Crohn’s and Colitis — Common but Misunderstood

By Nathan Blake |12/7/16

The first week of December marks the fifth annual Crohn’s and Colitis Awareness Week. These two conditions affect the digestive tracts of nearly 1.6 million Americans each year, although many more remain undiagnosed and deal with persistent pain and discomfort on a daily basis.

If you or a loved one has been diagnosed with either of these conditions, it is important to educate yourself about them in order to best manage the symptoms and reclaim a sense of normalcy.

What are Crohn’s and Colitis?

Crohn’s and colitis are among the most common forms of inflammatory bowel disease (IBD). IBD refers to a family of conditions that causes prolonged inflammation of parts or all of the intestinal tract. IBD and its various forms are known as invisible illnesses, referring to chronic conditions that impair a patient’s day-to-day activities yet show no outward signs.

Crohn’s disease is an inflammatory condition that can affect any part of the digestive tract from mouth to anus. The lining of the digestive tract becomes swollen and develops deep, open sores called ulcers, which can manifest in multiple areas including the esophagus, stomach, small intestine, colon, appendix, and in rare cases the skin and joints. Commonly, there are healthy portions of the intestine between inflamed areas that remain unaffected.

Ulcerative colitis is also an inflammatory disease, although its effects are specific to the superficial tissues of the colon and anus. With ulcerative colitis, ulcers develop on the inner lining on the large intestine. These ulcers may bleed and/or produce pus. Ulcerative colitis generally begins in the rectum and spreads upward to the first part of the colon.

Both diseases often appear gradually and then worsen with time, though many patients report periods of remission during which symptoms disappear for weeks or months. Periods of painful inflammation, on the other hand, are called flare-ups.

Common Symptoms of IBD

Because Crohn’s and colitis affect similar parts of the body, diagnosing these two diseases can be difficult. Their symptoms are often indistinguishable and can vary from person to person. Inflammation of the gastrointestinal tract often leads to the following symptoms, many of which are common for people dealing with Crohn’s or colitis.

• Diarrhea

• Rectal bleeding

• Urgent bowel movements

• Constipation

• Abdominal cramps/pains

• Fatigue

• Unintended weight loss

• Fever

• Night sweats

• Loss of appetite

What Causes Crohn’s and Colitis?

The intestine’s absorptive area spans over 4,300 square feet, making it the single largest surface in the human body, including the skin. Previously, diet and stress levels were implicated as the main determinants of IBD, but today they are seen as aggravating factors and not the actual cause.

While researchers are still unclear as to the exact causes of Crohn’s and colitis, many agree that they likely originate from a combination of factors.

Individual genes: People with a family history of IBD are 10 times more likely to develop the condition than those with no history.

Immune system: It is possible that Crohn’s and colitis appear in response to a viral, bacterial, or fungal infection of the intestinal tract, where the immune system produces an inflammatory response in the intestines to fight off the foreign agent(s). However, people with IBD often have inflammation even when no infection is present, leading researchers to believe that the patient’s immune system may be attacking the body itself. This phenomenon is known as an autoimmune response.

Environmental factors: Clinical and experimental evidence indicates that IBD may be associated with a range of seemingly unrelated environmental influences including cigarette smoking, diet, stress, use of hormones, vitamin D levels, and geographic/social status, among others.

Complications in IBD

Though these two diseases are rarely life-threatening, if left untreated, Crohn’s disease and ulcerative colitis can result in several serious complications deserving of immediate medical attention.

Fistulae: When ulcers extend completely through the intestinal wall, they create fistulae, or abnormal fusions between different parts of the body. The most common site for IBD fistula formation is the tissue surrounding the anus, where the fistula creates a connection between the rectum and the skin. Fistulae can occasionally become infected and form a life-threatening abscess—a localized pocket of pus—if left untreated.

Bleeding: Blood often appears in the stool of people with IBD, caused by inflammation, ulcer formation, and anal fissures. Some even pass blood alone in the absence of stool. Bleeding in the rectum is more common in ulcerative colitis than Crohn’s, but will vary depending on the area(s) affected.

Anemia: People with IBD have difficulties absorbing important nutrients from food, especially iron, which is absorbed in the small intestine (an area commonly affected by IBD). As a result, nearly half of people affected by Crohn’s or colitis do not receive adequate levels of vitamin B12, iron, and folic acid, all of which are necessary for the creation of new red blood cells. Patients with low levels of red blood cells develop anemia, resulting in headache, fatigue, chest pain, and weakness.

Treatment and Management

The goal in treating Crohn’s and colitis is to achieve and maintain remission, and mostly involves drug therapy to reduce the inflammation that causes IBD’s signs and symptoms. Immunosuppressants and anti-inflammatory drugs called aminosalicylates and corticosteroids have proven to be helpful in improving or completely stopping the symptoms of IBD. Biologics are a more recently developed therapy, created out of biological antibodies rather than chemical medications. Biologics also suppress the immune system but offer a distinct advantage in that they target specific proteins in the IBD patient rather than affecting the whole body.

However, there is currently no cure for Crohn’s disease, and ulcerative colitis can only be cured in the most severe cases when the entire large intestine is surgically removed.

Fortunately there are several ways that people with IBD can manage their symptoms. If you or a loved one has been diagnosed with IBD, consider the following strategies in conjunction with a physician’s oversight to help alleviate symptoms of the disease.

Manage stress: Many patients report an intensification of symptoms in times of stress. Consider adopting a meditation, yoga, or acupuncture routine to reduce symptoms, and get plenty of exercise, preferably daily.

Stay hydrated: Inflamed colons do not absorb water and electrolytes properly, resulting in diarrhea, increased bowel movements, and dehydration. Keep yourself hydrated with distilled water in order to combat this increased fluid loss, and monitor your urine to determine whether or not you are drinking enough liquids.

Limit “trigger” foods: Foods that cause flare-ups depend on the individual, but some are more commonly associated with intensified symptoms than others. They include fatty, spicy, and high-fiber foods; alcohol; coffee; carbonated drinks, nuts and seeds; raw fruits and vegetables; and red meat.

Get your vitamins: IBD flare-ups can negatively impact nutrition due to the increased bowel movements, loss in appetite, fatigue, etc. When the small intestine becomes inflamed, the body is unable to absorb nutrients from food. Coupled with a reduced appetite, IBD can easily lead to malnutrition. Patients can avoid malnutrition by eating smaller, well-balanced meals throughout the day. Your doctor may also recommend vitamin supplements as well.

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