Crohn's Disease

Symptoms

The main symptoms of Crohn's disease are belly pain and diarrhea (sometimes with blood). Losing weight without trying is another common symptom.

Less common symptoms include mouth sores, bowel blockages, anal tears (fissures), and sores (ulcers) that form tunnels (fistulas) between organs.

Infections, hormonal changes, smoking, medicines, and lifestyle changes can cause your symptoms to flare up. Your symptoms may be mild, moderate, or severe.

What Happens

Complications of Crohn's disease

Crohn's disease may cause sores, or ulcers, that form a tunnel through the intestine and into the nearby tissue. They are often around the anus and rectum. These tunnels, called fistulas, are a common problem with Crohn's disease. They may get infected. Crohn's disease can also cause anal fissures. These are narrow tears in the tissue from the muscles that control the anus (anal sphincters) up into the anal canal.

In long-term Crohn's disease, scar tissue may form and cause blockages (bowel obstructions) or narrowed areas (strictures). These can prevent stool from passing through the intestines. Blockages in the intestines also may be caused by inflammation and swelling, which may improve with medicines. Sometimes blockages can only be treated with surgery.

Sometimes symptoms of Crohn's disease affect other parts of the body. This can include the eyes, liver, blood, and bones.

When to Call

Call 911 anytime you think you may need emergency care. For example, call if:

• You passed out (lost consciousness).
• Your stools are maroon or very bloody.

Contact a doctor now if you have been diagnosed with Crohn's disease and you have:

• New or worse belly pain.
• A fever.
• New or worse nausea or vomiting.
• New or more blood in your stools.
• New or worse diarrhea.
• Symptoms of dehydration.
• Trouble passing any stools or gas.
• Pus draining from the area around the anus, or pain and swelling in the anal area.

If you have any of these symptoms and you have been diagnosed with Crohn's disease, your condition may have become much worse. Some of these symptoms, such as severe belly pain and bloating, also may be signs of toxic megacolon. This is a rare complication of Crohn's disease that requires emergency treatment. Without treatment, it can cause the colon to leak or rupture, which can be fatal.

People who have Crohn's disease usually know their pattern of symptoms. Watch closely for changes in your health, and be sure to contact your doctor if:

• You are losing weight.
• You are struggling to manage Crohn's disease.

Exams and Tests

Your doctor will ask you about your symptoms and do a physical exam. You may also have blood tests or imaging tests to find out if you have Crohn's disease.

Tests that may be done to diagnose or evaluate Crohn's disease include:

• Stool analysis. This test looks for blood and signs of infection in a sample of your stool.
• One or more imaging tests, such as a CT scan or an MRI.
• Barium X-rays of the small intestine or colon.
• Colonoscopy or flexible sigmoidoscopy. In these tests, the doctor uses a thin, lighted tube to look inside the colon.
• A biopsy. The doctor takes a sample of tissue and tests it to find out if you have Crohn's disease or another condition.

Treatment Overview

Your treatment will depend on the type of symptoms you have and how bad they are. Medicines are the most common treatment for Crohn's disease. Mild symptoms may be treated with over-the-counter medicines to stop diarrhea. Prescription medicines can control or prevent inflammation in the intestines and help relieve symptoms. They also promote the healing of damaged tissues.

People who have more severe, ongoing symptoms may need other treatments. These may include liquid feedings (supplemental nutrition) to let the intestines rest and heal or surgery to remove the damaged part of the intestine.

Self-Care

• Take your medicines exactly as prescribed. Contact your doctor if you think you are having a problem with your medicine. You will get more details on the specific medicines your doctor prescribes.
• Do not take anti-inflammatory medicines, such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve). They may make your symptoms worse. Do not take any other medicines or herbal remedies without talking to your doctor first.
• Avoid foods that make your symptoms worse. These might include milk, alcohol, high-fiber foods, or spicy foods. It may help to keep a diary of foods that make symptoms worse.
• Make sure to get enough iron. Any blood in your stools may make you lose iron. Good sources of iron include beef, lentils, spinach, raisins, and iron-enriched breads and cereals.
• Drink liquid meal replacements if your doctor recommends them. These are high in calories and contain vitamins and minerals. Severe Crohn's symptoms may make it hard for your body to absorb vitamins and minerals from the food you normally eat.
• Talk to a dietitian to make sure that you are getting the nutrition, including vitamins and minerals, that you need.
• Don't smoke, vape, or use other tobacco or nicotine products. These things can make Crohn's disease worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Stay up to date on all vaccines.
• Follow your doctor's cancer screening recommendations.
• Seek support from friends and family to help cope with Crohn's disease. The illness can affect all parts of your life. Get counseling if you need it.

Medicines

Medicines usually are the treatment of choice for Crohn's disease. They can control or prevent inflammation in the intestines. They help to:

• Relieve symptoms.
• Promote healing of damaged tissues.
• Put the disease into remission. And they can keep it from flaring up again.
• Postpone the need for surgery.

They include:

• Aminosalicylates. Your doctor may recommend these medicines during a flare-up or at other times.
• Antibiotics. These treat infections that can occur with Crohn's disease.
• Biologics. Your doctor may have you try these medicines if other medicines for Crohn's disease haven't worked for you.
• Corticosteroids. They usually stop symptoms and put the disease in remission. But they aren't used as long-term treatment to keep symptoms from coming back.
• Immune modulators. You may take these if other medicines don't work, if your symptoms come back when you stop taking steroid medicines, or if your symptoms come back often, even with treatment.

Research on new medicines and combinations of medicines is ongoing. Talk to your doctor about what medicines are best for you, based on the symptoms you have.