Does Ankylosing Spondylitis Cause GI Problems?

Doctors aren’t sure why, but the conditions are connected

Patient with lower back pain in doctor's office.

If you’re living with ankylosing spondylitis (AS), you know that the brunt of symptoms comes in your lower back and hips. The feeling of stiffness and joint pain is no surprise, but what if you start experiencing unusual bowel symptoms?

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As it turns out, AS can also affect other parts of your body, like your gastrointestinal (GI) tract. If you’re having symptoms related to inflammatory bowel disease (IBD), your treatment options may need to be different.

Gastroenterologist Asad Ur Rahman, MD, explains what we know about the connection between AS and gastrointestinal problems.

How are ankylosing spondylitis and IBD linked?

Around 5% to 10% of individuals with AS also have inflammatory bowel disease — either in the form of Crohn’s disease or ulcerative colitis. Currently, doctors have no clear answer as to why these conditions are linked.

In some cases, IBD may be the culprit behind gastrointestinal symptoms seen in people with AS. Dr. Rahman points out that inflammatory bowel disease causes your immune system to become intolerant to native bowel and its bacteria, when it should be normally fighting against infection. This kind of inflammation in the cells may be associated with other areas of immune intolerance, leading to ankylosing spondylitis.

“These inflammatory cells, when activated, can go to the joint’s spaces and cavities. This causes inflammation of those joint spaces, one of them being the spine joints,” Dr. Rahman explains. According to the Spondylitis Association of America, around 20% of people with IBD also have AS, with symptoms usually affecting their sacroiliac joints and spine. Dr. Rahman also notes that genetics may be a factor in linking these two conditions.

But why AS and IBD are connected still isn’t completely clear. In fact, Dr. Rahman says that sometimes you get symptoms of AS before the GI symptoms — or vice versa.

“It doesn’t have to be one followed by the other,” he explains. “In fact, we know some studies show that up to a half of people with ankylosing spondylitis have some ongoing minor inflammation of the small bowel or the colon.”

Common bowel problems with ankylosing spondylitis

Maybe you already know you have a history of inflammatory bowel disease. Or maybe, you know you’re living with ankylosing spondylitis and wonder if you may be developing some type of IBD. Whichever one came first, it’s good to listen to your body and take note of any GI symptoms you may be having.

Some common GI symptoms you may experience related to ankylosing spondylitis include:

  • Diarrhea.
  • Bloating.
  • Change in bowel habits.
  • Blood in your stool.
  • Signs of malnutrition.
  • Abdominal cramping.
  • Stomach pain.
  • A constant urge to go to the bathroom.
  • Nighttime bowel movements.

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“If you have ankylosing spondylitis and are showing signs of any GI upset, this should be one of the things that you should talk about with your healthcare provider in light of the association of IBD with AS,” advises Dr. Rahman.”

Treating GI issues and AS

One of the main ways that AS is treated is through getting regular exercise. But if you’re someone who’s living with both AS and IBD issues, it’s important to talk to your healthcare provider about how to tackle both.

“We try to find therapies that usually work for both these conditions and closely partner with rheumatologists,” Dr. Rahman says.

There are a number of treatments that your healthcare provider will consider if you have AS and IBD together. In some cases, they may recommend the following medicines:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Anti-inflammatory drugs like aspirin and ibuprofen (like Motrin® or Advil®) may be recommended as a form of pain management. But in some cases, these pain relievers could make symptoms worse, so it’s important to work with your doctor and proceed with caution.
  • TNF inhibitors. This type of drug could help relieve AS and IBD symptoms by targeting inflammation. It’s available only by prescription, and your doctor will work closely with you to determine the right dose for you.

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Other medications that could help with AS and IBD include sulfasalazine, methotrexate and tofacitinib, among others. Dr. Rahman strongly encourages anyone living with these combined symptoms to speak to their healthcare providers about next steps.

Dealing with GI and AS symptoms

Having two sets of symptoms at once can be jarring, but there are ways to find relief on your own, too.

Some lifestyle changes you can make to help relieve symptoms of AS and GI issues include:

  • Staying active. Light exercise is highly recommended for people living with ankylosing spondylitis to help keep their joints moving and improve posture — but it may also relieve your GI symptoms. “Aerobic exercises like swimming are very helpful in terms of keeping up mobility of the spine,” says Dr. Rahman. “And it’s also very important for people with inflammatory bowel disease to continue that physical activity.”
  • Knowing your limits. At the same time, certain physical activities and exercises may need to be tabled for the time being. Dr. Rahman strongly recommends meeting with a physical therapist to get a better idea of what your body can and can’t handle. It’s important to take into account any symptoms you’re feeling from AS or IBD.
  • Staying hydrated and avoiding processed sugars. While there isn’t a specific diet that can fully relieve IBD or AS, Dr. Rahman suggests talking to a nutritionist or dietitian to see if cutting out certain foods may relieve some symptoms. Generally, overly processed sugars and sticking to a Mediterranean diet may provide some anti-inflammatory benefits. Plus, drinking plenty of water is never a bad idea.

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