What is Metamucil’s Two-Week Challenge? │ Metamucil

What is Metamucil’s Two Week Challenge?

Metamucil’s Two-Week Challenge is a program that helps you get started with your daily Metamucil routine. It’s a fun way to keep you on track with taking Metamucil powders or capsules daily, so you can feel the full effect of psyllium fiber working in your gut.

Why two weeks? As with any dietary change, your body needs time to adjust. While you’ll likely notice the regularity* benefits of Metamucil sooner, we’re confident that after two weeks you’ll be feeling lighter and more energetic** and well on your way to making it a part of your daily health routine.

After you sign up, you’ll get an email every day for two weeks with tips, tricks, and reminders to keep you going strong on your daily Metamucil.

Why Should I Take Metamucil’s Two-Week Challenge?

It’s a challenge to add something new to your daily routine. But we believe that Metamucil can make a difference in your overall health, and we want to help you along your digestive health journey. Don’t just take our word for it, see what other people have to say after taking the Two-Week Challenge:

• “I take it every morning. It makes me feel lighter and I feel good all day.” – Frances, South Carolina
• “I was having some issues with irregularity. Metamucil fixed me. I feel so much better. I feel… less sluggish. I will continue to use Metamucil as a part of my daily routine.” – Camille, Pennsylvania
• “Metamucil worked great. I feel and look so much better. No more bloating… It also has brought my cholesterol numbers down & put my numbers where they need to be. I use it every night…” – Patricia, Massachusetts
• “I put the container on the counter for my morning ritual! Really loved the taste & looked forward to getting it daily. I also got three friends to come onboard…” – Elaine, Tennessee
• “I’ve been taking Metamucil for about three weeks now, it’s great… My poop is nice and soft, it comes out easy…” – Michael, New Jersey
• “Got to admit, it works. It eases that bloated belly feeling and keeps ‘things moving.’” – Allen, New York

How to Join Metamucil’s Two-Week Challenge

Ready to join for the Two-Week Challenge? Sign up here for daily inspirational reminders. visit our product pages or your favorite retailer to decide which Metamucil psyllium fiber supplement is right for you.

Once you have your Metamucil – it’s time to get started! Follow the instructions on the package and take your Metamucil daily for two full weeks.

10 Tips for Metamucil’s Two-Week Challenge

1. Pick the Metamucil Psyllium Fiber Product that Fits Your Lifestyle

Metamucil’s psyllium fiber comes in many forms and flavors. For your Two-Week Challenge, choose from our Powders and Capsules. If your lifestyle is more on-the-go, you may prefer Metamucil Capsules so you can keep them in your bag and take them at a time convenient to you. If you prefer to take your Metamucil in the morning when you wake up or in the evening before bed, then you may prefer mixing the Metamucil Powders into a cool drink. No matter which form you take—remember to take it daily.

2. Start Slow and Increase Your Psyllium Intake
Start with one serving daily of Metamucil at first, then gradually increase to your desired intake. You may experience gas or bloating in the first few days as your body adjusts to the added fiber. This is normal and should go away as your body gets used to the added fiber.

3. Put Powder into the Glass First
Make sure to put the powder into the dry, empty glass before pouring in the liquid. That will ensure a smoother drink so you can enjoy getting your daily fiber.

4. Only Mix into Cool Liquid
If you choose powdered Metamucil, you can mix with juice or water, but make sure that the liquid is cool. Hot liquids make it hard to mix and drink your Metamucil because the psyllium fiber gels faster in comparison.

5. Take it at the Same Time Every Day
It’s Metamucil-o-clock for someone out there, somewhere. Anytime is a good time to take Metamucil. Pick a time you know you’ll be consistent with – whether that’s in the morning with breakfast, with each meal, or before you head to bed. Naturally fitting Metamucil into your regular routine makes it easier to stay consistent. Set a reminder on your phone, tablet, computer, or alarm clock to help keep you on track. Metamucil can be taken up to 3x per day.

6. Add Metamucil to Your Smoothies
Metamucil powders can be mixed into more than just water or your favorite juice. You can also add it to your favorite smoothie or shake recipe. For example – try Metamucil’s Tropical Fruit Smoothie Recipe . The recipe calls for 1/2 cup of low-fat vanilla yogurt, 1/2 of a peeled banana, 1/4 cup mango juice, 1 rounded teaspoon of Metamucil Orange Powder, and 1/2 a cup of ice. Blend it all together and drink up to get 5g of fiber in your diet. Check out more Metamucil recipes here.

7. Pick Up Where You Left Off
Life can be incredibly busy sometimes and distract you from keeping up your healthy habits like exercise and taking your daily Metamucil. If you miss a day of Metamucil, don’t stress it. Pick up where you left off and continue your daily regimen.

8. Nominate a Friend to Take the Challenge with You
Invite a friend to take Metamucil’s Two-Week Challenge with you. Keep each other accountable by sending daily reminders to each other or selfies. Or add a friendly competition to the mix to incentivize taking your Metamucil even more. Winner can treat the other friend to a new cannister of Metamucil powders or a high-fiber lunch!

9. Read the Directions
It may sound obvious to simply recommend reading the directions . Identify the benefits you want to get from Metamucil—whether that’s to increase your daily fiber intake or help you feel less hungry in between meals* or something else. Then check the label to see how best to take it daily to deliver those benefits.

10. Keep Taking Metamucil Beyond the Two Weeks!
Metamucil’s Two Week Challenge isn’t the only time you can take Metamucil—in fact, you can take it every day, 365 days a year! If you’re enjoying the benefits you’re getting from taking your Metamucil during these two weeks, why stop? Keep up your daily psyllium fiber routine so you can feel what lighter feels like* year-round.

Plus, when taken daily over a longer period of time, you can get up to four different benefits from Metamucil’s psyllium fiber. Keep reading to learn about each benefit.

4 Health Benefits Metamucil Can Provide

Metamucil’s psyllium fiber capsules and powders have three different benefits that support your overall health and wellbeing. Keep reading to learn more.

1. Helps promote digestive health*

Taking Metamucil daily can help support regularity.* The psyllium fiber in Metamucil powders and capsules forms a gel that moves through the digestive tract helping trap and remove the waste.*

2. Helps support heart health by lowering cholesterol†

The gelled psyllium traps some bile acids in the small intestine. This prevents reabsorption, and the trapped bile acids can pass into the large intestine with waste. At that point, the liver would draw more cholesterol from the blood to make new bile acids, thus resulting in lower blood cholesterol levels. †

3. Helps Maintain Healthy Blood Sugar Levels*

The psyllium fiber in Metamucil powders and capsules form a viscous gel that traps sugars. They are then slowly released and absorbed into the body, helping you maintain healthy blood sugar levels.*

4. Bonus Metamucil Powders Also Help you feel less hungry between meals*

When you take Metamucil powders, the gel formed by the psyllium fiber in your stomach can help you feel fuller longer, helping curb your hunger between meals by reducing your desire to eat.*

Metamucil Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Uses

This medication is used to treat constipation. It increases the bulk in your stool, an effect that helps to cause movement of the intestines. It also works by increasing the amount of water in the stool, making the stool softer and easier to pass.Psyllium, one type of bulk-forming laxative, has also been used along with a proper diet to treat high cholesterol.

How to use Metamucil 0.4 Gram Capsule

Take this medication by mouth as directed by your doctor. If you are self-treating, follow all directions on the product package. If you have any questions, ask your doctor or pharmacist. To prevent choking from this medication, take it with a full glass of water or other liquid (8 ounces/240 milliliters). If you are taking the wafers, chew them thoroughly before swallowing.

For powder forms of this medication, measure each dose according to the directions on the product label. Mix in a full glass of water or other liquid (8 ounces/240 milliliters), stir completely, and drink right away. You may add more liquid to the mixture if it becomes too thick. When preparing the medication, be careful not to breathe in the powder since it may rarely cause an allergic reaction.

Dosage is based on your age, medical condition, and response to treatment. Do not increase your dose or take this drug more often than directed.

This product may decrease the absorption of other medications you may be taking. Take this product at least 2 hours from your other medications. Ask your doctor or pharmacist for more information or if you have any questions.

It may take 1 to 3 days before this medication starts working. Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day. Do not take this medication for more than 7 days unless directed by your doctor.

Tell your doctor if your condition lasts or gets worse, or if bleeding from the rectum occurs. If you think you may have a serious medical problem, get medical help right away.

Side Effects

Gas or stomach cramping may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

If your doctor has directed you to use this product, remember that your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This product must be taken with at least a full glass of water or other liquid (8 ounces/240 milliliters) so that it will not swell in the throat, causing choking. Get medical help right away if after taking this product you have symptoms of choking such as: chest pain, vomiting, difficulty swallowing/breathing.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before taking this bulk-forming laxative, tell your doctor or pharmacist if you are allergic it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: stomach/intestinal blockage, difficulty swallowing, appendicitis or symptoms of appendicitis (such as nausea/vomiting, sudden or unexplained stomach/abdominal pain), a sudden change in bowel habits that lasts for longer than 2 weeks, bleeding from the rectum.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Some products may contain sugar and/or aspartame. Caution is advised if you have diabetes, phenylketonuria (PKU), or any other condition that requires you to limit/avoid these substances in your diet. Ask your doctor or pharmacist about using this product safely.

Tell your doctor if you are pregnant before using this medication.

It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

Interactions

See also How To Use section.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Does Metamucil 0.4 Gram Capsule interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Keep all medical and lab appointments.

Lifestyle changes that may prevent or relieve constipation include exercising, drinking enough water, and eating a proper diet with fiber-rich foods such as bran, fresh fruits/vegetables. Talk to your doctor or pharmacist about lifestyle changes that might benefit you.

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Different brands of this medication have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

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Drug Survey

Are you currently using Metamucil 0.4 Gram Capsule?

This survey is being conducted by the WebMD marketing sciences department.

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Constipation – symptoms, causes, signs, diagnosis and treatment in “SM-Clinic”

This disease is treated by Gastroenterologist
, Proctologist

• What is constipation?
• Symptoms of constipation
• Causes of constipation
• Diagnosis of constipation in “SM-Clinic”
• Treatment of constipation in the “SM-Clinic”
• Prevention of constipation
• Doctors

Constipation is a short-term or permanent violation of bowel movements, in which it is impossible to completely empty the bowels. Situational constipation, triggered by stress or side effects of drugs, is not a pathology. The criterion for the disease is the absence of stool within 48-72 hours. In this case, the patient may complain of a strong urge to defecate, abdominal pain and general malaise. Strong straining does not lead to relief or is accompanied by the release of hard round stools without complete emptying of the intestine. Possible complications of constipation include anal fissure, intoxication of the body and the formation of hemorrhoids.

Constipation is one of the most common diseases of the gastrointestinal tract. Many doctors call constipation a symptom, however, in the international classification of diseases, this condition is designated as an independent pathology (code K59.0). In most cases, constipation affects the elderly. Treatment of constipation should primarily focus on improving nutrition. If necessary, medical therapy is applied.

Symptoms of constipation

Symptoms of constipation depend on the cause of this condition. The absence of a chair can be observed for three days in a row or occur intermittently. The accumulation of stool in the large intestine is accompanied by increased absorption of fluid, hardening of the stool and the penetration of toxins into the bloodstream. Hard stool damages the intestinal mucosa, and harmful substances adversely affect the patient’s well-being.

Other symptoms and signs:

• Feeling of heaviness in the abdomen;
• Passing stools in the form of hard black or dark brown balls;
• Paroxysmal pain in the abdomen;
• Strong irresolvable urge to defecate;
• Requires constant straining to empty the bowels;
• Passing a lot of mucus along with hard stools;
• Feeling of incomplete emptying of the bowels;
• Bloating
• Lack of appetite;
• Constant belching;
• Weakness and fatigue;
• Sleep disturbance.

Delayed stool adversely affects the intestinal microflora, so patients complain of increased gas formation. A sign of damage to the intestinal mucosa by hard stools may be the release of blood with feces.

Causes of constipation

The activity of the gastrointestinal tract directly depends on the lifestyle of a person. For the formation of normal stools and bowel movements, the intestines need a sufficient amount of fiber. This substance is found in many fruits and vegetables. A monotonous diet can be accompanied by chronic constipation and the formation of hard stools. Other risk factors for constipation include physical inactivity, chronic stress, sleep disturbance, and insufficient water intake. In some cases, constipation occurs even with a healthy lifestyle against the background of a pathological condition.

Other causes:

• Irritable bowel syndrome. This disease is characterized by dysfunction of the intestine. The patient may complain of intermittent constipation followed by diarrhea;
• Intestinal obstruction with the growth of tumors, the penetration of foreign bodies into the organ, parasitic infection, adhesions or other pathological conditions;
• Disturbance of intestinal motility. The movement of feces in the intestines is provided by wave-like contractions of the muscle tissues of the organ. Violation of the rhythm of the intestinal muscles can lead to constipation;
• Diseases of the nervous system. Intestinal functions depend on nervous regulation, therefore, pathologies of the spinal cord and peripheral nerves can cause defecation disorders;
• Unfavorable mental state, accompanied by anxiety and severe stress.

The effectiveness of the treatment of constipation depends on the successful identification of the cause of this condition.

Get advice

If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

You can find out more about the disease, prices for treatment and sign up for a consultation with a specialist by phone:

+7 (495) 292-39-72

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Why SM-Clinic?

1

Treatment is carried out in accordance with clinical guidelines

2

Comprehensive assessment of the nature of the disease and treatment prognosis

3

Modern diagnostic equipment and own laboratory

4

High level of service and balanced pricing policy

Diagnosis of constipation in “SM-Clinic”

With a constant violation of bowel movements, it is necessary to make an appointment with a proctologist. The doctor of our clinic conducts a consultation, during which he asks the patient in detail about complaints and studies the anamnesis. It is important for the doctor to determine how often the patient has stool retention. In addition, the proctologist needs to exclude the presence of intestinal obstruction, which requires urgent treatment. Severe bloating and the absence of gases indicate bowel obstruction. Additional examinations can clarify the diagnosis and identify the cause of constipation.

Applied diagnostic methods in “SM-Clinic”:

• Irrigoscopy is a method of X-ray examination of the colon. The doctor injects a contrast solution into the patient’s intestines using an enema. Then an x-ray examination is performed, during which the specialist sees a change in the shape of the intestine and the extensibility of its walls in real time. Getting several pictures in different positions allows the doctor to clarify the cause of constipation and exclude the presence of intestinal obstruction;
• Endoscopic examination of the large intestine (colonoscopy). The doctor inserts a flexible tube equipped with a camera and a light source into the patient’s rectum. During the study, the specialist studies the features of the contents of the intestine and the state of the mucous membrane of the organ, looking at the monitor. During the procedure, if necessary, a painless sampling of cells of the mucous membrane of the organ is performed for histological examination of the material in the laboratory. To eliminate discomfort, colonoscopy is performed under anesthesia;
• anorectal manometry. The proctologist appoints this study to assess the tone of the muscles of the intestine and the strength of the contraction of the sphincters of the rectum. A flexible tube is inserted into the intestine, after which the specialist fills the balloon at the end of the tube with air. The results of the study make it possible to detect the pathology of the muscles of the organ;
• Study of the defecation process using magnetic resonance imaging (defecography). This is the most highly informative method for diagnosing chronic constipation, allowing the doctor to evaluate the work of the pelvic floor muscles and the defecation process in general. Obtaining a three-dimensional image of the pelvic organs is carried out using a special apparatus. The doctor asks the patient to remove all metal jewelry and lie down on the tomography table. Before the study, a contrast agent is injected into the intestine using an enema. After removing the contrast from the intestine, a second scan is performed with functional tests, such as straining or relaxing the pelvic muscles;
• Blood test. In the treatment room, the nurse takes a small amount of blood from the patient’s vein and sends the material to the laboratory. Based on the results of a blood test, thyroid dysfunction and other causes of constipation are excluded. Own laboratory “SM-Clinic” allows you to conduct this study quickly and get reliable results.

The proctologist himself determines what examinations are necessary for the patient. In most cases, the diagnosis of constipation is limited to a few procedures.

Treatment of constipation in the SM-Clinic

According to the results of the diagnosis, the doctors of our clinic select a treatment plan for constipation. The prescribed therapy eliminates the cause of the pathology and normalizes the activity of the intestine. The gastroenterologist necessarily prescribes a special diet for the patient to restore intestinal motility and form a stool of the correct consistency. If a mechanical obstruction or other dangerous pathology is detected, emergency treatment is carried out.

Methods of constipation treatment in “SM-Clinic”:

• Prescription of drugs containing dietary fiber. The gastroenterologist prescribes the patient metamucil or another agent that normalizes the formation of stool and facilitates defecation;
• The use of drugs that improve intestinal motility. The doctor prescribes a short course of bisacodyl or another agent to the patient;
• The use of osmotic laxatives that eliminate excessive absorption of water by the walls of the intestine. It is lactulose, magnesium hydroxide or magnesium citrate;
• Use of stool softeners. The doctor prescribes docusate sodium or another drug that reduces the absorption of water in the large intestine to the patient;
• Use of enemas and anal suppositories. The proctologist explains how to properly perform bowel lavage at home. The doctor also prescribes suppositories based on glycerin or bisacodyl to facilitate bowel movements.

Our proctologists treat chronic constipation in a patient without long-term use of laxatives that negatively affect bowel function. The main task is to improve nutrition and eliminate negative factors from the daily life of the patient. The doctor controls all stages of treatment and achieves optimal results.

Prevention of constipation

A healthy lifestyle will help a person avoid developing constipation or other bowel problems.

Basic prevention methods:

• Eating enough foods containing dietary fiber and fats;
• Consumption of at least 2 liters of fluid per day;
• moderate physical activity;
• Eliminate stressors.

Our clinic’s gastroenterologists provide consultations to explain disease prevention methods.

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Diseases referred to Gastroenterologist

Avitaminosis
Ascariasis
Atrophic gastritis
Achalasia
Balantidiasis
Crohn’s disease
Viral hepatitis
Gastritis
gastroptosis
Gastroenteritis
Gastroenterocolitis
Helminthiasis
Liver hemangioma
Hepatitis A
Hepatitis B
Hepatitis D
Hepatitis E
Hepatitis C
Hepatomegaly
hiatal hernia
Diarrhea
diarrhea during pregnancy
Traveler’s diarrhea
Intestinal diverticulosis
Dysbacteriosis
Dyspepsia
Benign neoplasms of the esophagus
Duodenitis
Jaundice
Cholelithiasis
fatty liver disease
Fatty hepatosis
Heartburn
intestinal candidiasis
liver cyst
pancreatic cyst
intestinal colic
Colitis
Blood in stool
Flatulence
Mechanical jaundice
food poisoning
pancreatitis
Intestinal pneumatosis
Polyps of the stomach
Gallbladder polyps
Intestinal polyps
Postcholecystectomy syndrome
Reflux esophagitis (GERD)
Gilbert’s syndrome
Spasm of the esophagus
Toxic hepatitis
Helicobacteriosis
Cholangitis
cholestasis
Cholecystitis
Chronic gastritis
Chronic cholecystitis
celiac disease
Cirrhosis of the liver
Enteritis
Enterocolitis
Erosive gastritis
Esophageal ulcer
Peptic ulcer of the stomach and duodenum
Ulcerative colitis

Diseases referred to Proctologist

Anal fissure
anal fringes
Crohn’s disease
Pain in the anus
rectal prolapse
Haemorrhoids
warts
coccygeal passage
Blood in stool
paraproctitis
Proctitis
Rectovaginal fistula
Fistula of the rectum
Chronic pelvic pain syndrome
Encoprese
Ulcerative colitis

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Treatment of Crohn’s disease

Crohn’s disease is a chronic inflammatory bowel disease. Inflammation develops in the intestinal wall, which often extends to deeper layers, leads to digestive disorders (severe diarrhea, malnutrition, weight loss) and can cause some serious complications. Crohn’s disease is a precancerous condition: in such patients, the risk of developing a malignant tumor in the colon is significantly increased.

There is no cure for Crohn’s disease. However, modern treatments can significantly reduce symptoms and even lead to long-term remission. Many patients lead active, fulfilling lives. In International Clinic Medica24 , all modern methods of combating this disease are used. Our experienced doctors use the latest generation of medicines, perform surgical interventions of any complexity in an operating room equipped with modern equipment.

Our expert in this area:

Sergeev Petr Sergeevich

Deputy chief physician for medical work. Oncologist, surgeon, chemotherapist, Ph.D.

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Causes of the disease and risk factors

The exact causes of Crohn’s disease are unknown. Previously, it was believed that certain dietary habits and chronic stress lead to the disease. It has now been established that these factors can contribute to the progression of pathological changes in the intestine, but do not lead to them directly. According to modern concepts, Crohn’s disease develops as a result of the influence of various factors:

• Violation of the immune system. The immune system begins to react incorrectly to pathogens and attack the body’s own tissues, including the intestinal wall. It is believed that certain bacterial or viral infections lead to this disorder. However, it has not yet been possible to establish which pathogens have this effect.
• Heredity. 20% of patients have close relatives who have previously been diagnosed with Crohn’s disease. It is possible that certain genes are responsible for the predisposition to the disease. But in many patients, the family history is not burdened at all.
• Features of the intestinal microflora and the influence of external factors. Their role is currently under discussion.

Some risk factors are also known:

• Age. Crohn’s disease can develop in any age group, but is most commonly diagnosed in people in their 30s.
• Ethnic origin. Most often, Crohn’s disease is diagnosed in whites, especially Ashkenazi Jews. But at present, the prevalence of the disease is growing among the black population of the United States and Great Britain.
• Smoking. This is the most significant risk factor that can be influenced. A bad habit not only contributes to the development of the disease, but also makes its course more severe. Smokers with Crohn’s disease are more likely than non-smokers to need surgery.
• Taking non-steroidal anti-inflammatory drugs (NSAIDs). For example, ibuprofen belongs to this group. These drugs do not increase the risk of developing Crohn’s disease, but they can cause inflammation in the intestines, which can make it worse.

Symptoms

Crohn’s disease can occur in many different ways. Sometimes its symptoms increase gradually, and sometimes they appear suddenly. Different sections of the intestine may be involved in the pathological process, depending on this, in accordance with the Montreal classification, several forms of the disease are distinguished:

Colitis – with damage to the colon.

All three forms can be associated with lesions of the upper gastrointestinal tract, rectum, anus. In rare cases, the upper intestine and anorectal zone are affected separately.

If less than 6 months have passed since the onset of the first symptoms, then they speak of an acute course of Crohn’s disease. The chronic course is continuous and recurrent – when, during treatment, the patient has remissions for more than 6 months, and then a relapse occurs again. Depending on how long the bowel is affected in the aggregate, Crohn’s disease can be localized (less than 30 cm) or widespread (more than 100 cm).

Symptoms depend on all these features. In the active stage, Crohn’s disease can manifest itself with symptoms such as diarrhea, fever over 38 degrees, pain and cramps in the abdomen, constant fatigue, ulcers on the oral mucosa, blood in the stool, loss of appetite, weight loss. Some patients develop fistulas in the anus, holes that connect the intestine to the surface of the skin. At the same time, pain is disturbing, the contents of the intestine are released from the fistula.

In severe cases of Crohn’s disease, a number of extraintestinal manifestations may occur: inflammatory changes in the skin, eyes, joints, inflammation of the liver, bile ducts, iron deficiency anemia, kidney stones.

Possible complications of Crohn’s disease:

• Intestinal obstruction. As ulcers heal, scars form in the intestinal wall, blocking the intestinal lumen and impairing the passage of stool. In such cases, surgical treatment is indicated.
• Ulcers. They can appear not only in the intestine, but also on the mucous membrane of the oral cavity, in the anus.
• Fistulas. These are pathological openings that can connect intestinal loops to each other, to other organs (for example, the bladder, vagina), to the surface of the skin in the anus.
• Abscess. This term refers to a cavity with pus. In Crohn’s disease, it is formed as a result of purulent inflammation in the fistula.
• Anal fissure is a small tissue tear. It can become infected or lead to a fistula.
• Exhaustion. Diarrhea, abdominal pain and cramps can make it difficult to eat and absorb important substances. Because of this, the patient loses a lot of weight. Some patients develop B12 deficiency anemia because vitamin B12 is not absorbed.
• Cancer. Crohn’s disease is a precancerous condition and increases the risk of developing colon cancer. In addition, patients receive immunosuppressive therapy. These drugs suppress the immune system and increase the risk of developing lymphoma, skin cancer, and a number of other malignant neoplasms.
• Thrombosis. Crohn’s disease increases the risk of blood clots in the vessels of the lower extremities.

Diagnostic methods

To detect pathological changes in the intestines in Crohn’s disease, the following diagnostic methods are used:

• Colonoscopy scope. During this procedure, the endoscopist examines the entire length of the intestinal mucosa and, having detected pathologically altered tissues, can immediately remove their sample and send it to the laboratory for histological examination (to conduct a biopsy). Detection of inflammatory elements – granuloma – during the study of tissue under a microscope helps to confirm the diagnosis of Crohn’s disease.
• Video Capsule Endoscopy can be used as an alternative to colonoscopy in some cases. The patient is asked to swallow a small capsule containing a miniature video camera. It passes through the entire digestive tract and records the image.
• Computed tomography helps to assess the condition of not only the intestines, but also other organs. Often, CT enterography is performed – CT in combination with the use of a contrast solution. This study has now almost completely replaced radiography with contrast, which was widely used in the past.
• Magnetic resonance imaging is especially useful for evaluating fistulas.
• Balloon-assisted enteroscopy – endoscopic examination of the small intestine using a special endoscope and balloon tube. During this procedure, as well as during a colonoscopy, a biopsy can be performed.

Laboratory tests for Crohn’s disease include complete blood count, infection tests, coprogram, stool test for occult blood, parasitic infections.

Treatment of Crohn’s disease

There is no single treatment regimen for Crohn’s disease for all patients. Therapy for each patient is selected individually, and in some cases surgical interventions are also indicated. The main goals of treatment are to reduce the inflammation that causes the symptoms of the disease, minimize the risk of complications, and improve prognosis. If it was possible to reduce the symptoms and improve the quality of life of the patient, this can be considered a success. In the best case, a long-term remission can be achieved.

The main directions in the treatment of Crohn’s disease:

• diet;
• drug therapy;
• surgical interventions;
• psychosocial support.

Dietary guidelines

There is no universal diet that can improve the condition of all patients with Crohn’s disease. First of all, the patient must figure out which foods cause deterioration in him, and try to exclude them from the diet. The task of the diet for Crohn’s disease is to unload the intestines, give it a “rest” so that it can recover.

Foods that most often aggravate the course of the disease: alcohol in any form, butter, mayonnaise, margarine, carbonated drinks, coffee, tea, chocolate, corn, dairy products (if the patient is lactose intolerant), fatty, fried foods, high fiber foods, lentils, beans, legumes, cabbage, broccoli, onions, nuts and seeds, raw fruits and vegetables, red meat, spicy foods, whole grains, bran.

The patient is advised to keep a food diary, write down everything he ate in it, make notes about his well-being. This helps to identify all unwanted foods and choose the optimal diet. Some types of food do not have to be completely abandoned. For example, if raw vegetables aggravate symptoms, you can try eating them boiled. If meat causes problems, then you can try switching to minced meat. Making a diet is a certain work that takes some time, and it must be done by the patient together with the attending physician and nutritionist.

Many patients, especially those with symptoms of bowel obstruction, are advised to avoid fiber-rich foods. This is necessary to reduce the volume of stool and prevent the development of intestinal obstruction.

Drug therapy

Since Crohn’s disease is an inflammatory bowel disease, its treatment is often started with anti-inflammatory drugs:

• Glucocorticosteroids – preparations of hormones of the adrenal cortex. They have powerful anti-inflammatory effects, but are not effective in all patients with Crohn’s disease. Corticosteroids may be used short-term (within 3 to 4 months) to reduce symptoms or achieve remission. In some cases, they are combined with immunosuppressants – drugs that suppress immune responses. Currently, glucocorticosteroids are usually resorted to when other methods of treatment do not help the patient.
• Oral 5-amino salicylates have been widely used in the past, but currently the indications for their appointment are significantly limited.

immunosuppressants also suppress inflammation by suppressing the immune system. They are often used in combination to increase the effectiveness of treatment:

• Azathioprine and mercaptopurine are the two immunosuppressive agents most commonly used to treat inflammatory bowel disease. During the course of treatment, the doctor must carefully monitor the patient’s condition, monitor blood counts. Immunosuppressants can weaken the immune system enough to increase the risk of developing dangerous infections. In addition, they can lead to inflammation of the liver. If these complications began to develop, the doctor should identify them in a timely manner and change the treatment regimen.
• Methotrexate is used in some patients who are not responding to other treatments. This drug can also cause serious side effects and requires monitoring of the patient’s condition, laboratory parameters during the course of therapy.

Biological Therapies (Bios) target specific proteins that are produced by the immune system. This is a modern group of medicines, it includes:

• Natalizumab (Tysabri) and vedolizumab (Entivio) prevent certain immune system proteins – integrins – from interacting with intestinal mucosal cells. Natalizumab can cause a very dangerous complication – progressive multifocal leukoencephalopathy – so the indications for its use are very limited. No such risks have been identified for vedolizumab.
• Infliximab (Remicade), adalimumab (Humira), and certolizumab pegol (Cimsia) are included in the group of TNF inhibitors. They block an immune system protein called tumor necrosis factor.
• Ustekinumab (Stelara) is the most modern drug that has been introduced very recently. It affects the effect of interleukin, a protein involved in inflammation.

Some antibiotics are also used for Crohn’s disease, eg ciprofloxacin, metronidazole. It is believed that antibacterial drugs help destroy pathogens that have led to a malfunction of the immune system. In addition, antibiotics help to reduce the outflow of the contents of fistulas and abscesses, and sometimes completely eliminate them.

All drugs described above are drugs that help control Crohn’s disease. Simultaneously, symptomatic therapy is carried out. Prescribe drugs that help to cope with the manifestations of the disease:

• Antidiarrheal drugs. Drugs such as metamucil and methylcellulose help manage mild to moderate diarrhea. Loperamide helps with severe diarrhea.
• Analgesics. In some cases, painkillers such as acetaminophen (paracetamol), ibuprofen, naproxen are used for Crohn’s disease. However, in some cases, they can aggravate the course of the disease and worsen the symptoms.
• Vitamins and minerals . They can be prescribed if, due to malnutrition, the necessary substances do not enter the patient’s body.

Surgical treatment

There are 4 groups of indications for surgical treatment in Crohn’s disease:

1. Medication failure when medications fail to relieve symptoms.
2. Acute complications : intestinal bleeding, perforation (hole formation) of the intestinal wall, toxic dilatation of the colon (a rare complication in which the intestine expands more than 6 cm and there are signs of intoxication – poisoning of the body with substances that enter the blood through the intestinal wall).
3. Chronic complications : strictures (cicatricial narrowing) of the intestine, infiltrate in the abdominal cavity, intestinal fistulas, neoplasia (changes in mucous membrane cells that can lead to the development of a malignant tumor).
4. Growth retardation – usually seen in lesions of the upper intestines.

According to statistics, more than 70% of patients with Crohn’s disease need surgical treatment at one time or another. The decision to have an operation is always very difficult, doctors try to make it only in extreme cases. The specialists at the Medica24 International Clinic always carefully evaluate all potential benefits and risks, and if necessary, we convene consultations with the participation of experts.

In most cases of Crohn’s disease, bowel resection is performed – removal of part of it. This helps reduce symptoms, but does not lead to a complete cure. May relapse in another part of the bowel:

The risk of relapse can be reduced with medication. Smoking cessation is an important preventive measure. However, 50% of patients require further surgery. The larger the area of ​​the intestine that has to be removed, including during subsequent resections, the higher the risk of developing a complication – short bowel syndrome . Due to the loss of a large part of the intestine, the absorption of nutrients is disturbed, intestinal insufficiency develops. This condition manifests itself in the form of diarrhea, weight loss, general weakness, anemia, edema, muscle cramps, signs of hypovitaminosis.

Whenever possible, doctors try to resort to organ-preserving operations. For example, with intestinal strictures, interventions are performed aimed at restoring the normal width of its lumen: stricturoplasty, dilatation of strictures.

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Prognosis

There is no cure for Crohn’s disease. Most often it proceeds for a long time with periods of exacerbations and remissions. Sometimes the course is very heavy, with excruciating pain. However, modern treatment makes it possible to ensure a normal quality of life for most patients: they can do their usual activities, work, and experience little to no symptoms. Disability occurs in 10% of cases.

Mortality rates from Crohn’s disease are currently low. Most patients die from malignant tumors of the intestine. Therefore, all people with Crohn’s disease should be regularly observed by a doctor, undergo recommended screening studies. In some cases, death occurs from complications of thrombosis.

At International Clinic Medica24 , the most modern methods of treatment are used in accordance with the latest international recommendations.