What is going on with your stomach?
You come to realize that lately you’ve been having stomach pain, diarrhea and are extremely tired. You step on your scale and see that you’ve lost a significant amount of weight. What’s causing this to happen? How do you fix it? Can you prevent it from happening again?
Crohn’s disease is when your digestive tract becomes inflamed. It can involve different areas of your digestive tract, but the two most common areas are the ileum (last portion of the small intestines) and colon. The inflammation can penetrate far into the layers of your affected bowel tissue. The exact cause is unknown, but it’s thought to be related to your immune system and/or genetics. If your body is exposed to a bacteria or virus, it tries to fight it off. During this process, your immune cells might attack your digestive tract as well, which results in the inflammation. It has been found that those who have family members with Crohn’s are more likely to develop it. Certain factors can increase your chances of acquiring it, such as being under 30, being white (especially of Eastern European Jewish decent), living in urban areas and cigarette smoking. Stress, diet and medications, like ibuprofen or naproxen, aren’t thought to be causes, but definitely can aggravate your stomach, making your symptoms worse.
Symptoms can be mild to severe and typically appear gradually. Sometimes, they come on all of a sudden and, other times, you can have periods of remission. Symptoms include diarrhea, abdominal pain/cramping, blood in your stools, mouth sores, reduced appetite, weight loss, fever and fatigue. Some people have inflammation of their skin, eyes, joint, liver or bile ducts in addition to the inflammation in their intestines. Children can also have a delay in growth and/or sexual development. Unfortunately, there are several complications that can arise from having Crohn’s disease. Over time, the inflammation can cause your bowel tissue to become scarred and narrow, which can make it difficult for food to pass through and this results in a blockage, known as a bowel obstruction. This requires surgery to remove it. You can develop ulcers in your digestive tracts, including your mouth, anus or genital area. Sometimes, these ulcers can extend through your intestinal wall creating an abnormal connection between your intestines and different body parts. This is known as a fistula and can occur anywhere. They connect your intestines to another organ or to your skin (you have continuous drainage of bowel contents to your skin). They can also form an abscess that needs to be drained because it can lead to infections that are life-threatening. The most common type of fistula is one that is close to your anal area. You might also have an anal fissure, which is a small tear in the tissue that lines your anus or the skin around it. Another possible complication is malnutrition and anemia because your body isn’t absorbing the nutrients it needs. Crohn’s disease also increases your risk of developing colon cancer.
There isn’t a cure for Crohn’s disease, so the goal is to reduce the inflammation in order to decrease your symptoms. By doing this, the risk of long-term complications also decreases. It’s important to keep in mind that every person is different, so every treatment plan will be different. The most common first step is to use anti-inflammatory medications to reduce the amount of inflammation. Corticosteroids, such as prednisone and budesonide, are often tried for a few months to see if they will improve symptoms and cause remission. Another class of medications used to reduce inflammation include those that suppress your immune system. The two most widely used are azathioprine and mercaptopurine. For some individuals, they need to take a combination of these type of medications to get relief. Sometimes, you’ll need to take antibiotics to help get rid of an abscess, fistula or let your stomach heal from an infection. In addition, you may want to take over-the-counter medications to help manage symptoms, just be sure to check with your doctor first. If you’re having mild diarrhea, adding fiber to your diet via a supplement can bulk up your stool and this should help to decrease the amount of diarrhea. If your diarrhea is severe, you might need to try loperamide. If you’re having pain, your doctor will most likely recommend taking acetaminophen. If you’re deficient in vitamin B12, your doctor will want you to take iron supplements or receive B12 shots. Since Crohn’s disease and the steroids used to treat it can decrease the amount of calcium in your body, you’ll need to take a supplement. One that includes vitamin D is important because it helps your body to absorb the calcium. If your symptoms are severe or you’re getting ready for surgery, your doctor may have you follow a special diet that you receive via a feeding tube or given in your vein. This helps to provide your body with the nutrients it needs and allows your bowel time to rest. Your doctor also will want you to follow a low-residue, low fiber diet, which will reduce the size and frequency of your stools. This is especially important if you’re at risk of a bowel obstruction. If none of this works to improve your symptoms, your doctor will recommend surgery to remove the affected portion of your bowel, repair fistulas or drain abscesses. After surgery, you’ll probably still need to take medicine to decrease the likelihood of a reoccurrence. The only problem is that this is a temporary solution because the disease often does reappear. Typically, this happens close to where the surgery was performed.
While you might not be able to prevent Crohn’s disease from developing, there are things that you can do to help minimize the severity of your symptoms and help you increase the time between flare-ups. One of the most important things you can control is your diet. A key thing is to keep a food diary to track when your symptoms flare-up and see if there is any correlation to foods that you’ve eaten. Limiting dairy products is an important element since they can contribute to diarrhea, abdominal pain and gas. Foods that are high in fat, such as butter, margarine, cream sauces and fried foods, can also make your diarrhea worse because your body is unable to digest fats normally. For some individuals with Crohn’s disease, fiber can make symptoms worse. So, since fresh fruits and vegetables often have fiber, cooking them can help to decrease the level of the fiber’s impact on your body. It can be helpful to avoid spicy foods, alcohol and caffeine because they can also make your symptoms worse. You might need to take a multivitamin and/or mineral supplements to compensate for what your body is missing from your diet. It’s essential to drink plenty of water because this will help prevent you from becoming dehydrated (especially when you have diarrhea). Eating five or six small meals each day can lessen the severity of your symptoms while getting the nutrients your body needs. If you’re unsure of what to eat or are looking for more options, it’s a good idea to talk to a dietitian.
Besides diet, there are several things you can do to help. The number one thing is to not smoke or quit if you do since this can greatly impact the number of complications you have from Crohn’s disease. Another consideration is stress and how to reduce it. Exercise is a great way to decrease it, but talk to your doctor before starting a routine to make sure that it’s right for you. Practicing relaxation techniques, like deep breathing or meditation, is extremely useful in reducing stress. Some people use a biofeedback machine to help with this. All of these changes can seem overwhelming, so it’s valuable to learn as much as you can, join a support group and talk to a therapist, if needed.
Crohn’s disease can painful and uncomfortable, but by doing what you can to manage symptoms and prevent flare-ups, you’ll be able to participate in the things that you enjoy doing. If you have any questions or concerns about Crohn’s disease, please speak with your doctor. If you would like more information, please visit the MedlinePlus’s Crohn’s disease page at https://medlineplus.gov/crohnsdisease.html