdominal pain, or blood in your stool, those aren’t signs of aging,” Dr. Howard says. ”They’re signs that something’s wrong.”
Dr. Howard shared the common symptoms and treatments of a disease that affects about 2 to 3 million Americans during a presentation to Methodist Generations, an education and enrichment program for older adults.
DON’T WAIT TO SEEK HELP
IBD is a chronic inflammation of the digestive tract that includes two main conditions: Crohn’s disease, which can affect anywhere from the mouth to the anus, and ulcerative colitis, which is limited to the colon. Both diseases cause long-term irritation that can lead to diarrhea, abdominal pain, or bleeding.
When inflammation goes unchecked for years, it can cause complications like infections, narrowing of the intestines, or even bowel obstruction. Early diagnosis gives patients the best chance at controlling the disease and maintaining their quality of life.
“With today’s therapies, remission is realistic,” Dr. Howard says, “and life can absolutely get back to normal.”
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HOW IBD DIFFERS FROM IBS
IBD is on the rise around the world and affects about 1% of the U.S. population, compared with 10-15% who suffer from irritable bowel syndrome, or IBS, according to the Centers for Disease Control and Prevention.
“It’s important to know that IBD isn’t the same as IBS,” Dr. Howard said. “If we did a colonoscopy in someone with irritable bowel syndrome, everything would look normal. But with IBD, you can actually see inflammation and ulceration.”
For older adults, symptoms often appear differently. Instead of severe diarrhea, they may notice fatigue, abdominal discomfort, constipation, or a feeling of incomplete bowel movements. Because those signs overlap with more common age-related conditions such as diverticulitis, ischemic colitis, or even side effects from certain medications, IBD can be missed or mistaken for something less serious.
“That’s why testing and biopsies are so important,” Dr. Howard noted. “We don’t want to miss the real cause.”
GETTING DIAGNOSIS RIGHT
Determining whether a patient has IBD usually begins with blood work to look for inflammation or anemia and stool tests to rule out infections.
A colonoscopy remains the most reliable way to confirm a diagnosis because it allows doctors to both see and sample the intestinal lining.
Even when the colon looks normal, tissue biopsies can reveal microscopic colitis — a subtle but treatable form of inflammation that often affects older adults.
“Sometimes, especially with Crohn’s disease, we order special CAT scans that look at the small bowel to see if there’s inflammation or thickening of the walls there,” Dr. Howard says.
If the inflammation is higher up in the digestive tract, imaging or capsule endoscopy — a small camera swallowed like a pill — can provide additional insight.
REMISSION IS THE GOAL
IBD is chronic but highly treatable, and the goal is always remission because there is no cure. Short-term steroid medications can calm inflammation but aren’t meant for long-term use.
“Steroids are meant to get you feeling better, not to stay on forever,” Dr. Howard said. “They can raise blood pressure and blood sugar and weaken bones.”
Newer biologic and targeted medications offer safer, more precise options for long-term control. Because many older adults take multiple prescriptions, Dr. Howard stresses the importance of coordination among a patient’s primary care doctor, gastroenterologist, pharmacist, and dietitian to find the right balance of care.
“It really requires a whole healthcare team to look through what medications you’re on and what other conditions you have to make sure we’re getting the right treatment,” Dr. Howard says.
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