Contraceptive Choices for Women with Inflammatory Bowel Disease

Journal of Family Planning and Reproductive Health Care 2003: 29(3) What is inflammatory bowel disease (IBD)? Inflammatory bowel disease (IBD) refers to two distinct disorders – Crohn’s disease (CD) and ulcerative colitis (UC).1 These two disorders have distinct clinical and pathological features but their cause is unknown. In patients with large bowel disease only there may be difficulty distinguishing between the two. Disease may be ‘severe acute’, ‘intermittent relapsing’, ‘chronic persistent’ or ‘asymptomatic’, and patients may present with abdominal pain, diarrhoea with blood and mucus, and frequent bowel movements. Ulcerative colitis involves the large bowel (colon) only with inflammation of the superficial mucosal layer, which bleeds readily. The whole colon is affected in up to 20% of patients. Disease is confined to the rectum (proctitis) in 30% of patients. Crohn’s disease can affect the entire gastrointestinal tract and clinical symptoms reflect the site of disease. There is inflammation throughout the layers of the bowel wall (transmural) and affected areas can be interspersed with normal bowel (skip lesions). This transmural inflammation can lead to fibrosis and bowel obstruction, or to sinus tract and fistula formation involving adjacent organs. In contrast to UC, only 20% of CD patients will have disease confined to the colon. Small bowel involvement is most common, usually involving the distal ileum alone. The ileum and colon are both affected in up to 50% of patients and up to a third will present with perianal disease. Few will present with involvement predominantly in the mouth, oesophagus, gastroduodenum or proximal small bowel.