Inflammatory Bowel Disease
Crohn’s disease is a chronic inflammation primarily involving the intestinal tract. Although it may involve any part of the digestive tract from the mouth to the anus, it most commonly affects the last part of the small intestine (ileum) and/or the large intestine (colon and rectum). Crohn’s disease is a chronic condition and may recur at various times over a lifetime. Some people have long periods of remission, sometimes for years, when they are free of symptoms. There is no way to predict when a remission may occur or when symptoms will return.
Common Questions About Crohn's Disease
- What are the Symptoms of Crohn’s Disease? Because Crohn’s disease can affect any part of the intestine, symptoms may vary greatly from patient to patient. Common symptoms include cramping, abdominal pain, diarrhea, fever, weight loss, and bloating. Not all patients experience all of these symptoms, and some may experience none of them. Other symptoms may include anal pain or drainage, skin lesions, rectal abscess, fissure, and joint pain (arthritis).
- What Causes Crohn’s Disease? The exact cause is not known. However, current theories center on an immunologic (the body’s defense system) and/or bacterial cause. Crohn’s disease is not contagious but it does have a slight genetic (inherited) tendency. An X-ray study of the small intestine may be used to diagnose Crohn’s disease.
- How is Crohn’s Disease Treated? Initial treatment is almost always with medication. There is no “cure” for Crohn’s disease, but medical therapy with one or more drugs provides a means to treat early Crohn’s disease and relieve its symptoms. In more advanced or complicated cases of Crohn’s disease, surgery may be recommended. Emergency surgery is sometimes necessary when complications, such as a perforation of the intestine, obstruction (blockage) of the bowel or significant bleeding occur with Crohn’s disease. Other less urgent indications for surgery may include abscess formation, fistulas (abnormal communications from the intestine), severe anal disease, or persistence of the disease despite appropriate drug treatment. Not all patients with these or other complications require surgery. This decision is best reached through consultation with your colon and rectal surgeon.
Ulcerative colitis (UC) (sometimes called colitis ulcerative) is an inflammatory process that involves the lining of the colon and rectum. The cause of UC is unknown. The disease usually starts in the rectum and proceeds toward the beginning of the colon. Consequently, patients with UC have varying degrees of colonic involvement. The spectrum ranges from only rectal disease to total colon involvement. The extent of colonic disease is the most important factor with respect to the patient’s overall disease course and in their response to medical treatments.
If the disease can not be controlled medically, surgery may become necessary. If precancerous or cancerous tissue is found on a colon biopsy, surgery is recommended.
Typically, the entire colon and rectum are removed when a patient undergoes surgery for UC. The patient will evacuate their digestive contents in one of two ways: through an ileostomy or through a “neo-rectum” constructed from small bowel and reconnected to the anus.
Diverticulosis is a condition in which outpouchings form in the walls of the intestines. These pouches, known as diverticula, are about the size of large peas. They form in weakened areas of the bowels, most often in the lower part of the colon (large bowel).
Common Questions About Diverticulosis/Diverticulitis
- What are the Symptoms of Diverticulosis? Most people with diverticula do not have any symptoms from them. They may never know they have the condition. Some people feel pain and discomfort over the affected area or muscle spasms in the abdomen. Pain may be felt on the lower left side of the abdomen or, less often, in the middle or on the right side. Although the diverticula themselves do not cause symptoms, complications such as bleeding and infection may occur. Bleeding is an uncommon symptom and is usually not severe. Sometimes the pouches become infected and inflamed, a more serious condition known as diverticulitis. When inflammation is present, there may be fever and an increased white blood cell count as well as acute abdominal pain. Diverticulitis also may result in large abscesses (infected areas of pus), bowel blockage, or breaks and leaks through the bowel wall.
- What Causes Diverticula to Form? No one knows for sure why the pouches form. Scientists think they may be caused by increased pressure inside the colon due to muscle spasms or straining. The sacs might form when increased pressure acts on the soft spots along the bowel wall, especially if the person has constipation problems or uses laxatives too often.
- What are the Treatments? If you have diverticulosis with no symptoms, no treatment is needed. Some doctors advise eating a high-fiber diet and avoiding certain foods. Laxatives and enemas should not be used regularly. Patients with diverticulitis may be hospitalized and treated with bed rest, pain relievers, antibiotics, fluids given by vein, and careful monitoring.
- Is Surgery Ever Necessary? The majority of patients will recover form diverticulitis without surgery. Sometimes patients need surgery to drain an abscess that has resulted from a ruptured diverticulum and to remove that portion of the colon. Surgery is reserved for patients with very severe or multiple attacks. In those cases, the involved segment of colon can be removed and the colon rejoined. In some cases, the two ends of the colon cannot be rejoined right away, so more than one operation is needed. For instance, an operation may be performed to drain an abscess and remove diseased colon and a second operation done to rejoin the colon. In this case, the surgeon must connect the colon to a surgically created hole in the body’s surface (colostomy) until a second operation can be done to reconnect the colon. The delay between operations may be only a few weeks, or it might be several months if the patient needs time to overcome infection and build up strength. In rare cases, three operations are needed: the first to drain an abscess, the second to remove part of the colon, and the third to rejoin the bowel.