Crohn's Disease: Inflammatory Bowel Disease

Description

Alternative Names

Symptom Management

Diarrhea and Constipation

The following are some ways of managing diarrhea, constipation, or both:

• Mild to moderate diarrhea may be reduced by taking one teaspoon of psyllium hydrophilic colloid (Metamucil) twice a day in a glass of water.
• Antidiarrheal drugs include loperamide (Imodium) and Lomotil. In very ill patients, large doses of some antidiarrheal drugs, such as Lomotil, can trigger the onset of toxic megacolon.
• Opiates or drugs used to relax muscle spasms may help relieve mild to moderate diarrhea and abdominal cramps, but they should be used for very short periods and not for severe cases.
• Cholestyramine (Questran) has been found to be useful for reducing diarrhea in Crohn's patients who have had ileal resections.
• Bulk-type laxatives can help constipation.

Treating Anemia

Iron supplements may be required for anemia. Intravenous iron with or without erythropoietin (a hormone that acts in the bone marrow to increase the production of red blood cells) is effective for severe anemia in IBD that does not respond to iron alone. Crohn's disease patients benefit most from the combination.

Antidepressants

Antidepressants may help relieve emotional problems. However, inflammatory bowel disease is not a psychologic disorder, and such drugs will not affect the basic illness.

Pain-Relievers

Acetaminophen, sold as Tylenol and other common brands, is the drug of choice for mild pain. Acetaminophen is not one of the nonsteroidal anti-inflammatory drugs (NSAIDs), which include, among dozens of others, aspirin, ibuprofen (Advil, Motrin, Rufen), and naproxen (Anaprox, Naprosyn, Aleve). NSAIDs are often used against other inflammatory disorders, but they have been implicated in triggering inflammatory bowel disease; one study found that they doubled the risk for emergency treatment of gastrointestinal symptoms in patients with colitis. NSAIDs, therefore, should be avoided for IBD.

Stress Reduction

Although stress is not a cause of inflammatory bowel disease, there are reports of an association between stress and symptom flare-ups. Although no evidence exists to confirm that stress reduction techniques, such as relaxation methods, meditation, or cognitive therapy, manage the disease, they might be helpful.

Exercise

The effects of exercise in Crohn's disease are uncertain. Some research indicates that moderate exercise may trigger excess production of chemicals that could cause flare-up. One small study, however, reported significant improvement in patients who had been sedentary and who then embarked on a 12-week exercise program. They walked a little over two miles three times a week; during that period there were no flare-ups and they felt physically and emotionally better than before.