Crohn’s disease is a type of inflammatory bowel disease (IBD).
For an estimated 3 million people in the U.S., IBD’s like Crohn’s disease mean chronic pain, incredibly tricky-to-follow dietary restrictions, and keeping a mental note of where the nearest restroom is at all times.
And that’s if the symptoms are mild. In the worst cases it can mean invasive surgery and even death.
Despite having the word “bowel” in the name, IBD’s like Crohn’s can affect any part of the GI tract. The gastrointestinal (GI) tract is your digestive system. It’s every part of you that your Lucky Charms touch on their journey from cereal bowl to toilet bowl.
What is Crohn’s disease?
Crohn’s disease is a type of inflammatory bowel disease. It’s a chronic condition that causes a breakdown in the lining of the small and large intestines.
It can develop anywhere in the digestive system. A person can manage its symptoms through diet, medication, and surgery — but there’s not yet a cure.
Crohn’s most commonly develops at the end of the small bowel and beginning of the colon. Peeps who live with the condition will be familiar with the fact that Crohn’s is, both literally and figuratively, a massive pain in the ass.
In this article, we’ll cover symptoms, treatment, and whether or not you’re at risk of developing this often debilitating condition.
Crohn’s disease has similar symptoms to many other conditions, like irritable bowel syndrome (IBS). It’s tricky to diagnose, as your doc will have to rule out a lot of other health problems.
The main symptoms of Crohn’s disease are:
On top of these, Crohn’s can also cause unique symptoms in women, including:
- vulvar lesions
- heavy periods
- painful sex, if a fistula has developed near the vagina
These symptoms are common for many conditions, including the common flu or food poisoning. It’s the complications of Crohn’s that makes this chronic condition unique.
Crohn’s-related complications can be life-threatening.
The list of core symptoms don’t give a clear picture of what folk with Crohn’s disease experience on a daily basis.
- Bowel obstruction. This can become so severe that a person may need surgery to remove diseased sections of the bowels.
- Ulcers. These may form anywhere from the mouth through to the anus and genitals.
- Fistulas. Fistulas are connections between body parts that aren’t supposed to join up. For example, loops in your small intestine could end up connecting when ulcers eat through the digestive wall between them. They can lead to infection, abscesses, and even be fatal without treatment.
- Anal fissures. These are as painful as they sound.
- Malnutrition. Crohn’s can affect how well you absorb nutrients.
- Colorectal cancer. Crohn’s may increase a person’s risk for developing colorectal cancer, and their risk of mortality compared to those with colorectal cancer who don’t live with Crohn’s.
Crohn’s can mess with your quality of life for sure. Complications can be fatal. And peeps with severe Crohn’s are likely to face frequent and invasive surgical procedures.
Should I worry about Crohn’s disease?
Don’t worry about Crohn’s at all until you receive a diagnosis from a qualified medical professional. Crohn’s shares symptoms with many easily remedied conditions.
Extreme stress can make any of these symptoms, especially pain and cramping, much worse.
So, before you panic, ask yourself: do I have a genetic condition which causes my body to incorrectly line my bowels, or did I eat one donut too many for lunch?
We don’t know what causes Crohn’s yet. But research points to some possible causes and risk factors.
What causes Crohn’s disease?
Current research suggests that Crohn’s is mostly hereditary. If you have no prior family history of Crohn’s disease, your risk of developing it is much lower.
There’s no single cause that scientists have pinpointed as the main catalyst of Crohn’s development.
Diet and stress were previously prime suspects. However, modern science suggests that Crohn’s stems from a mix of hereditary factors and problems with the immune system.
Stress and diet can definitely make symptoms worse, however.
The short (and frustrating) answer is that nobody knows.
Since the science gods still haven’t agreed what causes Crohn’s, it’s difficult to define your risk of the condition without medical diagnosis.
Crohn’s has been proven to have hereditary links. If anybody in your family lives with an IBD you’re naturally at a higher risk. There are also possible environmental risk factors, and these include:
- Age. While the complications of Crohn’s are more of a risk for older adults, the majority of diagnoses occur in people who are under 30 years of age.
- Cigarette smoking. This one is a bit of a no-brainer. Smoking is bad, m-kay.
- Nonsteroidal anti-inflammatory medications (NSAIDs). No, this doesn’t mean that ibuprofen will give you Crohn’s disease. What it can do is cause bowel inflammation. This, in turn, can aggravate Crohn’s symptoms.
A specialist in digestive disorders (aka a gastroenterologist) will test people for Crohn’s and confirm a diagnosis.
Many other conditions present similar symptoms. Your gastroenterologist (or GI Joe to their pals) will need to rule out these conditions before arriving at a Crohn’s diagnosis and suggesting ways to manage it.
- Colonoscopy. Since Crohn’s most often affects the lower bowels, your gastroenterologist will like poke a flexible camera device up your butt to examine them. (It’s one of the few times in life that sticking something up your ass solves problems instead of causing them.)
- Biopsy. Your specialist may remove tiny bits of your bowel and examine them under a microscope to check for ulcers or inflammation.
- MRI or CT scan. These are the least invasive methods of testing for Crohn’s. Sometimes, you have to drink a solution beforehand that helps the specialist produce a clearer image.
Crohn’s doesn’t have a cure yet. But medical science is awesome, and the future is infinite. So hang tight.
Treatment focuses instead on managing symptoms and restoring quality of life.
There’s a host of different medications doctors can prescribe for Crohn’s. Most usually prescribe medication with the goal of reducing inflammation.
The most common treatments, among others, include:
These are steroid medications that help reduce inflammation by calming the body’s immune reaction. Examples include:
This class of medication may cause some side effects, such as:
- a loss of bone mass
- high blood glucose levels
- high blood pressure
- a higher risk of infection
- rapid mood changes
- increased body weight
Your doc will probably only prescribe these for short-term use.
These contain 5-aminosalicylic acid, which also helps you keep inflammation in check.
Doctors prescribe this for mild symptoms in people who only just received a diagnosis.
As side effects, you might experience:
These also help people reduce inflammation. But immunomodulators go about it in a different way.
The immune system causes inflammation by releasing chemicals. Immunomodulators aim to reduce the production of these chemicals and bring down inflammation.
- 6-mercaptopurine (which, in 2021, could well be a rap name)
Side effects include:
- an increased risk of infection due to reduced immune activity
These work by honing in on specific proteins that the immune system produces.
They neutralize these proteins and prevent them from inflaming more of your body. (If Batman only attacked arsonists, and came in pill form, he’d be a biologic.) They can be especially helpful if other medications don’t have the intended effect.
Your doc might prescribe one of the following biologics for Crohn’s:
- anti-tumor necrosis factor-alpha therapies, including adalimumab and certolizumab
- anti-integrin therapies like natalizumab and vedoliazumab
- anti-interleukin-12 and anti-interleukin-23 therapies, such as ustekinumab
It’s possible to have a toxic reaction to biologics. They can also increase your risk of infections like tuberculosis.
(Seriously, how are there more?)
Well, as Crohn’s can have effects right across the body, your doc will often have to manage complications as they crop up. This means that:
- They’ll prescribe antibiotics to treat infection due to fistulas and abscesses.
- You may need to take antidiarrheal drugs like loperamide to manage those runny poop symptoms.
- Over-the-counter (OTC) pain meds like acetaminophen can help mild pain (definitely avoid NSAIDs like ibuprofen, though, as they can make symptoms flare up).
- Vitamin and nutrient supplements can help you manage nutrient deficiencies.
- Crohn’s can disrupt your life in a way that can also affect mental health. For this reason, some folks with Crohn’s take antidepressants, and may also seek therapy.
If the meds aren’t effective, the next step is to bench your back passage for a few days to several weeks. This form of treatment is bowel rest. Bowel rest is a vacation from pooping. It’s a real thing that real doctors 100 percent prescribe.
But, how do you just… stop pooping? It’s not a case of staring yourself down in the mirror and demanding it point blank, Chris-Traeger-style. Science has your back.
You’ll limit yourself to only drinking special nutrient enriched liquids. Basically, you’ll be getting all the good stuff you need in a super shake so you don’t have to take a sh*t.
Bowel rest could mean not eating or drinking anything at all. You may have to receive nutrients through a feeding tube directly to your stomach or small intestine. Your nutrients might even have to enter your bod through an IV drip.
Depending on the flavor of the treatment, there’s a chance you’ll have to stay in the hospital during this treatment. But many folks with Crohn’s can complete bowel rest at home.
The benefits of bowel rest aren’t only for your rear end. Your small intestines very much enjoy not having solids pass through them for a little while. It gives them a chance to heal any inflammation or ulceration.
When the body hasn’t responded well to medicinal or dietary treatment, and if bowel rest isn’t doing the trick, surgery is the next step.
Crohn’s can lead to surgery for any number of reasons. There’s many procedures that a doctor might recommend to treat complications.
The most common surgical procedure for peeps with Crohn’s is a resection. This is a keyhole procedure where a small, infected section of bowel is removed. The healthy parts around it are then stitched together. Simple.
In more severe cases, the surgeon may need to remove whole sections of bowel.
An ileostomy may also be necessary. A surgeon constructs an artificial opening in your abdomen. It reroutes poop away from your bowel and into an external pouch.
Ileostomies are for life
The bad news: If you have an ileostomy, it’s for the rest of your life.
This can cause distress, particularly for teenagers and people who are more body conscious.
The good news: There are now clothing lines dedicated to young people with colostomy bags. You can also check out body positivity blogs and groups where they can meet others in the same boat.
The Crohn’s Disease Diet
Changing up your diet is one of the most effective means of easing the symptoms of Crohn’s on a day-to-day basis.
Diet changes are easier than, say, surgery to live with — but changing the way you eat is certainly no picnic. Especially with a diet as restrictive as the Crohn’s diet.
Keeping on top of this eating plan can add to the mental health difficulties caused by living with a chronic condition.
However, dietary alterations can be effective at significantly reducing the pain and discomfort caused by Crohn’s and other IBDs.
What to eat when you have Crohn’s?
The specifics of the Crohn’s diet vary depending on severity and unique complications. But the following guidelines generally apply across the board:
Safe to eat: ✅
- Low fiber fruits. You can eat bananas, melons, squash, and cooked fruit. Focus on soft fruits with lots of vitamins that aren’t too acidic.
- Lean protein. This means low fat pork cuts, chicken, fish, and eggs. Tofu, too — but much like a good mattress, it has to be firm, or you may well feel pain the next day.
- Refined grains. Sourdough, gluten-free bread, white pasta, and oatmeal are safe options for folks with Crohn’s. Potatoes, too, as long as you remove the skin.
- Fully cooked vegetables. You can eat vegetables that have no seeds, skin, or hard bits.
- Hard-to-digest fibers. Essentially this means anything that comes out almost as solid as it went in. Think skins on fruit, raw veg, whole nuts, and grains.
- Lactose. Lactose is quickly becoming Public Enemy #1 for dietitians. It’s been found that all that milk and dairy probably isn’t great for the gut even if you’re healthy. Crohn’s magnifies the digestion issues many people experience with lactose.
- Sugars, both absorbable and nonabsorbable. Sugar is very difficult for your digestive system to break down. Having sticky lumps of sugar meandering through your bowels can be agony during a flare-up.
- High fat and fried foods. Most fast food is bad for you at the best of times. Avoid foods that will add pressure to your digestive system.
- Alcohol and caffeinated drinks. Avoiding these is super important for people with Crohn’s.
- Spicy food. Remember how your last post-Mexican dinner poop went? You don’t need an active imagination to envisage how that would feel if your bowels are already inflamed.
Natural treatments may help improve comfort and quality of life for folks with Crohn’s. But not all natural remedies are created equal. It can be a dicey field, with more pseudoscience than a season of “Doctor Who.”
There are a few treatments that medical pros deem effective for treating Crohn’s. (Spoiler alert: none of them involve crystals.)
- Probiotics. You know how your gut contains good bacteria? Probiotics provide even more of them. A course of probiotics supports the friendly bacteria already fighting the good fight in your food tube.
- Prebiotics. You know those probiotics we just mentioned? Prebiotics are food for them. The good bacteria in your gut have a taste for nondigestible carbohydrates found in honey, bananas, whole grains, and some other foods. A course of prebiotics allows you to give them these indigestible carbs without ever having to peel a banana or fight an entire beehive (or open a jar, if you’re not a bear).
- Aloe vera. Doctors commonly recommend this herbal treatment to support Crohn’s management. Aloe is just as good at making your insides soft as your outsides. This can be really useful for pain relief.
- Fish oil. Recent studies suggest that fish oil might be pretty darn good for managing Crohn’s symptoms. Further research is necessary, but there’s promising evidence the omega-3 fatty acids in fish oil have anti-inflammatory properties.
These remedies are there to support conventional treatment, not replace it. Be sure to get your doctor’s guidance on the best treatment plan for you.
Crohn’s disease is one type of IBD. However, there are other kinds of IBD like ulcerative colitis. This is more common but much less severe than Crohn’s.
On paper, their lists of symptoms are almost exactly the same. But there are several key differences between Crohn’s and ulcerative colitis:
|Crohn’s disease||Ulcerative colitis|
|Usually occurs in the lower intestine or at the start of the bowels (but it can develop anywhere along the GI tract).||Affects the colon and rectum.|
|Inflammation can occur anywhere in the GI tract.||Inflammation is limited and continuous in the colon wall.|
The best way to differentiate is thinking of them as thumbs and fingers. All thumbs are fingers, not all fingers are thumbs, right?
It’s the same for Crohn’s and IBD. All variants of Crohn’s are types of IBD, not all IBD conditions are Crohn’s. We took a deeper dive on the differences here.
Crohn’s Disease and Social Security disability benefits
The U.S. Social Security Administration (SSA) recognizes severe Crohn’s disease as a disability.
People living with the most severe symptoms of Crohn’s may find that the condition disrupts their ability to work and lead an active life.
Folks with Crohn’s have a legal entitlement to an appeal hearing for Social Security disability benefits. Many in the Crohn’s community have made successful applications.
Understanding of conditions like Crohn’s has come a long way over the last few decades, and our legal system has reflected this when it comes to recognizing the condition as a valid disability.
To learn more about applying for disability due to Crohn’s disease, visit Disability Benefits Help or contact your local SSA office.
Most people receive a Crohn’s diagnosis between 15 to 35 years of age. But the condition also commonly develops in younger children.
Crohn’s presents similar symptoms in children as adults. However, children may also experience delayed growth or developmental issues in more severe cases.
Identifying conditions like Crohn’s in childhood enables earlier treatment that may reduce complications later in life.
As Crohn’s shares symptoms with many conditions, it’s when symptoms occur with abnormal frequency or for prolonged periods that a Crohn’s diagnosis will usually be considered.
If you have a child and your family has a history of IBD or Crohn’s, it’s important to inform their doctor. It could save a lot of time and unnecessary hospital visits — as well as catching the disease early and reducing the risk of complications.
Treatment for kids
The treatment options for Crohn’s in children are similar to those available for adults. However, the treatment plan focuses on reducing any impact on growth or development.
Long-term planning is important for treating Crohn’s in younger people. Doctors emphasize dietary changes and medicinal treatment to reduce the need for invasive surgery later in life.
Crohn’s disease is a type of IBD.
It can cause digestive distress and fatigue. But its complications, including ulcers, fistulas, and colorectal cancers, can be life-changing and even fatal without treatment.
Dietary changes, medications, and surgical procedures are available to help people manage symptoms and live with Crohn’s. But it can be seriously debilitating, and the SSA consider it a qualifying condition for disability benefits.