How to Manage Constipation Associated With Crohn’s Disease

People with Crohn’s disease often deal with diarrhea. Though not as common, constipation does occur and may signal an underlying problem.

A person is considered to be constipated if they:

• Have fewer than three bowel movements a week
• Have to strain to pass stool
• Are unable to completely empty their bowels

Not being able to “go” is common. About 52 million people, or nearly 16 percent of the American population, suffer from constipation, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

“Anyone can develop constipation. Most often it’s because they aren’t drinking enough fluids or eating enough dietary fiber, or they’re taking certain medications,” says Justin L. Sewell, MD, a professor of clinical medicine in the division of gastroenterology at the University of California in San Francisco.

“For people with Crohn’s, constipation could mean actual blockage in the intestine,” Dr. Sewell says, “so it’s important to determine if there’s evidence of active disease or inflammation.”

Here are some possible reasons people with Crohn’s may have constipation.

Strictures

For people with Crohn’s, strictures — narrowed areas in the gastrointestinal tract, usually in the small intestine — can cause abdominal pain, cramping, and vomiting. Strictures can also block food from passing through the digestive tract. Anal strictures are typically the cause of constipation.

“If there’s a stricture in the bowels, it’s generally managed with medications or requires surgery to remove a part of the bowel that’s blocking the passage of food,” says Sewell.

In general, 23 to 45 percent of people with ulcerative colitis and up to 75 percent of people with Crohn’s disease will eventually require surgery, according to the Crohn’s and Colitis Foundation. While surgery may be optional for some, others will require it because of complications of the disease.

Small bowel resection — surgery that removes diseased sections of the small intestine — is commonly used to treat strictures. A less-invasive alternative is strictureplasty, in which the surgeon makes a lengthwise incision along the narrowed area and then sews it up crosswise, widening the area without removing any portion of the small intestine, thus preserving intestine length.

The procedure is generally safe and effective, but it can cause bleeding in the bowels and fluid leakage from the stitches, and other strictures may form over time.

Even though it seems preferable to cut out a section of the bowel if the stricture is short, Sewell notes, if it’s a long stricture or the patient has already had previous resections, it puts them at risk of short bowel syndrome. “Then, perhaps, strictureplasty would be more favorable,” he says.

Proctitis

Common among people with inflammatory bowel disease (IBD), proctitis is inflammation in the lining of the rectum that causes tenesmus, a frequent urge to go to the bathroom even when the bowels are empty. There’s generally a feeling of fullness in the rectum and pain during bowel movements.

“This is usually common among patients with ulcerative colitis, but it could occur in people with Crohn’s,” says Sewell.

The cause is rectal inflammation, so keeping an eye on the disease and staying on top of prescribed medications could help prevent inflammation from worsening and causing tenesmus.

But if the symptom does develop, doctors may prescribe mesalamine (a 5-ASA), steroids, biologics, or anti-inflammatory topical treatments, such as aminosalicylates.

Fissures

An anal fissure is a cut or tear in the anus that typically causes itching, pain, and bleeding with bowel movements.

“Since it’s painful, people will often delay going to the bathroom,” says Sewell. “The longer they wait, the harder the stool becomes, which makes it harder for the stool to pass.”

Anal fissures — not to be confused with fistulas, which are abnormal openings that form in the wall of the intestine and connect to other tissues or organs — are usually managed with daily warm sitz baths to clean the affected area and a topical treatment such as hydrocortisone. Severe cases often require surgery.

Certain medications

Medications such as antidepressants, painkillers, iron supplements, and calcium channel blockers for hypertension and heart disease can cause constipation, too.

If reducing or stopping the medication isn’t an option, Sewell recommends increasing water and dietary fiber intake or using stool softeners or stimulant laxatives.

Can Diet Help Prevent or Relieve Constipation?

According to the Crohn’s and Colitis Foundation, nutrition is vital to controlling IBD symptoms. Food choices can become more complicated for people with Crohn’s, because certain foods may worsen symptoms.

A variety of diets have been used to help manage Crohn’s symptoms or maintain remission, but there is no one tried-and-true diet that works for constipation.

“Getting enough fluids, including fiber in the diet, such as soluble fiber like fruits, vegetables, and whole grains, or taking fiber supplements could help,” says Adam Cheifetz, MD, director of the center for inflammatory bowel disease at Beth Israel Deaconess Medical Center in Boston. “An unprocessed healthy diet without a lot of additives is key,” he says.

Increasing fiber should be gradual, cautions Kelly Kennedy, RDN, Everyday Health staff nutritionist, to prevent gas and discomfort.

“Fiber is something that many people with Crohn’s disease limit, so I wouldn’t advise going from 0 to 60, but rather increasing little by little until the desired effects are achieved,” she says. And during a Crohn’s flare, patients should limit fiber intake and replace it with foods like white pasta and white rice, even though they are considered to be processed foods. When the flare is over, they can return to gradually increasing fiber intake, Kennedy says.

For people with significant strictures, a low-residue diet may be recommended. If effective it would be used for the short term, until the patient has had surgery, for example, says Dr. Cheifetz.

“The diet helps by preventing high-residue foods that are not digestible, like corn, nuts, skins of fruits, and mushrooms, from getting stuck behind a stricture leading to a small bowel obstruction,” he says. (Patients should always get an okay from their doctor first.)

The use of probiotics, also called good bacteria, is thought to be good for the gut and has been linked to positive health outcomes, according to a review published in March 2017 in the journal Nutrients. However, more research is needed. A recent study found the effects of probiotics inconclusive. While they can’t hurt, the American College of Gastroenterology does not recommend them outside of a trial. You can find probiotics in yogurt that contains live and active cultures or in supplement form.

“The main limitation at this time is that they haven’t quite figured out which strain(s) and in which amounts might be helpful for a condition such as Crohn’s disease,” Kennedy says.

“I’ve used probiotics in patients who have underlying [irritable bowel syndrome] symptoms,” Cheifetz says. “It’s been helpful, especially for those who deal with bloating.”

Avoiding foods that worsen or trigger symptoms and making sure to follow a well-balanced, nutrient-rich diet are key.

“The only diet I would recommend is a general healthy diet with lots of whole foods and being sure to limit or avoid processed foods, which are low in nutritional value and fiber,” says Kennedy.

Crohn’s disease and constipation: Causes and treatments

Crohn’s disease tends to cause frequent diarrhea, but it can also cause constipation. This constipation may result from medications, other health conditions, or lifestyle factors.

Doctors consider a person to have constipation if they have fewer than three bowel movements a week. Other symptoms of constipation can include hard or dry stools, pain or difficulty passing stools, and a feeling of incomplete evacuation.

In this article, we discuss potential causes of constipation in people with Crohn’s disease, treatment options, and when to see a doctor.

There are several possible causes of constipation in people with Crohn’s disease. These can include:

Medications

A variety of medications can cause constipation, including antidiarrheal drugs, iron supplements, calcium channel blockers, and certain pain relievers.

Low-fiber diet

Doctors sometimes recommend a low-fiber diet for people experiencing a Crohn’s flare-up.

However, reducing the intake of fiber while also taking antidiarrheal medications can lead to constipation in some individuals.

Strictures

Share on PinterestEating fresh fruit can provide essential dietary fiber, which may help prevent constipation.

Crohn’s disease can cause a section of the intestines to narrow, due to severe inflammation.

This section is called a stricture, and it can block or slow the passage of stool or digested food through the bowels, leading to constipation.

Strictures can also cause abdominal pain, bloating, and nausea and vomiting. It is important for people with symptoms of a stricture or another blockage to see a doctor.

Without treatment, a stricture can lead to potentially life-threatening complications. Doctors can often treat strictures with medications, but some people may require surgery, such as a strictureplasty or bowel resection.

Other causes

Other causes of constipation in people with Crohn’s disease may include:

• not drinking enough fluids
• eating too little food
• an inactive lifestyle
• irritable bowel syndrome
• proctitis, which is an inflammation of the rectum

Treatments include dietary and lifestyle changes, medications, and bowel training. We discuss some of these options below:

Dietary fiber

Consuming more dietary fiber leads to more water absorption in the bowels. This makes stools softer and easier to pass.

Foods rich in fiber include:

• fresh or dried fruits, such as unpeeled apples and pears, prunes, berries, and oranges
• fresh or cooked vegetables, such as spinach, carrots, broccoli, sweet potatoes, and unpeeled potatoes
• legumes, such as lentils, beans, and peas
• nuts and seeds
• high-fiber breakfast cereals, which often include bran or whole grains
• whole-grain breads, pastas, and rice

Speak to a doctor or dietician before making significant dietary changes. People with strictures should not adopt high-fiber diets.

To prevent gas and bloating, it is best to gradually introduce high-fiber foods into the diet.

Fluids

Drinking more fluids can help soften stools and make them easier to pass. Fluids can include:

• water
• clear soups
• fruit and vegetable juices with no added sugar
• low-sugar sports drinks
• non-caffeinated beverages

Exercise

Share on PinterestRegular exercise can help support healthy bowel movements.

Getting more exercise can help stools move through the colon more quickly and increase the frequency of bowel movements.

Experts recommend doing at least 30 minutes of aerobic exercise on most days, or about 150 minutes per week. This can involve activities such as cycling, swimming, and brisk walking.

It may not always be easy or possible to exercise when symptoms flare up. Other ways to increase physical activity can include:

• Taking short walks
• using the car and elevator less
• taking regular breaks from desks and computers to walk around and stretch

Laxatives

Laxatives are a short-term option for the treatment of constipation. Longer-term use of these medications can make it difficult for a person to have a bowel movement without taking a laxative.

People with Crohn’s disease should speak to a doctor before trying a laxative.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, the following types of laxatives are available over the counter:

• osmotic agents, such as milk of magnesia or Miralax
• bulk-forming agents, such as Citrucel or FiberCon
• stool softeners, such as Colace or Docusate
• lubricants, such as mineral oil
• stimulants, such as Correctol or Dulcolax

Doctors generally only recommend stimulant laxatives for people with severe constipation, or if other treatments have not worked.

Prescription medications

For people with severe or difficult-to-treat constipation, a doctor may prescribe lubiprostone, linaclotide, or plecanatide.

Lubiprostone works by increasing fluid in the large intestine, which helps soften stool and lead to more frequent bowel movements.

Linaclotide and plecanatide can help restore regular bowel movements, but they may take up to 1 week to have an effect. These two medications may cause severe dehydration in some people, and children should not take them.

Doctors need to rule out any intestinal obstructions, such as from strictures, before a person starts taking these medications.

Stopping medications

If a medication is causing a person’s constipation, the doctor may recommend changing, reducing, or stopping the drug or supplement.

Bowel training

Doctors may recommend bowel training for some people with constipation.

This involves trying to have a bowel movement at the same time each day. Bowel training may also include changing the way a person sits on the toilet.

Over time, this can help a person have more regular bowel movements.

Biofeedback therapy

Biofeedback therapy can help treat constipation in people who have problems with their pelvic floor muscles.

It involves using electronic devices to provide feedback on the activity of specific muscles, which allows the person to retrain them and gain better control.

Share on PinterestA person with Crohn’s disease should see a doctor if they experience a high fever.

People with Crohn’s disease should have regular check-ins with their doctor or other members of their healthcare team. Doing so allows healthcare professionals to monitor symptoms and recommend adjustments to the treatment plan.

Severe or sudden constipation, especially if it is associated with abdominal pain, may indicate a stricture or blockage in the bowels. Without treatment, blockages can lead to life-threatening complications, such as tearing in the intestine.

Symptoms of a stricture or blockage can include:

• severe abdominal pain, cramping, or bloating
• nausea and vomiting
• a high fever
• severe constipation
• an inability to pass gas

Anyone with these symptoms should speak to a doctor immediately.

Although Crohn’s disease typically causes diarrhea during flare-ups, some people may also experience constipation. Causes of this constipation can include medications, strictures, lifestyle factors, and other health conditions.

Constipation treatments for people with Crohn’s disease include making dietary and lifestyle changes, taking stool softeners or laxatives, and bowel training.

Consider speaking to a healthcare professional if symptoms do not improve.

Read this article in Spanish.

Crohn’s disease: diagnosis and treatment in Moscow

Causes of Crohn’s disease

Scientists are still wondering what exactly causes the disease. There are several theories according to which it may be an unexplored virus or microorganism. There are opinions that people get sick because of problems with immunity or malnutrition. It is known that genetics plays an important role in the occurrence of the disease. Almost all patients have close relatives suffering from Crohn’s disease.

For unknown reasons, ulcers and areas of overgrown connective tissue (granulomas) appear on the surface of organs. Because of this, the sizes and shapes of organs change, their work is disrupted. The most frequently recorded form of the disease with ulcerative lesions of the intestine. It is very dangerous, because the changed mucosa thickens, making it difficult for food to pass. Constant inflammation of the mucosa leads to persistent diarrhea that is difficult to treat.

Symptoms of Crohn’s disease

Patients experience instability of the stool (alternating constipation and diarrhea), bloating and increased flatulence. An inflamed intestine causes pain that occurs in one place (localized) or spreads throughout the abdomen. Pain is not associated with eating. During exacerbations, the temperature may rise significantly, chills, fever, nausea and vomiting may occur. Sometimes there is blood in the stool.

Crohn’s disease, like all chronic pathologies, occurs with periods of exacerbations and remissions (subsidence of symptoms). At this time, patients feel normal.

In addition to intestinal damage, the disease causes ulcers and nodules on the skin, inflammation of the joints and even the eyes. Due to improper digestion, the absorption of vitamins from food is disrupted, which leads to beriberi and anemia (anemia). The liver and gallbladder are often affected. Patients lose weight, complain of weakness, apathy, nausea and dry mouth. Irritation of the skin around the anus, caused by diarrhea, provokes the appearance of anal fissures and other lesions of the rectum. Patients suffering from constipation often develop hemorrhoids.

If Crohn’s disease is not treated, complications can occur:

● Life-threatening intestinal perforation;

● Fistulas through which intestinal contents and flora penetrate into other organs;

● Destruction of blood vessels leading to massive bleeding;

● Adhesive patency disorder. In this case, an operation is performed during which artificial pathways are created for the removal of food. The intestine is brought out with the formation of a stoma. The stool is removed into the colostomy bag.

People with Crohn’s disease are five times more likely to develop bowel cancer than healthy people. Those most at risk are those who have had cases of oncological pathologies of the colon or small intestine in the family.

Treatment of Crohn’s disease

Crohn’s disease is very difficult to detect, so patients are misdiagnosed and treated ineffectively for a long time. For diagnosis, a complex of laboratory, radiographic and endoscopic studies is carried out, only after that it is possible to identify the disease.

Radical methods of combating the disease do not exist. Only symptomatic and treatment and medical procedures are used that improve the condition of the intestines, prevent scarring and relieve inflammation.

Since the disease can affect different parts of the gastrointestinal tract, its manifestations can also vary. Treatment is selected individually, taking into account the symptoms that a particular person has.

Constipation in Crohn’s disease: treatment and recommendations

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Constipation in Crohn’s disease: treatment and advice

Crohn’s disease tends to cause frequent diarrhea, but it can also lead to constipation, which can result from medication, other illnesses, or certain lifestyle factors.

Doctors diagnose constipation when a person has fewer than three stools per week. Other symptoms may include hard or dry stools, pain or difficulty passing a bowel movement, and a feeling of incomplete evacuation.

Constipation can be caused by the following:

1. Use of medications. Various drugs can have this side effect, including antidiarrheals, iron supplements, calcium channel blockers, sorbents (eg, activated charcoal, smecta, almagel, etc.), and certain pain relievers.
2. Low fiber diet. Doctors sometimes recommend a low-fiber diet for individuals who are at the peak of Crohn’s disease. However, reducing the intake of plant fibers, as well as taking antidiarrheal drugs, can lead to constipation in some people.
3. Strictures. Crohn’s disease can cause narrowing of the intestinal tract due to a strong inflammatory process. These wall changes, called strictures, can block or slow the passage of feces or digested food through the intestines, resulting in constipation. Strictures can also cause abdominal pain, bloating, nausea, and vomiting, so it’s important for people with symptoms of eating disorders to see a doctor. Without proper treatment, a stricture can lead to potentially life-threatening complications. Doctors can often prescribe certain medications, but some patients require surgery.
4. Other causes may include: insufficient fluid intake, too little daily diet, inactive lifestyle, irritable bowel syndrome, proctitis (inflammation of the rectal wall. – approx. Trans.).

Treatment for this problem is complex and may include the following:
1. Eating more dietary fiber, which results in more water absorption in the intestines, making stools easier to pass. Fiber-rich foods include: fresh or dried fruits; fresh or boiled vegetables; legumes; nuts and seeds; high-fiber breakfast cereals; whole grain bread, pasta and rice.