Crohn's and colitis - complication

Crohn's disease and ulcerative colitis are collectively known as inflammatory bowel disease (IBD). Both conditions affect the bowel, but in slightly different ways. Crohn's disease causes inflammation of the full thickness of the bowel wall and can target any part of the digestive tract, from mouth to anus. Ulcerative colitis is inflammation of the large bowel (colon and rectum). The causes of IBD are unknown, but researchers suspect either an autoimmune reaction or some kind of infection. Since IBD targets the digestive tract, common symptoms include abdominal pain, diarrhoea, nausea and weight loss. A person with IBD has to pay close attention to diet, since malnutrition is a real possibility. Other complications of the digestive tract include fistulas (skin ulcers that may connect to the bowel, or connections between the bowel and other organs) and intestinal obstruction. Sometimes, a person with IBD experiences symptoms in other areas of the body. These are often referred to as 'extra-intestinal manifestations'. Complications caused by nutritional deficienciesIBD impairs absorption of food nutrients, which can lead to nutritional deficiencies. Some of the complications of malnutrition include:
Dehydration - people with ulcerative colitis, and some people with Crohn's disease, experience diarrhoea. The loss of fluid from the body can lead to dehydration. In severe cases, this can damage the kidneys.
Anaemia - a combination of reduced dietary iron intake and loss of blood from the bowel can lead to anaemia, a condition characterised by the blood's reduced ability to carry oxygen.
Weight loss - reduced appetite and malabsorption of food nutrients can result in weight loss.
Reduced growth (in children) - inadequate nutrition during childhood and adolescence can impair growth and physical development.Inflammation in other areasSome people with IBD have painful inflammation in other areas of the body, including:
Joints of the fingers, hands, feet, ankles and knees
Joints of the spine, including vertebrae and sacroiliac joints (located at the pelvis)
Eyes
Skin.Skin problemsTwo specific skin problems that can occur as a result of IBD are:
Pyoderma gangrenosum - small, sunken ulcers form on the skin.
Erythema nodosum - painful small reddened nodules appear on the skin (typically, on the legs).Fistulas are abnormal holesFistulas are abnormal openings in the body. People with Crohn's disease are more likely to develop fistulas than are people with ulcerative colitis. The surface of the chronically inflamed bowel can become rough and sticky, causing it to 'glue' to a nearby structure, such as a neighbouring loop of intestine or an abdominal organ. This triggers additional inflammation, and may lead to small holes (fistulas) between the structures. Sometimes, fistulas become blocked causing abscesses to form.Intestinal obstructionSome people with Crohn's disease may experience intestinal obstruction. Food can no longer move through the intestine, which results in severe abdominal pain, bloating and (in some cases) vomiting. Toxic megacolonToxic megacolon is a rare complication. Mild abdominal distension (bloating) is a common and harmless event, even in people without IBD. However, the irritated and inflamed large intestine (large bowel) of a person with IBD can suddenly and severely distend. A section of the intestinal wall may balloon to the point of rupture. A ruptured bowel spills its contents into the abdominal cavity, causing infection (peritonitis). Toxic megacolon is a life threatening emergency. Seek urgent medical attention if you experience symptoms, including:
Hard, swollen abdomen
Severe abdominal pain
Fever
Bloody diarrhoea
Accelerated heart rate.Treatment optionsTreatment depends on the complication, but may include the following:
Complications caused by nutritional deficiencies - options include vitamin and mineral supplements (orally or by injection), alterations to diet (such as consuming a low fibre diet) or liquid diets, in severe cases.
Inflammation in other body areas - these complications usually ease when the bowel inflammation is brought under control with the appropriate medications.
Fistulas - small openings often heal by themselves, with treatment to ease the inflammation. Larger fistulas may need to be surgically closed. Antibiotics and surgical drainage are necessary in the case of abscesses.
Intestinal obstruction - in some cases, medical treatment to ease the inflammation will clear the obstruction. In severe cases, surgery is required.
Toxic megacolon - the person is hospitalised, and given fluids and nutrients intravenously instead of by mouth. Antibiotics and steroids are used to reduce inflammation. Sometimes, it may be necessary to draw off the stomach contents with a slender tube (gastric suctioning). A ruptured bowel needs surgical repair or removal. In severe cases, the whole of the large bowel may need to be surgically removed.Where to get help
Your doctor
Gastroenterologist
Australian Crohn's and Colitis Association (ACCA) Tel. (03) 9726 9008Things to remember
Crohn's disease and ulcerative colitis are collectively known as inflammatory bowel disease (IBD).
Sometimes, a person with IBD experiences symptoms in other areas of the body (extra-intestinal manifestations).
Most complications ease when the bowel inflammation is brought under control with the appropriate medications.
Complications include conditions caused by malnutrition; inflammation of the joints, eyes and skin; fistulas; intestinal obstruction and toxic megacolon.
You might also be interested in:Crohn's and colitis.Crohn's and colitis - dietary considerations.Digestive system.Diverticulosis and diverticulitis.Irritable bowel syndrome.Want to know more?For references, related links and support group information, go to More information.