Caring for Patients with Crohn’s Disease

March 07 2023

Symptoms of Crohn’s Plus Treatment and Lifestyle Changes for Remission

Crohn’s disease can be very difficult to live with. It is both painful and debilitating, and it may lead to life-threatening complications.

While there are no known cures for the disease, there are therapies and treatments that can greatly reduce the symptoms. With treatment, many people with Crohn’s disease are able to function well and live a normal, full life.

What is Crohn’s?

Crohn’s disease is a type of inflammatory bowel disease. It causes swelling of the tissues in the digestive tract, known as inflammation. The small and/or large intestine can be involved. 

Symptoms of Crohn’s can range from mild to severe. They usually develop gradually, but sometimes a symptom will onset suddenly and without warning. It’s also possible to have periods of remission where there are no symptoms. 

Symptoms typically include:

• Diarrhea
• Fever
• Fatigue
• Abdominal pain and cramping
• Blood in your stool
• Mouth sores
• Reduced appetite and weight loss
• Malnutrition 
• Pain or drainage near or around the anus due to inflammation from a tunnel into the skin (fistula)

Some also experience symptoms outside of the intestinal tract, including:

• Inflammation of skin, eyes, and joints
• Inflammation of the liver or bile ducts
• Kidney stones
• Iron deficiency (anemia)
• Delayed growth or sexual development (in children)

Patients should seek out a doctor if they experience symptoms such as abdominal pain, blood in their stool, nausea and vomiting, diarrhea that lasts more than two weeks, unexplained weight loss, or fever in addition to any of the above symptoms. 

Risk Factors

There are some factors that increase a person’s risk for developing Crohn’s disease. 

• Age: While Crohn’s can occur at any age, you are more likely to develop the condition when you are young; most people are diagnosed before age 30.
• Ethnicity: Crohn’s can affect any ethnic group, however, white people have the highest risk, especially those of Eastern European Jewish and Ashkenazi Jewish descent. There has been an increase of cases among black people living in North America and the UK, as well as in Middle Eastern populations and migrants to the US.
• Family History: If you have a first-degree relative (parent, sibling, child) with the disease, you are at a higher risk.
• Cigarette Smoking: Smoking leads to more severe disease and a greater risk of having surgery.
• Nonsteroidal Anti-Inflammatory Medications: These medications do not cause Crohn’s but can worsen the disease. Medications in this category include: ibuprofen (Advil, Motrin IB), naproxen sodium (Aleve), diclofenac sodium, and others. 

Complications from Crohn’s

Health care professionals, patients, and family of the patient should be aware of some of the more severe complications from the disease. Treatment is more effective if these complications are caught earlier, however, prevention is the best medicine!

• Bowel Obstruction: over time, parts of the bowel can scar and narrow, which can block the flow of digestive contents; may require surgery to widen or remove the diseased portion of the bowel.
• Ulcers: chronic inflammation can lead to open sores in the digestive tract, including the mouth and anus.
• Fistulas: sometimes the sores can extend through the intestinal wall, creating a fistula, or hole.
• Anal Fissure: this is a small tear in the tissue that lines the anus or in the skin around the anus where infections can occur; it is often associated with painful bowel movements.
• Malnutrition: diarrhea, abdominal pain, and cramping can make it difficult to eat or absorb nutrients from the foods you eat; this can lead to malnutrition, low iron, and vitamin B-12 deficiency. 
• Colon Cancer: Crohn’s increases the risk for developing colon cancer; it’s recommended that those with Crohn’s get a colonoscopy about 8 years after disease onset and have one every 1-2 years afterward.
• Skin Disorders: people with Crohn’s may develop a skin condition called hidradenitis suppurativa, which causes deep nodules and abscesses in the armpits, groin, under the breasts, and in the perianal or genital area.
• Blood Clots: Crohn’s increases the risk of blood clots in veins and arteries, which can lead to a stroke.
• Other Problems and Risks: other complications of Crohn’s include osteoporosis, arthritis, gallbladder or liver disease, decreased immune system function, cancer such as lymphoma and skin cancers, as well as an increased risk of infection. 

Treating Crohn’s Disease

Treating Crohn’s disease involves treating the symptoms of the disease. The goal of treatment is to reduce inflammation that triggers the symptoms of Crohn’s. Another goal is to improve long-term prognosis by limiting complications. Working toward both can help patients find more long-term remission and symptom relief. 

Anti-inflammatory drugs can help treat the inflammation itself. Corticosteroids and Oral 5-aminosalicylates are two of the most common types of anti-inflammatory drugs used. 

Immune system suppressors are used to target the immune system, which produces the substances that cause inflammation. For many patients, a combination of drugs works better than a single immune-suppressing drug alone. 

Biologics is a class of therapies that targets the proteins made by the immune system. 

Antibiotics can reduce the amount of drainage from fistulas and abscesses, sometimes healing them. Some researchers also believe that antibiotics can help reduce harmful bacteria that may be causing inflammation in the intestine.

Anti-diarrheals, pain relievers, and vitamins and supplements can also help relieve some of the symptoms of Crohn’s. Patients should always speak to their doctor first before starting a non-prescription medication. 

Nutrition therapy may be used. This is a special diet given by mouth or a feeding tube, or nutrients are infused into a vein. This can improve overall nutrition and allow the bowel to rest and may reduce inflammation in the short term. This therapy may be done in combination with medications, such as immune system suppressors. A low residue or low-fiber diet may also be recommended to reduce the risk of intestinal blockage. 

Surgery may be used if diet, drugs, therapies, and lifestyle changes do not relieve symptoms. Nearly half of Crohn’s patients will require at least one surgery, however, surgery does not cure the disease. During surgery, portions of the damaged digestive tract are removed and then the healthy tissue is reconnected. Surgery can also be used to close fistulas and drain abscesses. It is important to know that the benefits of surgery are generally temporary, and the best approach will be to use medication following surgery to reduce risk of recurrence. 

Lifestyle Changes

It is important for patients to also make some lifestyle changes in order to control symptoms and lengthen periods of remission.

Diet can play a role in the severity of symptoms. While there is no firm evidence that what you eat can cause inflammatory bowel disease, certain foods and drinks can aggravate symptoms. Patients should keep a food diary to track what they are eating, how they feel, and to discover what foods are causing symptoms to flare. Some general dietary suggestions that a dietitian or doctor may give include: 

• Limiting dairy products
• Eating smaller meals
• Drink plenty of liquids (water is best; alcohol and caffeine can make diarrhea worse, carbonated drinks can produce gas)
• Adding multivitamins

Smoking can increase your risk of developing Crohn’s but it can also make it worse in Crohn’s patients. Smoking cessation strategies should be discussed with the medical team and implemented. 

Stress can trigger flares or make symptoms worse. Patients should speak with their doctor about an exercise plan that is right for them that will help relieve stress. Other techniques for stress reduction include speaking with a therapist, biofeedback, and relaxation and breathing exercises. 

Support groups can help patients with Crohn’s cope. Not only can it provide emotional support, but it can also provide additional education on the disease and treatment options that can be discussed with their medical team. 

Home Health for Crohn’s

Home health care is a great option for patients with Crohn’s disease. Patients don’t have to worry about having an episode of diarrhea on the way to an appointment during a flare or canceling an appointment because of a flare. Home health patients can receive the same high quality health care at home with an accredited and licensed agency. 

If you need care for Crohn’s disease, All American would love to help you live a healthier and happier life! We offer top quality health care in the comfort of your own home. Visit our site to learn more about our accreditations and licensing, as well as our customizable care options.