Crohn's and Colitis. Dr. Hillary Steinhart

questions.

       Prioritize your list of questions from most important to the least important.

      Take care of the questions that are causing you the most concern first so that you can feel more at ease and more comfortable asking other questions. Often your doctor’s answer to the most pressing question also answers other questions on your list.

       Bring a friend or relative to help you remember what you have discussed.

      Many patients ask a spouse, relative, or friend to accompany them to the appointment, to help them remember the questions they planned to ask and make note of the answers given by the doctor. Their emotional support is also important.

       Make notes about key points in the discussion.

      You or your companion should make a record of what your doctor investigates and concludes so that you can follow any treatment program the doctor may prescribe. This is especially important if treatment options are presented to you for your decision. You may want to refer to your notes when making your decision.

What is an abscess?

The inflamed areas of the intestine may be tender to touch, so that any pressure applied to the abdomen may produce pain. When ulcers extend right through the intestinal wall, it can produce a reaction around the intestine, resulting in a swelling that can be felt by a physician examining the patient. Occasionally, this area can become infected by the bacteria from the intestine that are able to penetrate through the ulcer into the area of swelling. This is called an abscess. When this occurs, patients usually feel a constant pain over the affected area and may also have a fever.

       Abdominal Pain

      Unlike ulcerative colitis, where the inflammation is limited to the innermost lining of the intestine, in Crohn’s disease, the inflammation and ulcers can penetrate through all the layers of the intestinal wall. Since there are nerves that can transmit pain signals in the deeper layers of the intestine, this means that pain may be a more consistent feature of Crohn’s disease.

       Strictures and Blockages

      If Crohn’s disease produces some narrowing of the intestine (most often in the small intestine), it can produce some degree of blockage, making it difficult for food and intestinal contents to get through the narrowed areas. This can be experienced as crampy abdominal pain that occurs within minutes to several hours after a meal, depending on the precise location of the narrowing. Bloating of the abdomen can occur along with this pain, and, when it is particularly severe, nausea and vomiting may also occur. More complete blockages can occur, and these will be associated with symptoms of abdominal pain, distension, nausea, and vomiting. During the episode, the person may not be able to pass any stool or gas.

       Immediate Medical Attention

      Episodes of abdominal pain that last more than 4 to 6 hours without passage of gas or stool require immediate medical attention and often require hospitalization.

       Bowel Movements

      As is the case in ulcerative colitis, patients with Crohn’s disease may have crampy abdominal pain around the time of bowel movements. This may be due to irritability of the intestine and the associated spasm that can occur as a result of inflammation.

       Diarrhea

      Diarrhea is a common, but not universal, symptom of Crohn’s disease. In fact, some patients with intestinal narrowing actually present with decreased bowel movements and constipation. The diarrhea that occurs in patients with Crohn’s disease is usually not bloody, but when the lower part of the large intestine is inflamed, bleeding can occur more often.

       Fatigue

      Fatigue is a very common symptom in Crohn’s disease and can be one of the most difficult symptoms to completely reverse with medical therapy. As in ulcerative colitis, it is probably due to the release of cytokines from the inflamed intestinal tissues.

       Weight Loss

      Weight loss may be due to the changes in metabolism caused by the cytokines, but it can also be caused by reduced nutrient intake as a result of pain that occurs after eating. In patients with small intestinal inflammation, there may be problems with absorption of nutrients, which can lead to weight loss.

       Anal Problems

      While patients with ulcerative colitis may describe irritation of the skin around the anus or may even develop hemorrhoids (swollen veins) because of the frequent bowel movements, patients with Crohn’s disease are at risk of developing certain specific problems that are more serious. They can develop anal fissures or ulcers (painful breaks in the skin inside the anus), abscesses (painful collections of pus), and fistulas (small openings to the skin around the anus that can drain stool, pus, or blood).

       Nutrient Deficiencies

      Depending on the part of the intestine involved in Crohn’s disease, patients can develop specific nutrient deficiencies. For example, the last part of the small intestine (terminal ileum) is commonly affected in Crohn’s disease; this is also where vitamin B₁₂ is absorbed. As a result, vitamin B₁₂ deficiency can develop in patients with Crohn’s disease of the terminal ileum.

       Extra-Intestinal Symptoms

      Both ulcerative colitis and Crohn’s disease can present with certain associated symptoms or conditions outside of the intestine. These are called extra-intestinal manifestations and are usually due to inflammation of other tissues outside of the bowel — joints, eyes, skin, and liver, for example. Joint manifestations (arthritis) are the most common. These extraintestinal manifestations can occur at the time of first diagnosis of IBD, or they can occur later on in the course of the disease. In occasional cases, they can first occur months or even years before the bowel symptoms first become apparent. The same major extra-intestinal manifestations and symptoms (joint, eye, skin, and liver) can occur in both disorders.

       Onset of Symptoms

      Inflammatory bowel disease usually first develops in one of three different patterns of symptom onset: gradual, sudden, and relapsing or remitting.

       Gradual Onset

      Most often, Crohn’s disease and ulcerative colitis develop very gradually so that it takes many weeks, months, or, in some cases, years before patients recognize the symptoms and mention them to their doctor for diagnosis.

       Sudden Onset

      Unusually, though certainly not rarely, inflammatory bowel disease develops abruptly. Symptoms may come on suddenly, sometimes so quickly that the disease seems to develop virtually overnight, with the person going from a state of good health to a serious and severe illness without any obvious warning. This type of presentation is quite striking and can often make it very difficult for patients and their families. Important medical management decisions, including the choice of medications and the possibility of undergoing surgery, may be required before the patient has the chance to learn about the disease and its consequences, complications, and potential treatments.

       Relapsing or Remitting Onset

      Inflammatory bowel disease may also develop following a so-called relapsing or remitting course. Patients can present with mild episodes or flares that occur for days, weeks, or even months at a time. During these flares, symptoms get noticeably worse, but then seem to go away spontaneously (also called going into remission) so that the person goes back to a