Crohn's and Colitis. Dr. Hillary Steinhart

getting through and being excreted.

       Abdominal Pain

      The inflammation of the inner lining of the intestine can produce abdominal pain, but because the inner lining of the intestine does not have nerve endings that can detect painful stimuli, abdominal pain is not a constant feature in most cases of ulcerative colitis. When it does occur, pain tends to be crampy, occurring around the time of bowel movements, and is often associated with rectal urgency. This pain is probably due more to the contraction or spasm of the intestine than to the inflammation of the inner lining itself.

       Diarrhea

      When the inflammation of the large intestine extends above the rectum, it affects the normal fluid-absorptive function of the large intestine, resulting in loose or liquid stools, also known as diarrhea. The liquid stool may be mixed with variable amounts of blood and mucus.

       Intestinal Gas

      Some patients experiencing a flare of ulcerative colitis will feel that they have an increased amount of gas or that the odor of the gas changes. Some even say that they can tell when a flare is about to come on because of this change in the odor. The amount of gas produced during a flare of colitis has never actually been studied, but it is likely that, even if the amount of gas produced is not increased, the inflamed rectum and large intestine are more sensitive to the presence of gas and, therefore, will pass it more frequently.

       Fatigue

      When the inflammation in the colon is particularly bad or when it involves a large portion of the colon, patients with ulcerative colitis may suffer from fatigue and weight loss. The fatigue is most often due to the inflammation itself, but can also be due to anemia resulting from blood loss in the stool. Chronic blood loss can, over time, lead to iron-deficiency anemia. When a person is anemic, the blood is not able to carry oxygen to the tissues in the body as effectively, and, as a result, a person may experience fatigue and breathlessness with minimal amounts of exertion.

       Cytokines

      Intestinal inflammation itself, even without producing anemia or iron deficiency, can also produce fatigue. This probably occurs as a result of certain proteins, called cytokines, that are released from inflamed tissues and that can produce symptoms such as fatigue, loss of appetite, and fever.

       Weight Loss

      Cytokines can also produce changes in metabolism that result in loss of body weight, even when food intake is at a level that should be sufficient to maintain a person’s healthy nutritional state.

       Crohn’s Disease Symptoms

      Crohn’s disease can affect any part of the gastrointestinal tract. As a result, the symptoms reported by patients with Crohn’s disease can be much more varied than those reported by patients with ulcerative colitis.

      As with ulcerative colitis, the symptoms experienced in Crohn’s disease are highly dependent upon the location and severity of the inflammation within the gastrointestinal tract. However, the relative prominence of the symptoms may be different in Crohn’s disease than in ulcerative colitis. Because there are locations that are much more commonly affected than others, there are presenting symptoms that also tend to be more common than others. As a general rule, abdominal pain, diarrhea, fatigue, and weight loss tend to be the most common presenting symptoms in Crohn’s disease. In children, failure to grow normally, or “failure to thrive,” is a common presenting symptom.

       Atypical Symptoms

      Because the locations within the gut that are affected by the disease vary from person to person, there is no “typical” patient or “typical” symptom presentation in Crohn’s disease.

       Quick Guide to Crohn’s Disease Symptoms

      The symptoms of Crohn’s disease are similar to the symptoms of ulcerative colitis. However, a number of additional symptoms, not typically experienced in ulcerative colitis, may be experienced in patients with Crohn’s disease. One problem that is very uncommon in ulcerative colitis, but may be seen in Crohn’s disease, is the occurrence of fistulas and abscesses around the anus and ulcers within the anal canal. These complications occur because of the tendency of Crohn’s disease to penetrate more deeply into the bowel lining.

      If you experience any one or combination of the following symptoms, be sure to consult with your doctor.

      •Rectal bleeding (blood and mucus in the stool)

      •Rectal urgency (frequent trips to the toilet and urgent need to move the bowels that often can’t be delayed)

      •Severe abdominal cramps

      •Frequent diarrhea

      •Increased intestinal gas

      •Persistent fatigue

      •Weight loss

      •Fistulas and abscesses around the anus and ulcers within the anal canal

      •Failure to grow or thrive in children

       Tips for Working with Your Doctor

      Working with your doctor to diagnose your symptoms is the first step in understanding and treating inflammatory bowel disease. However, some patients find their initial meeting with their doctor somewhat unsatisfactory because they do not have enough time to ask all the questions they may have. While most doctors do have busy schedules, you can make the most of your appointments with them by being well prepared. To get the most out of your visit to your doctor, try the following tips:

       Make sure there is enough time.

      If you think that your problems and concerns are going to take longer than the time your doctor usually allocates for an appointment, ask for a longer meeting. You will find this much more satisfactory than trying to “find a moment” at the end of the appointment to raise what may be your most pressing questions and concerns. If you do come to the end of your allotted time, acknowledge to the doctor that you have run out of time and that you still have items to discuss. The doctor may sometimes ask you to continue or, in some cases, suggest that you schedule another appointment.

       Keep your description of symptoms focused and factual.

      The doctor wants to hear about what you are feeling, so just describe what you are experiencing without jumping to conclusions or making speculations. You might say to your doctor, “I’m here today because I keep getting episodes when I can’t move my bowels, my belly becomes distended like I’m 9 months pregnant, and I start vomiting. It feels exactly like it did when I had surgery for a bowel obstruction 4 years ago, but maybe a little less severe.” Although you may suspect this is caused by a bowel obstruction, you don’t need to interpret the experience or make a diagnosis. That is the doctor’s job — to determine if the symptoms are due to a bowel obstruction or due to some other cause or condition that could produce similar symptoms.

       Bring a list of your medications and their doses.

      The doctor will need to know if you are taking any medications and their dosage. Report if you have experienced any side effects and when they first started in relation to when you began taking the medications.

       Make a list of your questions and issues.

      Keep your list of questions short enough that it can be covered in the available time and try to make sure that the questions are specific and to the point rather than being overly general and difficult to answer concisely. For example, answering a question such as “What are the possible side effects of this medication?” may take up the entire appointment, whereas asking “What are the common and serious side effects of this drug?” will get the information you are really looking for in a relatively short