Personal Perspective | Michael Attwood

​Living with Crohn’s and Colitis: The illness you can’t see

People often assume Crohn’s and Colitis are just “bad stomach problems.” But living with inflammatory bowel disease is far more complicated than food intolerance, indigestion, or an upset gut. It’s an autoimmune disease, a chronic condition where the body’s immune system mistakenly attacks the digestive tract as though it were a foreign invader.

In my case, it began in 2012. At first, it was bleeding and symptoms I tried to ignore because, when you’re younger, you convince yourself it’s probably nothing serious. Eventually, after months of symptoms, I was diagnosed with ulcerative colitis, a form of IBD that affects the lower digestive tract. Years later, as my symptoms worsened and the pain became more severe, my diagnosis progressed to Crohn’s disease, which can affect anywhere from the mouth to the end of the digestive system.

What surprised me most was how unpredictable the disease is. For some people, symptoms remain relatively mild. For others, it becomes life-altering. There is currently no cure, and while treatments have improved enormously, Crohn’s and colitis are chronic illnesses that often fluctuate between periods of remission and painful flare-ups.

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More than “a bad stomach”

One of the biggest misconceptions about Crohn’s and Colitis is that they are caused by food or are essentially food allergies. They are not.

Certain foods can absolutely make symptoms worse. Eating a huge meal or very spicy food when your digestive system is inflamed can increase pain and discomfort. But food itself is not the root cause. Even if I ate perfectly every day, the immune system would still be attacking my digestive tract underneath it all.

That distinction matters because people often search for miracle diets or “cures” online. Some swear by veganism, others by carnivore diets, liquid diets, fasting, supplements, or cutting out entire food groups. While diet may help some people manage symptoms, Crohn’s and colitis are immune disorders not dietary failures.

The reality is far less simple and far less controllable.

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Pain, fatigue, and the invisible side of illness

For years, I had relatively little pain. Then things changed.

Now the condition affects me daily, especially at night. Chronic pain has a strange way of reshaping your life. You can function during the day, go to work, meet friends, laugh, appear completely normal and still spend the early hours of the morning awake in agony. Sleep deprivation becomes part of your routine. When my daughter was born people would ask how I was coping with the sleepless nights, but it was already part of my day to day existence I just had company!

Hospital appointments, colonoscopies, medications and injections are also a constant feature in my life. I inject myself with immune suppressant medication every two weeks and these drugs help control the inflammation but come with their own consequences. Because the immune system is suppressed, infections become more common, illnesses hit harder, and even minor health problems can linger longer than they should.

There’s also the reality people rarely talk about openly: suppositories, enemas, urgent bathroom trips, and the sheer amount of time Crohn’s and Colitis can consume. It’s not glamorous, and for many an uncomfortable conversation.

That silence is part of the problem.

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The illness you can’t see

Crohn’s and Colitis are often described as invisible illnesses, and that description feels accurate. Most people looking at me would have no idea anything is wrong. I don’t “look ill.” I still work, socialise, exercise, and get on with life.

But invisible doesn’t mean insignificant.

There’s a strange disconnect that comes with hidden illness. You might be in severe pain while sitting in a meeting. You might have slept two hours the night before. You might be mentally calculating the nearest toilet everywhere you go. Yet because there are no obvious outward signs, people assume you’re fine.

That resilience can sometimes work against you. The better you become at coping, the easier it is for others to underestimate what you’re carrying.

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Progress, treatment, hope and global variance

A generation ago, many people with Crohn’s or colitis had far fewer options. Surgery and permanent colostomy bags were much more common outcomes. Today, biologic medications and immune suppressants have dramatically improved quality of life for many patients, including me.

That doesn’t mean the disease disappears. Some people still require major surgery, and flare-ups remain unpredictable. But medical science is moving quickly. Researchers continue to explore genetics, environmental causes, immune responses, and new therapies. There’s hope that future treatments will become even more targeted and effective. 

One example that always stood out to me was former Japanese Prime Minister Shinzo Abe. He resigned suddenly in 2007 because of complications linked to ulcerative colitis, but after finding an effective treatment, he returned to politics and later became Japan’s longest-serving Prime Minister from 2012 onwards. His story was a reminder that while these diseases can be debilitating, advances in medicine can genuinely change people’s lives.

There’s also growing interest in the way Crohn’s and Colitis vary across the world. Long-term research has consistently shown what scientists call a “north-south gradient,” where rates of inflammatory bowel disease rise significantly the further populations live from the equator. While the exact causes are still not fully understood, researchers believe environmental and lifestyle factors play a major role alongside genetics. That variation offers a degree of hope, because if scientists can better understand why these patterns exist, it may eventually lead to more effective prevention and treatment strategies in the future.

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Final thought

For many people, including myself it’s a constant balancing act between pain, exhaustion, medication, work, relationships, and everyday life. Yet despite all of that, people continue to work, parent, travel, laugh, and carry on.

That resilience is real. But so is the illness behind it.