WHAT IS CROHN'S DISEASE?
Crohn’s disease is an incurable inflammatory disorder that can affect any part of the gastrointestinal tract. The gastrointestinal tract is a system of body organs responsible for carrying and digesting food, absorbing nutrients and getting rid of waste. Inflammation (red, swollen, and tender areas) always affects the innermost lining of the gastrointestinal tract, called the mucosa. However, the disease can affect the deeper layers of the gastrointestinal wall and even extend through the entire bowel wall.
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.
WHAT ARE THE SYMPTOMS OF CROHN'S DISEASE?
Crohn’s disease can present as abdominal disease, anorectal (anus and rectum) disease, or both. Patients with Crohn’s disease are at greater risk of developing a fistula. A fistula is a small tunnel that tracks from one portion of bowel to either another portion of bowel, another organ, or the skin. Symptoms vary widely among patients and often come and go over a long period of time. These include:
- Abdominal cramping
- Abdominal pain
- Ongoing diarrhea
- Chronic constipation
- Bleeding with bowel movements
- Fever
- Extreme tiredness
- Weight loss
- Drainage from the skin around the anus
- Abscesses (infections) around the anus that come back
- Anal fissures
WHOM DOES IT AFFECT?
Any age group may be affected, but the majority of patients are young adults between 16 and 40 years old. Crohn's disease occurs most commonly in people living in northern climates. It affects men and women equally and appears to be common in some families. About 20 percent of people with Crohn's disease have a relative, most often a brother or sister, and sometimes a parent or child, with some form of inflammatory bowel disease.
Crohn's disease and a similar condition called ulcerative colitis are often grouped together as inflammatory bowel disease.
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?
MEDICAL TREATMENT
Medications are always the first option unless emergency surgery is required. Several treatment approaches are used at the onset and for the long term to help patients control their disease. The most common initial therapy includes anti-inflammatory medications. Diet and lifestyle changes can also help.
SURGICAL TREATMENT
Surgery may be needed when patients develop disease-related abdominal and anorectal complications. Emergency surgery may be performed when a patient has either a perforation (a hole in their bowel) or a blockage of the bowel. Both of these conditions can be life-threatening. Immediate surgery may also be required for an abscess near the anus.
Abdominal surgery: Surgery is typically performed when the patient’s symptoms are no longer being controlled with their medications. This usually means there is a section of bowel that is either too scarred or narrow to function properly. The surgery can be performed either through an open approach or a minimally invasive approach. Your surgeon will decide on the safest approach based on your individual case.
The most common procedure is removal of the last portion of the small bowel and the first portion of the large bowel to relieve an abnormal, narrowed section (called an ileocolic). Following removal of this part of the bowel, the remaining bowel is reconnected if possible. The end of the bowel can also be brought out through a surgical opening in the skin of the abdominal wall. This procedure (called an ostomy) redirects waste (feces) from the bowels.
Anorectal surgery: This is most commonly done to open and drain anorectal abscesses. A seton (small drain) may be left in place for a period of time until the infection clears up. Surgery is also used to treat anorectal fistulas. In combination with this procedure, an ostomy may be created, but usually only in severe cases.
Not all with these or other complications require surgery. The decision by your gastroenterologist and colo rectal surgery is best.
HOW CAN I REDUCE RECURRENCE?
Recurrence is most common in patients who stop taking their medications, so it is vital to follow your physician’s advise. Smoking negatively impacts every organ in the body and presents health risks for everyone, so quitting is advised. For patients with Crohn’s disease, smoking has been linked to higher recurrence rates, so quitting can reduce this risk.
WHO IS A COLON & RECTAL SURGEON?
Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum and anus. They have completed advanced surgical training in the treatment of these diseases as well as full general surgical training. They are well-versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions.
