is where the danger lies. Some complications are common to Crohn’s disease and ulcerative colitis, whereas others are unique to one form of IBD or the other. Generally, the complications can be divided into those that occur directly from the inflammation or ulceration that occurs in the intestine and those that occur in areas of the body that are not directly connected to the intestine or directly related to the intestinal inflammation.
Crohn’s Disease Complications: Strictures, Abscesses, and Fistulas
Inflammation and Ulceration Complications
Inflammation and ulcerations can lead to strictures, fistulas, and abscesses in the gut. If these complications are not properly managed, they can, in turn, lead to further tissue damage and uncontrolled infection. Death can occur if this happens. While these complications are often seen in Crohn’s disease, they are very rare in ulcerative colitis.
| What are strictures? | |
| Strictures are segments of the intestine in which the normally large internal opening becomes narrowed. This can be due to the swelling that occurs in the tissues of the intestinal wall as a result of active inflammation, similar to the swelling you get when you experience an injury, such as a broken bone. More often, the stricture is due to scarring of the intestinal tissues following repeated or ongoing episodes of inflammation and healing. |
Strictures
Strictures are not necessarily a problem until they cause a bowel obstruction, commonly referred to as a blockage. Food or other material becomes caught in the narrowed stricture, preventing anything else from passing through. This produces back pressure in the intestine “upstream” from the stricture, causing sharp, often crampy pain, a distended abdomen, and nausea and vomiting. Sometimes there may be warning signs that a stricture may be worsening or leading to an obstruction. These signs include frequent or recurrent pain in the center of the abdomen after eating, along with a feeling of distension or bloating of the abdomen.
Foods to Avoid When You Have an Intestinal Stricture
•Popcorn
•Nuts
•Seeds
•Corn
•Raw vegetables
•Skins on fruits
Bowel Obstruction
Not everyone with a stricture develops intestinal obstruction. If you experience a bowel obstruction that is not severe and know the symptoms, you can sometimes manage it on your own by avoiding solid food and drinking only fluids for several hours or even a few days. If you have a stricture, it is important that you avoid eating foods that aren’t easily digested and that, as a result, may get lodged in the narrowed part of the intestine. These foods include popcorn, nuts, seeds, corn, raw vegetables (particularly stringy ones like celery), and skins on fruits.
This complication can be an emergency situation. You will usually require monitoring in a hospital setting, with intravenous fluids given to prevent dehydration and possibly the insertion of a nasogastric tube (a plastic tube inserted through the nose and down the esophagus into the stomach) to take fluid and gas out of the stomach.
Bowel Obstruction Symptoms
•Severe crampy pain, usually centered in the middle of the abdomen
•Distension or bloating of the abdomen
•Reduced number of bowel motions
•Not passing gas
•Nausea and vomiting
Not all symptoms are necessarily present when a bowel obstruction has occurred, particularly if it is partial or incomplete.
If the obstruction does not settle with these measures, then surgery is usually required to remove the strictured area of bowel. Fortunately, most obstructions that are due to Crohn’s disease strictures settle without the immediate need for surgery, but repeated obstructions usually mean that surgery is required. In that instance, the surgery can be scheduled electively so that it is performed when you are well nourished, not sick, and not on medications that might affect healing and recovery after surgery. Medications are not very effective at relieving obstruction, particularly when the narrowing is due to scarring.
Immediate Medical Attention
If there is fever with the stricture symptoms, if there is frequent vomiting, or if after 6 to 8 hours symptoms of the obstruction are not starting to clear, as evidenced by reduced pain, decreased abdominal distension, and resumption of normal bowel motions and passing gas, then immediate medical attention is needed.
Abscesses
When a deep ulcer penetrates through all of the layers of the intestine, the contents of the intestine, primarily bacteria and fecal material, can leak out and into the abdominal cavity and tissues around the intestine. When a lot of this material leaks out suddenly, it can produce a serious, and occasionally fatal, infection called peritonitis.
In Crohn’s disease, this leakage normally occurs very gradually, and the tissues around the intestine have a chance to react and to form a barrier against free leakage of the bacteria into the abdominal cavity. As a result, the bacteria accumulate in a localized area that is effectively walled off. The bacteria grow in the center of this walled-off region, causing a localized infection known as an abscess. An abscess typically contains pus in its center.
Serious Bacterial Infection
When an abscess is not properly treated, it can grow in size. Eventually, the bacteria can spread into the bloodstream and throughout the body, or it can burst into adjacent organs and tissues or into the abdominal cavity, causing the pus to spread throughout the abdomen. Any of these situations can be extremely serious or life threatening.
Fistulas
Fistulas are abnormal channels or tracts joining one part of the intestine to another part of the intestine or to another organ. When an area of the intestine becomes inflamed and ulcerated, the ulcer can penetrate through the full thickness of the intestine wall into an adjacent tissue. This is promoted by the fact that inflamed intestine tends to be “sticky” on its outside surface and will attach to other adjacent segments of intestine, to surrounding organs, or to the inner surface of the abdominal wall.
When a fistula forms between two segments of intestine, there may be no obvious bad consequences, but it is possible that the fistula can result in ingested food bypassing large segments of the intestine. This can cause decreased absorption of nutrients, leading to weight loss and malnutrition. Fistulas can pass from the intestines to adjacent organs, such as the bladder, which, in turn, leads to recurrent urinary infections.
Perianal Fistulas
The most common type of fistula occurs in the area around
