Each year on World Inflammatory Bowel Disease (IBD) Day, we come together to raise awareness for those living with Crohn’s disease and ulcerative colitis. These are two chronic, invisible illnesses that affect millions of people worldwide. While these conditions can impact anyone, women often face unique challenges when it comes to managing IBD, particularly during key life stages such as menstruation, fertility, pregnancy, and menopause.

What is IBD?

Inflammatory bowel disease (IBD) refers to a group of conditions that cause inflammation in the gastrointestinal tract. The main types of IBD are ulcerative colitis and Crohn’s disease. These are lifelong conditions characterised by periods of flares (when symptoms are active) and remission (when symptoms improve). It’s estimated that nearly 180,000 Australian’s are living with IBD and this number is steadily rising.

What makes IBD particularly challenging is that it is an invisible illness: many people look outwardly ‘well’ while managing a complex and exhausting condition behind the scenes. The unpredictability of flare-ups, the need for urgent bathroom access, and the impact on daily life can lead to feelings of embarrassment, isolation or being misunderstood.

That’s why World IBD Day matters: it’s a chance to raise awareness, reduce stigma, and start important conversations about what it means to live with IBD. It also highlights the value of compassionate, multidisciplinary care: including the critical support dietitians provide in helping people manage symptoms and improve quality of life.

What are the symptoms?

IBD symptoms can vary depending on the severity of inflammation and where it occurs. They can range from mild to severe. Symptoms that are common to both ulcerative colitis and Crohn’s disease include:

• Abdominal or anal pain
• Diarrhoea with or without blood and mucus
• Losing weight without trying
• Loss of appetite
• Fatigue

How does IBD affect women?

For women, IBD can be particularly complex and it affects them in unique ways, including:

• Hormonal changes throughout the menstrual cycle can affect symptom patterns
• Women with IBD are more likely to experience pre-menstrual symptoms such as headache and pelvic pain
• Abdominal pain, diarrhoea, and other IBD symptoms can be more severe before and during menstruation
• Higher risk for iron deficiency due to the body’s altered ability to absorb iron, the higher risk for bleeding in the gastrointestinal tract, and blood loss through menstruation

Beyond the physical symptoms, IBD can deeply affect a woman’s relationship with food, her body image and social life. That’s why compassionate, holistic care is so important. This is also where a dietitian can provide guidance.

The Dietitian’s Role

IBD management requires a multidisciplinary approach often involving gastroenterologists, general practitioners, psychologists, and dietitians. Dietitians are uniquely positioned to support women with IBD in both the acute and long-term phases of their condition.

Our role goes far beyond handing out generic meal plans. We help translate complex medical advice into everyday eating strategies that work for real life: whether you’re juggling work, parenting, pregnancy, or just trying to enjoy a meal out with friends. We also focus on reducing the risk of malnutrition, managing side effects and improving gut health; and take into consideration a woman’s preferences, values and support network.

Importantly, we know that no two people with IBD are alike. That’s why we create individualised nutrition care plans tailored to each woman’s symptoms, nutritional needs, lifestyle and goals.

How Dietitians Support Women with IBD

Managing Flares, and Supporting Remission

During a flare, symptoms like diarrhoea, abdominal pain, and reduced appetite can make eating difficult. A dietitian can recommend gentle, lower-fibre dietary options that are easier to digest and help reduce irritation. We also monitor hydration, electrolyte balance, and energy intake during this time.

Once symptoms are under control, we gradually support women to liberalise their diet again, aiming for as much variety as possible while still respecting individual triggers. This helps to promote gut microbiome diversity and support long-term health.

Preventing and Managing Nutrient Deficiencies

Between 20-85% of patients with IBD are malnourished. Women with IBD are at increased risk of deficiencies in:

• Iron: due to blood loss and inflammation
• Vitamin B12: especially in those with Crohn’s, if the disease affects the lower part of small intestine
• Vitamin D and calcium: especially if long courses of oral corticosteroids are needed, as steroids can weaken bones
• Zinc: 1 in 2 IBD patients have a zinc deficiency

Dietitians work closely with the medical team to monitor these nutrients. To support repletion of these nutrients in someone who may be low, we work with patients to identify whether a ‘food first’ approach is feasible (this is often our first line of therapy), and how to increase intake through diet. We also recommend supplements if needed, but this varies from person-to-person.

Supporting Fertility, Pregnancy and Breastfeeding

IBD can influence a woman’s reproductive health, but with the right support, many women go on to have healthy pregnancies. Dietitians play a key role in:

• Optimising nutritional status before conception
• Managing symptoms during pregnancy
• Preventing nutrient deficiencies
• Supporting weight gain and foetal growth
• Assisting with breastfeeding nutrition and energy demands postpartum

We also help women navigate pregnancy-related food aversions and nausea while ensuring they continue to get the nutrition they and their baby need.

Empowering Women Through Nutrition

One of the most rewarding parts of being a dietitian is helping women with IBD rebuild confidence in their bodies and their ability to nourish themselves. Many women come to us feeling fearful of food, unsure of what they can eat without worsening symptoms. Others feel overwhelmed by conflicting advice online or have tried overly restrictive diets that leave them depleted and frustrated.

Our approach is to meet women where they are: physically, emotionally, and socially. We take the time to understand which symptoms are most impacting their daily life, and we work together to improve these through targeted diet and lifestyle strategies. When needed, we also facilitate referrals to ensure comprehensive care.

As part of a multidisciplinary team, we collaborate closely with healthcare providers to monitor nutrient levels and support women in maintaining optimal nutritional status. Whatever life stage a woman is at, we guide them using evidence-based nutrition strategies and provide education so that they can confidently manage themselves.

Ultimately, our role is to empower people with IBD to eat well with confidence: not through restriction, but through personalised support, education, and compassion.