Crohn's Disease

What is Crohn's disease?

Crohn's disease is an inflammation of the intestines (bowel). It can affect the part of the small intestine called the ileum or the large intestine (colon) or both. It is a life-long condition, but it may come and go. Sometimes you have symptoms and sometimes you don't. Crohn's disease is one of the two illnesses called inflammatory bowel disease. (The other inflammatory bowel disease is ulcerative colitis.)

The disease causes swelling, redness, even sores (ulcers) in the intestines. These ulcers can create a hole in the wall of the intestine, which can cause life-threatening infection and bleeding. Both the swelling and scar tissue from the sores can block the passage of food through the intestines.

How does it occur?

The cause of Crohn's disease is not known.

What are the symptoms?

Symptoms of Crohn's disease include:

• abdominal pain or cramping, often on the lower right side
• diarrhea
• slight fever
• fatigue
• weight loss
• tenderness of the rectum
• rectal pain with bowel movements
• mucus in bowel movements.

How is it diagnosed?

Your healthcare provider will review your symptoms and examine you. The exam will include a rectal exam to look for inflammation and sores and to check for blood in the stool. Tests you may have are:

• blood tests
• a barium swallow X-ray exam to look at the upper small intestine
• a barium enema X-ray exam to look for inflammation in the lower intestine.

You will usually have a colonoscopy. This is a procedure in which your provider uses a thin, flexible tube with a tiny camera to look at the inside of your intestine, checking for the redness, swelling, and ulcers of Crohn's disease. During this procedure your provider may do a biopsy, taking a small piece of tissue for lab tests.

How is it treated?

Because there is no cure for Crohn's disease, treatment for mild illness is based on your symptoms. The goals of treatment are to:

• Prevent pain.
• Help your bowel work normally (for example, help it absorb food properly).
• Avoid problems that can be caused by this disease.

You may need medicine. The 5 main types of medicines used for Crohn's disease are:

• salicylic acid anti-inflammatories, such as sulfasalazine (oral) and mesalamine (oral or topical)
• antibiotics, such as metronidazole (oral) or ciprofloxacin (oral or IV)
• steroid anti-inflammatories, such as hydrocortisone (IV, oral, or topical)
• immune-suppressing drugs, such as mercaptopurine and azathioprine.
• infliximab (Remicade), which is a new medicine that blocks the body's response to inflammation (for example, swelling and pain)

Some of these medicines are available as creams or ointments to be used in the rectal area. Some are available as enemas to help with lower bowel and rectal symptoms.

Your healthcare provider may also prescribe antidiarrheal medicines, since diarrhea is one of the most common symptoms. The diarrhea can limit your normal daily activities as well as cause mineral imbalances, malnutrition, and dehydration.

If you are having many symptoms that medicine is not controlling well, you may need to stay at the hospital. Your treatment at the hospital may include:

• resting your bowel by not eating
• intravenous (IV) feeding for nutrition and fluids
• blood transfusions to restore blood you have lost
• IV medicines
• nasogastric suction (done through a tube passed from the nose to the stomach) to drain out acidic digestive juices to help rest the intestines.

Crohn's disease can cause complications. These problems include blockage of the bowel, abscesses (infections) in the abdomen or rectum, and fistulas. A fistula is an abnormal connection that can form between two parts of the bowel or between the bowel and other organs, such as the bladder or vagina. It can cause infection and stool leakage. Complications from Crohn's disease often require surgery.

How long will the effects last?

Crohn's disease is an unpredictable chronic disease. You may go for weeks or months without symptoms or you may have symptoms every day. However, with treatment the disease can be well managed. Most people with Crohn's disease live full, active lives.

People with Crohn's disease have an increased risk of cancer of the colon or anus. Your healthcare provider will recommend that you have a colonoscopy on a regular schedule to look for cancer and catch it at an early stage. How often you need a colonoscopy for colon and anus cancer depends in part on how long you have had Crohn's disease.

How can I take care of myself?

It is important to follow your healthcare provider's instructions. Ask your provider when you should call about pain, diarrhea, or bleeding.

If you have diarrhea, avoid foods that have a laxative effect, such as raw fruits and concentrated fruit juices. Resting your bowel by not eating solid foods for a few hours can help. Instead of eating during this time, just drink clear liquids, such as the rehydrating fluids (sports drinks) that you can buy at the store. As the diarrhea gets better after a few hours, eat frequent small, bland meals. Gradually over a couple of days return to your usual diet.

Don't use a lot of stimulants, such as caffeine (coffee, tea, chocolate, soft drinks) and nicotine. Avoid milk products if they cause symptoms.

Ask your healthcare provider if you should increase or decrease the amount of roughage (fiber) in your diet.

If you have cramps or abdominal pain, it may help to put heat on your abdomen: a covered hot water bottle or a heating pad set on low.

In addition:

• Take the full course of treatment your provider prescribes.
• Do not smoke. Smoking seems to cause repeated attacks of pain and diarrhea.
• Follow a balanced, healthy diet according to your provider's advice.
• Stay physically active according to your healthcare provider's recommendation.
• Learn relaxation techniques to reduce stress.
• Talk with a counselor or mental health professional about managing the anxiety, stress, and depression often caused by a serious chronic illness.
• Develop a positive support system (family and friends) to help with the normal stresses of daily life.
• Keep your regular follow-up appointments with your healthcare provider.
• Ask your healthcare provider how often you should have a colonoscopy for cancer screening.

For more information you may also want to write or call:

Crohn's and Colitis Foundation of America
Phone: 800-932-2423
Web site: http://www.ccfa.org

How can I help prevent Crohn's disease?

There is no known way to prevent Crohn's disease.