From Prevention
If you have Crohn’s disease, you likely know how to handle run-of-the-mill symptoms like stomach pain, diarrhea, and bloating. But what do you do when your condition causes something more serious, like an ulcer or an abscess?
It may not be fun to think about, but knowing the answer to these types of questions is important—and can help keep you healthy. Here’s a look at six of the most challenging symptoms Crohn’s might throw your way—plus your options for managing them.
1. Anal fissures
Serious diarrhea or very large, hard stools can create tears in the thin, moist tissue of the lower rectum. Anal fissures are painful, but the good news is that they’re relatively easy to treat, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
The treatment: To soothe the discomfort and promote healing, your doctor might recommend numbing creams or daily sitz baths. If you’re having trouble going to the bathroom, nitrate or calcium channel blocker creams can make bowel movements easier. Botox injections into your sphincter can also help relax the muscle, which reduces pain and spasms, allowing the fissure to heal, according to The American Society of Colon and Rectal Surgeons (ASCRS).
As for avoiding them in the future? There’s no surefire way to prevent fissures, but avoiding irritating soaps (like ones with fragrances or harsh chemicals), trying not to strain during bowel movements, drinking plenty of water, and eating a fiber-rich diet will all help, says Marc Bernstein, MD, a gastroenterologist at Florida Digestive Health Specialists.
2. Ulcers
Gastrointestinal inflammation related to Crohn’s can cause mouth, stomach, or intestinal ulcers. But the antacids that are typically used to treat stomach ulcers in people without Crohn’s aren’t helpful, cautions Peyton Berookim, MD, FACOF, the Director of the Gastroenterology Institute of Southern California. Antacids neutralize excess acid in the stomach, which aren’t usually the cause of Crohn’s-related ulcers.
The treatment: A Crohn’s-related ulcer may be a sign that your inflammation needs to be managed better. Your doctor might start by checking the ulcer for infection, which can be treated with antibiotics. If it’s not infected, the next step is to take medication to suppress the inflammation, Dr. Bernstein says. “There are different options ranging from pills to IV infusions,” he adds. You probably won’t need surgery—it’s only necessary if the ulcer causes a tear in your intestinal lining.
3. Bowel obstructions
Crohn’s-related inflammation can make the intestine swell and grow narrower, creating blockages that prevent food from passing through. Bowel obstructions often lead to pain, cramping, vomiting, constipation, and swelling—and they can be life-threatening, according to the National Library of Medicine.
The treatment: If you suspect that you have an obstruction, see your doctor ASAP. While complete blockages usually require surgery, partial ones may not. “Anti-inflammatory medications and resting the bowel by not eating can help relieve the inflammation that may be driving the intestinal narrowing,” Dr. Bernstein says. That might mean temporarily getting your nutrition through IV fluids, then moving on to a liquid diet before transitioning back to solid foods.
4. Abscesses
Up to 30 percent of people with Crohn’s will develop these infected, fluid-filled pockets in their abdomen or pelvis. Abscesses can be a result of intestinal inflammation or a complication after abdominal surgery for Crohn’s-related issues. They often cause symptoms like stomach pain or fever, but there’s only one way to diagnose them: a physical exam.
The treatment: It’s usually a combination approach of antibiotics and percutaneous abscess drainage, when a practitioner uses a needle or catheter to clear out the infected fluid. Some serious abscesses might also require surgery.
5. Malnutrition
It’s no secret that Crohn’s can dull your appetite. Pair that with poor nutrient absorption (thanks to intestinal inflammation), and you could very well find yourself coming up short on key vitamins and nutrients.
The treatment: Your gastroenterologist and a registered dietitian can help you put together an eating plan that’s both satisfying and nourishing. If you still aren’t getting all the nutrients you need, you might need to get them directly via IV fluids and feeding tubes, per the NIDDK.
6. Fistulas
Fistulas are abnormal passages between two body parts—and they can form almost anywhere (such as between an artery and a vein or between the bowel and the vagina). For people with Crohn’s, untreated abscesses can lead to fistulas between intestinal loops or around the anus. They’re painful, and they often lead to bloody or smelly pus around the anus as well as a fever or chills. So if you think you have one, you should see your doctor.
The treatment: There’s no one preferred method for dealing with fistulas. The first step may be to take antibiotics along with anti-inflammatory medications, Dr. Berookim notes. But in some cases, you may need surgery to remove all or part of the infected intestinal tissue. “Your gastroenterologist and colorectal surgeon can develop the best treatment path,” Dr. Bernstein says.
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