Dr. Elizabeth Squirell

How we check on your IBD

The tests your IBD team uses, why you have them even when you feel well, when you need colon cancer check-ups, and the other health checks that matter with IBD.

Reviewed October 2026 8 min read

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At a glance

  • Keep up with your tests even when you feel well. Inflammation can be there without symptoms.
  • For a stool calprotectin test, use the first stool of the day and drop it off as your kit says.
  • Intestinal ultrasound needs no bowel prep and uses no radiation. Come as you are.
  • If IBD affects your colon, ask your team when your next check-up colonoscopy is due. It can be every year, every few years, or less often, based on your risk.
  • Keep your vaccines up to date. Get any live vaccines before you start medicines that weaken the immune system.
  • Get a skin check every year, and protect your skin from the sun.
  • If you have a cervix and have taken immune-suppressing medicine for 3 years or more, Ontario advises an HPV test every 3 years (not 5).
  • For pain, acetaminophen (Tylenol) is usually the safest choice. Don't take more than the label says. Avoid ibuprofen (Advil, Motrin) and naproxen (Aleve), which can trigger flares.
  • Tell your team if you feel low, worried or very tired. This is part of IBD care.

Why test when you feel well?

How you feel does not always match what is happening inside your bowel. Inflammation can be there with no symptoms. Left alone, it can lead to scarring or other problems later.

Tests let your team see what symptoms can’t show. They help answer three questions:

  • Is the treatment working?
  • Is a flare starting, even before you notice it?
  • Is the medicine safe for you?

When things are stable, many people have a visit and tests every 6 to 12 months. You may need them more often when you start a new medicine, or during a flare.

The tests we use

The tests your team may use
Test What it shows What to expect
Blood tests Inflammation (CRP), blood count, iron, vitamin B12 and D, liver and kidney health, medicine safety A quick blood draw at a lab
Stool calprotectin Inflammation in the bowel You collect a small stool sample at home
Intestinal ultrasound The bowel wall: thickness, blood flow, narrowing A scan on your belly. No prep, no needles, no radiation
Colonoscopy The inside lining of the colon and the end of the small bowel. Small samples (biopsies) can be taken Bowel prep the day before, and medicine to help you relax
MRI The small bowel and areas around the bowel You lie still inside a scanner. It uses magnets, not radiation
CT scan The bowel and nearby organs, often in an emergency A fast scan. It uses X-rays (radiation)

Stool calprotectin

Calprotectin is a protein that white blood cells release when there is inflammation in the bowel. A stool test measures it. It helps your team spot a flare early, or check if a new medicine is working.

  • Use the first stool of the day if you can.
  • Follow the kit’s steps and drop it off as the kit says.
  • A low result usually means the bowel is calm. A high result often means inflammation. Your team looks at the result alongside your symptoms and other tests.

Intestinal ultrasound

Intestinal ultrasound (IUS) uses sound waves to look at the bowel wall through your belly. It needs no bowel prep, no sedation and no radiation. You can usually see the pictures and talk about them right away. Dr. Squirell is trained in IUS. See Intestinal ultrasound.

Sometimes another test is still needed. IUS does not replace colonoscopy when samples or a cancer check-up are needed.

Colonoscopy

A colonoscopy uses a thin, flexible camera to look inside the colon. It is the best way to see if the lining has healed and to take biopsies. See Getting ready for your colonoscopy.

Colon cancer check-ups

Long-term inflammation in the colon raises the risk of colon cancer. The risk is still low. Regular check-up colonoscopies find early changes, called dysplasia, before they turn into cancer.

  1. About 8 years after symptoms began

    Your first check-up

    The first one is about 8 years after your IBD symptoms began. If you also have PSC (a liver condition linked to IBD), they start when PSC is found and are done every year.

  2. After that

    Repeat on a schedule set for you

    How often depends on your own risk, not one rule for everyone. It ranges from every year for higher risk to every 5 years or longer for lower risk. Your risk is higher if you have ongoing inflammation, a lot of the colon involved, past dysplasia, a narrowing in the colon, or a close family member with colon cancer.

Who may not need them: people whose colitis has only ever been in the rectum, and people with Crohn’s that has never involved the colon. These people should follow the usual screening for their age.

Ask your team when your next check-up is due. Write it down. Missing these check-ups is a common reason cancers are found late.

Staying healthy with IBD

IBD care is more than the bowel. Your family doctor and IBD team share these jobs.

Your health check list

  • Get the flu shot every year, and ask which other vaccines you need.
  • Have a full skin check once a year, with your family doctor or a dermatologist.
  • Ask if you need a bone density scan (DEXA).
  • If you have a cervix, keep up with your HPV test.
  • Tell your team how your mood, sleep and energy are.

Vaccines

Some IBD medicines weaken your immune system, so vaccines matter more. Besides the yearly flu shot, stay up to date on COVID-19, pneumonia, shingles (Shingrix), hepatitis B and HPV vaccines, as advised. Live vaccines (like MMR, chickenpox and yellow fever) should be given at least 4 weeks before you start medicines that weaken the immune system. They are not given while you take them. See Vaccines and IBD.

Bone health

Steroids, inflammation and low vitamin D can thin your bones. Your team may suggest a bone density scan (DEXA) if you have taken steroids for more than 3 months, are past menopause, or have other risk factors. Get enough calcium and vitamin D, and do weight-bearing exercise like walking.

Skin checks

Some IBD medicines raise the risk of skin cancer. This is true for azathioprine and mercaptopurine, and the risk stays higher even after you stop them. Anti-TNF medicines are also linked to a small rise in melanoma risk.

  • Use sunscreen, a hat and shade.
  • Show a doctor any new or changing spot.

Cervical screening (Ontario)

In March 2025, Ontario switched from the Pap test to the HPV test. Most people are tested every 5 years. If you have taken immune-suppressing medicine for 3 years or more, Ontario advises testing every 3 years after a normal HPV test. Ask your family doctor or nurse practitioner which schedule fits you.

Pain relievers

  • Acetaminophen (Tylenol) is usually the safest pain reliever for people with IBD, when taken as directed. Adults should not take more than 4,000 mg in a day from all products. Your limit may be lower if you have liver disease or drink 3 or more alcoholic drinks a day. Many cold and flu products also contain acetaminophen, so check labels.
  • NSAIDs such as ibuprofen (Advil, Motrin), naproxen (Aleve) and diclofenac can trigger a flare. Avoid them unless your team says it’s OK.
  • If you take a low-dose aspirin for your heart, don’t stop it on your own. Ask your doctor.

Mood, sleep and tiredness

Feeling low, worried or very tired is common with IBD. Your team should ask about your mood at least once a year. You can bring it up at any time. Tiredness can come from inflammation, low iron or poor sleep, and these can be treated. See Mental health and fatigue.

Do I still need tests if my calprotectin is normal?

Often, yes. A normal result is good news, but your team may still want an ultrasound or colonoscopy to confirm healing, or a colonoscopy for a cancer check-up. Calprotectin is one piece of the picture.

Who arranges my tests?

Your IBD team will tell you which tests are due and give you forms or kits. Some checks, like skin checks, cervical screening and many vaccines, are done by your family doctor or pharmacist. Bring a list of your medicines and past results to each visit.

Read next

Sources for this guide

Sources

  1. Turner D, Ricciuto A, Lewis A, et al. STRIDE-II: an update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) initiative of the IOIBD. Gastroenterology 2021;160:1570–83. PMID 33359090 Targets include symptom relief, normal CRP and calprotectin, and endoscopic healing; check them over time.
  2. Bressler B, Panaccione R, Fedorak RN, Seidman EG. Clinicians' guide to the use of fecal calprotectin to identify and monitor disease activity in inflammatory bowel disease. Can J Gastroenterol Hepatol 2015;29:369–72. PMID 26125109 Use the first stool of the day; under 50–100 µg/g suggests quiet disease, 100–250 possible inflammation, over 250 likely active inflammation.
  3. Jairath V, Adsul S, Allocca M, et al. Integrating intestinal ultrasound to clinical trials in patients with Crohn's disease: opportunities and challenges. Inflamm Bowel Dis 2025;31:3429–42. PMID 40971817 Intestinal ultrasound needs no sedation, bowel prep or radiation, gives real-time results, and detects inflammation and complications; compared with MRI and CT.
  4. East JE, Gordon M, Nigam GB, et al. British Society of Gastroenterology guidelines on colorectal surveillance in inflammatory bowel disease. Gut 2025;75(3):e335023 (published online 30 April 2025). PMID 40306978 Risk check colonoscopy 8 years after symptoms start (at diagnosis with PSC); then yearly, every 3 years, or back to regular screening by risk; no surveillance for proctitis-only UC or Crohn's without colon involvement.
  5. Kucharzik T, Taylor S, Allocca M, et al. ECCO-ESGAR-ESP-IBUS Guideline on Diagnostics and Monitoring of Patients with Inflammatory Bowel Disease: Part 1. J Crohns Colitis 2025;19(7):jjaf106. PMID 40741688 Current European guideline: screening colonoscopy for all IBD patients 8 years after first symptoms, with high-definition chromoendoscopy; intestinal ultrasound is an alternative to MRI for monitoring Crohn's, and shows treatment response within weeks; endoscopy is still needed for cancer surveillance.
  6. Murthy S, Nistor I. Colonic Dysplasia/Cancer Surveillance clinical care pathway. Crohn's and Colitis Canada PACE IBD Clinical Care Pathways, version June 23, 2025. Canadian pathway: first colonoscopy 8–10 years after diagnosis; then every 5 years (low risk), 2–3 years (moderate) or 1 year (high risk, including PSC from diagnosis).
  7. Nistor I, Huang V. Health Maintenance clinical care pathway. Crohn's and Colitis Canada PACE IBD Clinical Care Pathways, version January 21, 2026. Yearly vaccine review; no live vaccines on immunosuppression; yearly skin exam; DEXA bone scan criteria; vitamin D; yearly screening for depression and anxiety; follow local cervical screening rules.
  8. Farraye FA, Melmed GY, Lichtenstein GR, et al. ACG clinical guideline update: preventive care in inflammatory bowel disease. Am J Gastroenterol 2025;120:1447–73. PMID 40701559 Health maintenance in IBD: vaccines, bone health, cervical and skin cancer screening, depression and anxiety screening, smoking cessation.
  9. Peyrin-Biroulet L, Khosrotehrani K, Carrat F, et al. Increased risk for nonmelanoma skin cancers in patients who receive thiopurines for inflammatory bowel disease. Gastroenterology 2011;141:1621–28. PMID 21708105 Current and past thiopurine use raise non-melanoma skin cancer risk; advises sun protection and lifelong skin checks.
  10. Ontario Health (Cancer Care Ontario), Ontario Cervical Screening Program: HPV testing guidance, as summarized in Health Sciences North Cancer Screening Update, April 2025. HPV testing replaced Pap tests on March 3, 2025. Average risk: every 5 years. Immunocompromised, including people treated for 3 years or more with immune-suppressing medicine: every 3 years after a negative HPV test.
  11. Ontario Health. Ontario introduces new cervical screening test to better prevent cervical cancer (accessed October 2026). Most eligible people screen every 5 years with HPV testing, starting at age 25.
  12. Health Canada. Acetaminophen (accessed October 2026). Adults: no more than 4,000 mg a day from all sources; the safe limit may be lower with liver disease or 3 or more alcoholic drinks a day; overdose can cause liver damage.
  13. Takeuchi K, Smale S, Premchand P, et al. Prevalence and mechanism of nonsteroidal anti-inflammatory drug-induced clinical relapse in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol 2006;4:196–202. PMID 16469680 In quiet IBD, common NSAIDs led to relapse in 17–28% within 9 days; no early relapse with acetaminophen or low-dose aspirin.
  14. Long MD, Kappelman MD, Martin CF, et al. Role of nonsteroidal anti-inflammatory drugs in exacerbations of inflammatory bowel disease. J Clin Gastroenterol 2016;50:152–6. PMID 26485106 Regular NSAID use (5 or more times a month) was linked with active Crohn's disease 6 months later.
  15. Narula N, Leung Y. Induction of Advanced Therapy clinical care pathway. Crohn's and Colitis Canada PACE IBD Clinical Care Pathways, version January 21, 2026. Visits every 2–4 months when starting, then every 6–12 months once stable; blood tests and calprotectin before visits.
  16. Squirell E, Hearn J, MacMillan M. Deprescribing advanced therapies in inflammatory bowel disease. Canadian IBD Today 2025;3(2):5–12. Anti-TNF therapy carries a modest (about 1.5-fold) increase in melanoma risk; thiopurine skin cancer risk persists after stopping.
  17. Public Health Agency of Canada. Canadian Immunization Guide, Part 3: Immunization of immunocompromised persons (last partial update September 2026). Live vaccines at least 4 weeks before immunosuppressive therapy starts; generally wait at least 3 months after stopping.

This guide is for general education. It can't replace advice from your own care team, who know your health history.

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