Living With Crohn's Disease

Crohn's disease is a long-term condition that causes inflammation of the lining of the digestive system.

Inflammation can affect any part of the digestive system, from the mouth to the back passage, but most commonly occurs in the last section of the small intestine (ileum) or the large intestine (colon).

Common symptoms can include:

• diarrhoea
• abdominal pain
• fatigue (extreme tiredness)
• unintended weight loss
• blood and mucus in your faeces (stools)

People with Crohn's disease sometimes go for long periods without symptoms or with very mild symptoms. This is known as remission. Remission can be followed by periods where symptoms flare up and become particularly troublesome.

A few symptoms are common among all types of Crohn's disease. These symptoms include abdominal pain with cramps, diarrhea, weight loss, and a lack of energy. Pain usually begins within an hour of eating and is most often around the navel, the lower right abdomen, or both. Activities like jogging will often make the pain worse.

Another symptom that differentiates Crohn's from ulcerative colitis is swelling. This swelling is found in about 25 percent of people with Crohn's and is usually located in the lower right part of the abdomen. The swelling is typically about the size and firmness of a small grapefruit. The tenderness of the swelling, which is easily felt, ranges from mild to extreme. Mild tenderness points to an inflamed intestine and enlarged lymph glands. Extreme tenderness may be due to an abscess, in which case the skin may appear red and/or stretched. Moderate tenderness could signal a combination of the above causes. 

Another symptom of Crohn's disease that affects 25 percent of people is perianal disease. It’s usually in the form of an abnormal connection between two organs that aren't typically joined (a fistula), which may also include one or more abscesses. Some people have swollen skin tags around the anus as well.

Symptoms of Crohn's disease of the colon (Crohn's colitis) manifest differently depending on where the disease is located in the colon. 

If the disease is on the right side of the colon, a person will generally have cramps and diarrhea. If it’s located on the left side or involves most of the colon, a person may experience blood in the stool in addition to the other symptoms. 

If the disease is located on the rectum, symptoms will be similar to ulcerative colitis. They may include bloody diarrhea or the feeling of having a bowel movement in which little or nothing comes out. 

Between 70 and 80 percent of people with Crohn's disease of the small intestine (small bowel Crohn's) will experience cramps, diarrhea, and weight loss. 

Occasionally, a person with small bowel Crohn's will have constipation rather than diarrhea. Pain is so extreme with this type of Crohn's that some people will avoid eating. This accounts for most of the weight loss. 

The ileum is a portion of the small intestine. Someone with both Crohn's of the ileum and Crohn's colitis may experience symptoms associated with either of the diseases above, or both. This is because Crohn's of the ileum may flare up when the colonic disease is in remission, or vice versa. 

The duodenum is the part of the small intestine closest to the stomach. Many people who have Crohn's of the stomach or duodenum will experience no symptoms at all. Over 90 percent of those who have symptoms, however, will have pain in the upper abdomen either during or immediately following a meal. A smaller percentage will experience nausea, vomiting, or both. 

Around half of the people who have symptoms of Crohn's of the stomach or duodenum will experience weight loss because they are avoiding food. In some cases, because of scarring, this type of Crohn's will cause a narrowing of the outlet of the stomach into the duodenum. If this happens, you will usually experience a decrease in appetite, a prolonged bloated feeling located in the upper abdomen, and nausea. 

These types of Crohn's are extremely rare so it’s not possible to identify their "typical" symptoms. Crohn's disease of the appendix may mimic appendicitis and can be present without any other unique symptoms. Crohn's of the esophagus may cause pain behind the breastbone while swallowing. 

If the esophagus has become narrowed due to scarring, a person may have trouble swallowing or food may become stuck on the way down. Contact your doctor immediately if you have these symptoms. 

 Signs and symptoms of Crohn's of the mouth normally consist of large, painful sores in the mouth.  If you have this symptom, contact your doctor.

Why it happens

The exact cause of Crohn's disease is unknown. However, research suggests that a combination of factors may be responsible. These include:

• genetics – genes that you inherit from your parents may increase your risk of developing Crohn's disease
• the immune system – the inflammation may be caused by a problem with the immune system (the body's defence against infection and illness) that causes it to attack healthy bacteria in the gut
• previous infection – a previous infection may trigger an abnormal response from the immune system
• smoking – smokers with Crohn's disease usually have more severe symptoms than non-smokers
• environmental factors – Crohn's disease is most common in westernised countries such as the UK, and least common in poorer parts of the world such as Africa, which suggests the environment (particularly sanitation) has a part to play

Treating Crohn's disease

There is currently no cure for Crohn's disease, so the aim of treatment is to stop the inflammatory process, relieve symptoms (induce and maintain remission) and avoid surgery wherever possible.

The first treatment offered to reduce symptoms is usually steroid medication (corticosteroids). If this doesn't help, medication to suppress the immune system (immunosuppressants) and medication to reduce inflammation may be used.

In some cases, surgery may be needed to remove the inflamed section of intestine.

Once your symptoms are under control (in remission), further medication may be needed to help maintain this.

Crohn’s Disease sufferers who go into remission may experience months, years, even decades of little to no symptoms, often thanks to medications. For some patients, fear of a recurrence can often affect their well-being and for others, lack of proper care and maintenance causes symptoms to come back in time, so it is important to understand the various maintenance therapies available to Crohn’s sufferers.

In the early days of a Crohn’s diagnosis, a patient will likely be prescribed more intense therapies to lessen symptoms. These therapies are intended to be short-term. Once a patient has achieved remission, the key is to prevent infection and lessen inflammation.

Lifestyle Changes for Crohn's Disease

For those hoping to maintain remission through lifestyle changes, a few organic solutions may provide the symptom-free remission you seek. While these aren’t guaranteed remedies, living a healthy lifestyle can improve your overall health in many ways.

Limit Dairy

For many Crohn’s patients, excessive trips to the bathroom interfere with being able to live a normal life. By limiting dairy in your diet, you may be able to improve a variety of gastrointestinal conditions, including diarrhea and abdominal pain. Lactose intolerance is not an uncommon problem and can exacerbate Crohn’s symptoms. If limiting your dairy intake doesn’t work, a product like Lactaid can be a simple solution.

Reduce Fat Intake

Aim to lower the fat intake in your diet. If you suffer from Crohn’s Disease, your body may have a difficult time digesting fat. If your body isn’t digesting and absorbing fat properly, it may pass through your intestine, worsening your Crohn’s symptoms, especially diarrhea. Avoid butter and fried foods especially.

Avoid Fiber

While fiber can make irregular bowel movements regular, in Crohn’s patients fiber can create more abdominal pain and worsen diarrhea. By limiting fiber in your diet, you can ease your symptoms.

Stop Smoking

If you smoke when you’re diagnosed with Crohn’s, you should stop immediately. Smoking is associated with a higher risk of developing Crohn’s and once you have it, smoking is said to block remission and increase your chance of a relapse. By not smoking, you’ll not only improve the condition of your digestive tract, you’ll improve your overall health.

Avoid Caffeine

While that early-morning coffee may give you the impetus you need to get to work in the morning, it could be interfering with your Crohn’s symptoms. Caffeine stimulates your intestines, which worsens symptoms such as diarrhea. Alcohol can also interfere with your gastrointestinal functions. By focusing on drinking as much water as possible, you’ll avoid dehydration, which can be a problem for those suffering from diarrhea.

Exercise

If you haven’t begun an exercise regime, now is a great time to start. Exercising is thought to stabilize your body’s bowel function, in addition to the overall stress relief benefits. Since stress can make Crohn’s worse, this is an added benefit.

While remission is a definite accomplishment for Crohn’s patients, staying as healthy as possible can help ensure you’re symptom-free as long as possible. Through diet and mild medications, you’ll lessen the chance of a relapse and have good overall health, more energy, and an overall improved sense of well-being.

Alternative Treatments for Crohn's Disease

Alternative medicine is often used in conjunction with the terms “complementary medicine” or “integrative medicine,” but they can actually mean different things. In general, these are treatments outside the typical mainstream Western medicine. According to the National Center for Complementary and Alternative Medicine (NCCAM), the term “alternative treatments” means you are using a non-mainstream, non-traditional approach to treat an illness in place of conventional, evidence-based medicine.

It’s a good idea to talk to your doctor about any alternative therapies you are considering. Some alternative therapies may work well in conjunction with your medical treatments. Others may interact dangerously with your medical treatments. Many alternative therapies are simply lifestyle changes that promote general health and wellbeing.

Probiotics

Your gastrointestinal tract contains “good” bacteria, which help with digestion and offer protection against “bad” bacteria. If you have taken antibiotics or have an illness, you may not have a sufficient supply of the good bacteria. Probiotics are living microorganisms that you can consume. They act very much like the good bacteria in your gut.

Probiotics have not been proven to reduce the symptoms of Crohn’s disease and further study is needed. They may be more or less beneficial depending on the location and stage of the disease. Some strains might work for one person but not others. If you decide to try probiotics, talk to your doctor first, and try to find a product that is free of dairy because many people with Crohn’s disease are sensitive to dairy products.

Prebiotics

Prebiotics are nondigestible carbohydrates found in artichokes, honey, whole grains, bananas, onions, and garlic. They are food for probiotics and for intestinal bacteria. Adding prebiotics to your diet might improve the function of your normal intestinal bacteria. Using prebiotics along with probiotics might make the probiotics more effective.

Acupuncture

Acupuncture uses thin needles inserted into special points on your body.  It is believed that this stimulates your brain to release endorphins. Endorphins are chemicals that block pain. They may also strengthen your immune system and help fight infection.

Herbal and Botanical Treatments

Talk to you doctor before trying any herbal or botanical treatments. Some can interact dangerously with medications you might be taking. They may also have undesirable side effects. Some herbal and botanical treatments reported to help ease the symptoms of Crohn’s disease include:

• aloe vera juice
• slippery elm bark
• chamomile
• peppermint

Biofeedback

Biofeedback is a form of  relaxation therapy. With the help of a machine that monitors your body temperature, perspiration level, blood flow, and brain waves, you are able to see how your body responds to pain and learn to control these responses. Over time, you can learn to manage your muscle contractions and pain.

Fish Oil

Fish oil has long been used to promote cholesterol health, but its benefits to Crohn’s patients have also been suggested. According to a medical journal article in the Cochrane Database of System Reviews, omega-3 fatty acids, found in fish oil, have anti-inflammatory properties. Since Crohn’s disease is a chronic inflammatory condition, a diet rich in omega-3s or omega-3 supplementation may reduce symptoms.

According to a small study published in the New England Journal of Medicine (NEJM),  patients taking fish oil were twice as likely to remain in remission as those who took a placebo. (NEJM,1996). Talk to your doctor before starting fish oil supplementation. Taking high doses of fish oil, or taking it in combination with blood thinning medication, can lead to bleeding problems.

Who is affected?

Crohn's disease is a relatively uncommon condition. There are currently at least 115,000 people living with the condition in the UK.

Crohn's disease can affect people of all ages, including children. However, most cases first develop between the ages of 16 and 30. 

A large number of cases also develop between the ages of 60 and 80.

It affects slightly more women than men, but in children more boys are affected than girls.

The condition is more common in white people than in black or Asian people. It is most prevalent among Jewish people of European descent.

Complications

Over time, inflammation can damage sections of the digestive system, resulting in additional complications such as narrowing of the intestine (stricture), or a channel developing between the end of the bowel and the skin near the anus or vagina (fistula). These problems usually require surgical treatment.