# Crohn's disease: Managing symptoms (Mayo Clinic)



## David Baxter PhD (Oct 23, 2012)

*Crohn's disease: Managing symptoms*
Mayo Clinic
Retrieved October 2012

There is no cure for Crohn's disease. But treatments and diet and lifestyle changes help many people function well.

*Definition*
August 9, 2011

Crohn's disease is an inflammatory bowel disease (IBD). It causes  inflammation of the lining of your digestive tract, which can lead to  abdominal pain, severe diarrhea and even malnutrition. Inflammation  caused by Crohn's disease can involve different areas of the digestive  tract in different people.  

  The inflammation caused by Crohn's disease often spreads deep into the  layers of affected bowel tissue. Like ulcerative colitis, another common  IBD, Crohn's disease can be both painful and debilitating, and  sometimes may lead to life-threatening complications.  

  While there's no known cure for Crohn's disease, therapies can greatly  reduce the signs and symptoms of Crohn's disease and even bring about  long-term remission. With treatment, many people with Crohn's disease  are able to function well.  

*Symptoms* 
Inflammation of Crohn's disease may involve different areas in different  people. In some people, just the small intestine is affected. In  others, it's confined to the colon (part of the large intestine). The  most common areas affected by Crohn's disease are the last part of the  small intestine (ileum) and the colon. Inflammation may be confined to  the bowel wall, which can lead to scarring (stenosis), or inflammation  may spread through the bowel wall (fistula).  

  Signs and symptoms of Crohn's disease can range from mild to severe and  may develop gradually or come on suddenly, without warning. You may also  have periods of time when you have no signs or symptoms (remission).  When the disease is active, signs and symptoms may include:  


*Diarrhea.* The inflammation that occurs in Crohn's  disease causes cells in the affected areas of your intestine to secrete  large amounts of water and salt. Because the colon can't completely  absorb this excess fluid, you develop diarrhea. Intensified intestinal  cramping also can contribute to loose stools. Diarrhea is a common  problem for people with Crohn's. 
*Abdominal pain and cramping.* Inflammation and  ulceration may cause the walls of portions of your bowel to swell and  eventually thicken with scar tissue. This affects the normal movement of  contents through your digestive tract and may lead to pain and  cramping. Mild Crohn's disease usually causes slight to moderate  intestinal discomfort, but in more-serious cases, the pain may be severe  and include nausea and vomiting. 
*Blood in your stool.* Food moving through your  digestive tract may cause inflamed tissue to bleed, or your bowel may  also bleed on its own. You might notice bright red blood in the toilet  bowl or darker blood mixed with your stool. You can also have bleeding  you don't see (occult blood). 
*Ulcers.* Crohn's disease can cause small sores on  the surface of the intestine that eventually become large ulcers that  penetrate deep into ? and sometimes through ? the intestinal walls. You  may also have ulcers in your mouth similar to canker sores. 
*Reduced appetite and weight loss.* Abdominal pain  and cramping and the inflammatory reaction in the wall of your bowel can  affect both your appetite and your ability to digest and absorb food. 
 *
Other signs and symptoms* 
People with severe Crohn's disease may also experience:  


Fever 
Fatigue 
Arthritis 
Eye inflammation 
Mouth sores 
Skin disorders 
Inflammation of the liver or bile ducts 
Delayed growth or sexual development, in children 
 *
When to see a doctor* 
See your doctor if you have persistent changes in your bowel habits or  if you have any of the signs and symptoms of Crohn's disease, such as:  


Abdominal pain 
Blood in your stool 
Ongoing bouts of diarrhea that don't respond to over-the-counter (OTC) medications 
Unexplained fever lasting more than a day or two 
 *
Causes* 
The exact cause of Crohn's disease remains unknown. Previously, diet and  stress were suspected, but now doctors know that although these factors  may aggravate existing Crohn's disease, they don't cause it. Now,  researchers believe that a number of factors, such as heredity and a  malfunctioning immune system, play a role in the development of Crohn's  disease.  


*Immune system.* It's possible that a virus or  bacterium may trigger Crohn's disease. When your immune system tries to  fight off the invading microorganism, an abnormal immune response causes  the immune system to attack the cells in the digestive tract, too. 
*Heredity.* Crohn's is more common in people who have  family members with the disease, leading experts to suspect that one or  more genes may make people more susceptible to Crohn's disease.  However, most people with Crohn's disease don't have a family history of  the disease. 
 *
Risk factors* 
Risk factors for Crohn's disease may include:  


*Age.* Crohn's disease can occur at any age, but  you're likely to develop the condition when you're young. Most people  who develop Crohn's disease are diagnosed before they're 30 years old. 
*Ethnicity.* Although whites have the highest risk of  the disease, it can affect any ethnic group. If you're of Eastern  European (Ashkenazi) Jewish descent, your risk is even higher. 
*Family history.* You're at higher risk if you have a  close relative, such as a parent, sibling or child, with the disease.  As many as 1 in 5 people with Crohn's disease has a family member with  the disease. 
*Cigarette smoking.* Cigarette smoking is the most  important controllable risk factor for developing Crohn's disease.  Smoking also leads to more severe disease and a greater risk of surgery.  If you smoke, stop. Discuss this with your doctor and get help. There  are many smoking-cessation programs available if you are unable to quit  on your own. 
*Where you live.* If you live in an urban area or in  an industrialized country, you're more likely to develop Crohn's  disease. Because Crohn's disease occurs more often among people living  in cities and industrial nations, it may be that environmental factors,  including a diet high in fat or refined foods, play a role in Crohn's  disease. People living in northern climates also seem to have a greater  risk of the disease. 
 *
Complications* 
Crohn's disease may lead to one or more of the following complications:  


*Bowel obstruction.* Crohn's disease affects the  thickness of the intestinal wall. Over time, parts of the bowel can  thicken and narrow, which may block the flow of digestive contents  through the affected part of your intestine. Some cases require surgery  to remove the diseased portion of your bowel. 
*Ulcers.* Chronic inflammation can lead to open sores  (ulcers) anywhere in your digestive tract, including your mouth and  anus, and in the genital area (perineum) and anus. 
*Fistulas.* Sometimes ulcers can extend completely  through the intestinal wall, creating a fistula ? an abnormal connection  between different parts of your intestine, between your intestine and  skin, or between your intestine and another organ, such as the bladder  or vagina. When internal fistulas develop, food may bypass areas of the  bowel that are necessary for absorption. An external fistula can cause  continuous drainage of bowel contents to your skin, and in some cases, a  fistula may become infected and form an abscess, a problem that can be  life-threatening if left untreated. Fistulas around the anal area  (perianal) are the most common kind of fistula. 
*Anal fissure.* This is a crack, or cleft, in the  anus or in the skin around the anus where infections can occur. It's  often associated with painful bowel movements. This may lead to a  perianal fistula. 
*Malnutrition.* Diarrhea, abdominal pain and cramping  may make it difficult for you to eat or for your intestine to absorb  enough nutrients to keep you nourished. Additionally, anemia is common  in people with Crohn's disease. 
*Colon** cancer.* Having Crohn's disease that affects your colon increases your risk of colon cancer. 
*Other health problems.* In addition to inflammation  and ulcers in the digestive tract, Crohn's disease can cause problems in  other parts of the body, such as arthritis, inflammation of the eyes or  skin, clubbing of the fingernails, kidney stones, gallstones and,  occasionally, inflammation of the bile ducts. People with long-standing  Crohn's disease also may develop osteoporosis, a condition that causes  weak, brittle bones. 

*Tests and diagnosis* 
Your doctor will likely diagnose Crohn's disease only after ruling out  other possible causes for your signs and symptoms, including irritable  bowel syndrome (IBS), diverticulitis and colon cancer. To help confirm a  diagnosis of Crohn's disease, you may have one or more of the following  tests and procedures:  


*Blood tests.* Your doctor may suggest blood tests to  check for anemia ? a condition in which there aren't enough red blood  cells to carry adequate oxygen to your tissues ? or to check for signs  of infection. Two tests that look for the presence of certain antibodies  can sometimes help diagnose which type of inflammatory bowel disease  you have, but not everyone with Crohn's disease has these antibodies.  While your doctor may order these tests, a positive finding doesn't mean  you have Crohn's disease and a negative finding doesn't mean that  you're free of the disease. Because these tests aren't yet definitive,  the American College of Gastroenterology doesn't currently recommend  antibody or genetic testing for Crohn's disease. 
*Fecal occult blood test.* You may need to provide a stool sample so that your doctor can test for blood in your stool. 
*Colonoscopy.* This test allows your doctor to view  your entire colon using a thin, flexible, lighted tube with an attached  camera. During the procedure, your doctor can also take small samples of  tissue (biopsy) for laboratory analysis, which may help confirm a  diagnosis. Some people have clusters of inflammatory cells called  granulomas, which help confirm the diagnosis of Crohn's disease because  granulomas don't occur with ulcerative colitis. Risks of colonoscopy  include perforation of the colon wall and bleeding. 
*Flexible sigmoidoscopy.* In this procedure, your doctor uses a slender, flexible, lighted tube to examine the sigmoid, the last section of your colon. 
*Computerized tomography (CT).* You may have a CT  scan, a special X-ray technique that provides more detail than a  standard X-ray does. This test looks at the entire bowel as well as at  tissues outside the bowel that can't be seen with other tests. Your  doctor may order this scan to better understand the location and extent  of your disease or to check for complications such as partial blockages,  abscesses or fistulas. Although not invasive, a CT scan exposes you to  more radiation than a conventional X-ray does. CT enterography is a  special CT scan that provides better images of the small bowel. This  test has replaced barium X-rays in many medical centers. 
*Magnetic resonance imaging.* An MRI scanner uses a  magnetic field and radio waves to create detailed images of organs and  tissues. Most MRI machines are large, tube-shaped magnets. During the  test, you lie on a movable table inside the MRI machine. This test is  very helpful in diagnosing and managing Crohn's disease. It's biggest  advantage is that there is no radiation exposure. It's particularly  useful for evaluating a fistula around the anal area (pelvic MRI) or the  small intestine (MRI enterography). 
*Capsule endoscopy.* If you have signs and symptoms  that suggest Crohn's disease but other diagnostic tests are negative,  your doctor may perform capsule endoscopy. For this test you swallow a  capsule that has a camera in it. The camera takes pictures, which are  transmitted to a computer that you wear on your belt. The images are  then downloaded, displayed on a monitor and checked for signs of Crohn's  disease. Once it's made the trip through your digestive system, the  camera exits your body painlessly in your stool. Capsule endoscopy is  generally very safe, but if you have a partial blockage in the bowel,  there's a slight chance the capsule may become lodged in your intestine.  In addition, the images provided by capsule endoscopy may not be  detailed enough. Endoscopy with biopsy is often still needed to confirm  the diagnosis of Crohn's disease and to exclude other causes of your  symptoms. 
*Double balloon endoscopy.* For this test, a longer  scope is used to look further into the small bowel where standard  endoscopes don't reach. This technique is useful when capsule endoscopy  shows abnormalities, but the diagnosis is still in question. It allows  for biopsy of the abnormal area. It's usually performed in specialized  endoscopy centers. 
*Small bowel imaging.* This test looks at the part of  the small bowel that can't be seen by colonoscopy. After you drink a  solution containing barium, X-ray, CT or MRI images are taken of your  small intestine. The test can help locate areas of narrowing or  inflammation in the small bowel that are seen in Crohn's disease. The  test can also help your doctor determine which type of inflammatory  bowel disease you have. 
*Barium enema.* This diagnostic test allows your  doctor to evaluate your large intestine with an X-ray. Before the test,  you receive an enema with a contrast solution  containing barium. The  barium dye coats the lining of the bowel, creating a silhouette of your  rectum, colon and a portion of your small intestine that's visible on an  X-ray. This test is rarely done anymore because of the availability of  colonoscopy and CT scanning. 
 *
Treatments and drugs*  There is currently no cure for Crohn's disease, and there is no one treatment that works for everyone.  

  The goal of medical treatment is to reduce the inflammation that  triggers your signs and symptoms. It is also to improve long-term  prognosis by limiting complications. In the best cases, this may lead  not only to symptom relief but also to long-term remission. Treatment  for Crohn's disease usually involves drug therapy or, in certain cases,  surgery.  

*Anti-inflammatory drugs *
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:  


*Sulfasalazine (Azulfidine).* Although this drug  isn't always effective for treating Crohn's disease, it may be of some  help for Crohn's that affects the colon. It has a number of side  effects, including nausea, vomiting, heartburn and headache. Don't take  this medication if you're allergic to sulfa medications. 
*Mesalamine (Asacol, Rowasa).* This medication is  less likely to cause side effects than sulfasalazine, but possible side  effects include nausea, vomiting, heartburn, diarrhea and headache. You  take it in tablet form or use it rectally in the form of an enema or  suppository, depending on which part of your colon is affected. This  medication is generally ineffective for disease involving the small  intestine. 
 *Corticosteroids.* Corticosteroids can help reduce  inflammation anywhere in your body, but they have numerous side effects,  including a puffy face, excessive facial hair, night sweats, insomnia  and hyperactivity. More-serious side effects include high blood  pressure, diabetes, osteoporosis, bone fractures, cataracts, glaucoma  and an increased susceptibility to infections. Long-term use of  corticosteroids in children can lead to stunted growth.  

  Also, these medications don't work for everyone with Crohn's disease.  Doctors generally use corticosteroids only if you have moderate to  severe inflammatory bowel disease that doesn't respond to other  treatments. A newer type of corticosteroid, budesonide (Entocort EC),  works faster than do traditional steroids and appears to produce fewer  side effects. Entocort EC is effective only in Crohn's disease that  involves the lower small intestine and the first part of the large  intestine.  

  Corticosteroids aren't for long-term use. But, they can be used for  short-term (three to four months) symptom improvement and to induce  remission. Corticosteroids also may be used with an immune system  suppressor ? the corticosteroids can induce remission, while the immune  system suppressors can help maintain remission. 
 *
Immune system suppressors *
These drugs also reduce inflammation, but they target your immune system  rather than directly treating inflammation. By suppressing the immune  response, inflammation is also reduced. Sometimes, these drugs are used  in combination. For example, a combination of azathioprine and  infliximab has been shown to work better than either drug alone in some  people. Immunosuppressant drugs include:  


*Azathioprine (Imuran) and mercaptopurine (Purinethol).*  These are the most widely used immunosuppressants for treatment of  inflammatory bowel disease. If you're taking either of these  medications, you'll need to follow up closely with your doctor and have  your blood checked regularly to look for side effects, such as a lowered  resistance to infection. These drugs may also cause nausea and  vomiting. 
 *Infliximab (Remicade).* This drug is for adults and  children with moderate to severe Crohn's disease. It may be used soon  after diagnosis, particularly if your doctor suspects that you're likely  to have more severe Crohn's disease or if you have a fistula. It's also  used after other drugs have failed. It may be combined with an  immunosuppressant in some people, but this practice is somewhat  controversial. Infliximab works by neutralizing a protein produced by  your immune system known as tumor necrosis factor (TNF). Infliximab  finds TNF in your bloodstream and removes it before it causes  inflammation in your intestinal tract.  

  Some people with heart failure, people with multiple sclerosis, and  those with cancer or a history of cancer can't take infliximab or the  other members of this class (adalimumab and certolizumab pegol). Talk to  your doctor about the potential risks of taking infliximab.  Tuberculosis and other serious infections have been associated with the  use of immune-suppressing drugs. If you have an active infection, don't  take these medications. You should have a skin test for tuberculosis, a  chest X-ray and a test for hepatitis B before taking infliximab. 
 *Adalimumab (Humira).* Adalimumab works similarly to  infliximab by blocking TNF for people with moderate to severe Crohn's  disease. It can be used soon after you're diagnosed if you have a  fistula, or if you have more severe Crohn's disease. It also may be used  after other medications have failed to improve your symptoms.  Adalimumab may be used instead of infliximab or certoluzimab pegol, or  it can be used if infliximab or certoluzimab pegol stop working.  Adalimumab may reduce the signs and symptoms of Crohn's disease and may  cause remission.  

  However, adalimumab, like infliximab, carries a small risk of  infections, including tuberculosis and serious fungal infections. You  should have a skin test for tuberculosis, a chest X-ray and a test for  hepatitis B before taking infliximab. The most common side effects of  adalimumab are skin irritation and pain at the injection site, nausea,  runny nose, and upper respiratory infection. 
*Certolizumab pegol (Cimzia).* Approved by the Food  and Drug Administration (FDA) for the treatment of Crohn's disease,  certolizumab pegol works by inhibiting TNF. Certolizumab pegol is  prescribed for people with moderate to severe Crohn's disease.  Certolizumab pegol may be used instead of infliximab or adalimumab, or  it can be used if infliximab or adalimumab stop working. Common side  effects include headache, upper respiratory infections, abdominal pain,  nausea and reactions at the injection site. Like other medications that  inhibit TNF, because this drug affects your immune system, you're also  at risk of becoming seriously ill with certain infections, such as  tuberculosis. You should have a skin test for tuberculosis, a chest  X-ray and a test for hepatitis B before starting certolizumab pegol. 
*Methotrexate (Rheumatrex).* This drug, which is used  to treat cancer, psoriasis and rheumatoid arthritis, is sometimes used  for people with Crohn's disease who don't respond well to other  medications. Short-term side effects include nausea, fatigue and  diarrhea, and rarely, it can cause potentially life-threatening  pneumonia. Long-term use can lead to scarring of the liver and sometimes  to cancer. Avoid becoming pregnant while taking methotrexate. If you're  taking this medication, follow up closely with your doctor and have  your blood checked regularly to look for side effects. 
*Cyclosporine (Gengraf, Neoral, Sandimmune).* This  potent drug, often used to help heal Crohn's-related fistulas, is  normally reserved for people who haven't responded well to other  medications. Cyclosporine has the potential for serious side effects,  such as kidney and liver damage, seizures, and fatal infections. This  medication isn't for long-term use. 
*Natalizumab (Tysabri).* This drug works by  inhibiting certain immune cell molecules ? integrins ? from binding to  other cells in your intestinal lining. Blocking these molecules is  thought to reduce chronic inflammation that occurs when they bind to  your intestinal cells. Natalizumab is approved for people with moderate  to severe Crohn's disease with evidence of inflammation and who aren't  responding well to other conventional Crohn's disease therapies  including TNF blockers and immunomodulators. Because the drug is  associated with a rare, but serious, risk of multifocal  leukoencephalopathy ? a brain infection that usually leads to death or  severe disability ? you must be enrolled in a special restricted  distribution program to use it. 
 *
Medications and cancer risk* 
Immune system suppressors also are associated with a small risk of  developing cancer such as lymphoma. These include azathioprine,  mercaptopurine, methotrexate, infliximab, adalimumab, certolizumab pegol  and others. The risk may be due to the immune system suppression that  these medications cause. While these medications do increase risk, they  may be necessary for people with Crohn's disease to improve quality of  life and avoid surgery or hospitalization. Work with your doctor to  determine which medications are right for you.  

*Antibiotics *
Antibiotics can reduce the amount of drainage and sometimes heal  fistulas and abscesses in people with Crohn's disease. Researchers also  believe antibiotics help reduce harmful intestinal bacteria and suppress  the intestine's immune system, which can trigger symptoms. However,  there's no strong evidence that antibiotics are effective for Crohn's  disease. Frequently prescribed antibiotics include:  


*Metronidazole (Flagyl).* Once the most commonly used  antibiotic for Crohn's disease, metronidazole can cause serious side  effects, including numbness and tingling in your hands and feet and,  occasionally, muscle pain or weakness. If these effects occur, stop the  medication and call your doctor. 
*Ciprofloxacin (Cipro).* This drug, which improves  symptoms in some people with Crohn's disease, is now generally preferred  to metronidazole. A rare side effect of this medication is tendon  rupture. 
 *
Other medications *
In addition to controlling inflammation, some medications may help  relieve your signs and symptoms. Depending on the severity of your  Crohn's disease, your doctor may recommend one or more of the following:   


*Anti-diarrheals.* A fiber supplement, such as  psyllium powder (Metamucil) or methylcellulose (Citrucel), can help  relieve mild to moderate diarrhea by adding bulk to your stool. For more  severe diarrhea, loperamide (Imodium) may be effective. Use  anti-diarrheals with caution and only after consulting your doctor. 
*Laxatives.* In some cases, swelling may cause your  intestines to narrow, leading to constipation. Talk to your doctor  before taking any laxatives, because even those sold over-the-counter  may be too harsh for your system. 
*Pain relievers.* For mild pain, your doctor may  recommend acetaminophen (Tylenol, others). Avoid aspirin, ibuprofen  (Advil, Motrin, others) and naproxen (Aleve). These are likely to make  your symptoms worse. 
*Iron supplements.* If you have chronic intestinal  bleeding, you may develop iron deficiency anemia. Taking iron  supplements may help restore your iron levels to normal and reduce this  type of anemia once your bleeding has stopped or diminished. 
*Nutrition.* Your doctor may recommend a special diet  given via a feeding tube (enteral nutrition) or nutrients injected into  a vein (parenteral nutrition) to treat your Crohn's disease. This can  improve your overall nutrition and allow the bowel to rest. Bowel rest  can reduce inflammation in the short term. However, once regular feeding  is restarted, your signs and symptoms may return. Your doctor may use  nutrition therapy short term and combine it with other medications, such  as immune system suppressors. Enteral and parenteral nutrition are  typically used to get people healthier for surgery or when other  medications fail to control symptoms. Your doctor may also recommend a  low residue or low-fiber diet if you have a narrowed bowel (stricture)  to try to reduce the risk of a blockage. A low residue diet is one  that's designed to reduce the size and number of your stools. 
*Vitamin B-12 shots.* Vitamin B-12 helps prevent  anemia, promotes normal growth and development, and is essential for  proper nerve function. It's absorbed in the terminal ileum, a part of  the small intestine often affected by Crohn's disease. If inflammation  of your terminal ileum is interfering with your ability to absorb this  vitamin, you may need monthly B-12 shots for life. You'll also need  lifelong B-12 injections if your terminal ileum has been removed during  surgery. 
*Calcium and vitamin D supplements.* You may need to  take a calcium supplement with added vitamin D. This is because Crohn's  disease and steroids used to treat it can increase your risk of  osteoporosis. Ask your doctor if a calcium supplement is right for you. 
 *
Future medications* 
New medications are in development and in clinical trial. If your  Crohn's disease isn't well controlled with current medications, ask your  doctor if there are clinical trials available to you.  

*Surgery* 
If diet and lifestyle changes, drug therapy or other treatments don't  relieve your signs and symptoms, your doctor may recommend surgery.  

  During surgery, your surgeon removes a damaged portion of your digestive  tract and then reconnects the healthy sections. In addition, surgery  may also be used to close fistulas and drain abscesses. A common  procedure for Crohn's is strictureplasty, which widens a segment of the  intestine that has become too narrow.  

  The benefits of surgery for Crohn's are usually temporary. The disease  often recurs, frequently near the reconnected tissue or elsewhere in the  digestive tract. Up to 3 of 4 people with Crohn's disease eventually  need some type of surgery. Many will also need a second procedure or  more. The best approach is to follow surgery with medication to minimize  the risk of recurrence.  

*Cancer surveillance* 
Screening for colon cancer may need to be done more frequently because  people who have Crohn's disease that affects the colon have an increased  risk of colon cancer. General colon cancer screening guidelines call  for a colonoscopy every 10 years beginning at age 50. Ask your doctor if  you need to have this test done sooner and more frequently.  

*Lifestyle and home remedies* 
Sometimes you may feel helpless when facing Crohn's disease. But changes  in your diet and lifestyle may help control your symptoms and lengthen  the time between flare-ups.  

*Diet* 
There's no firm evidence that what you eat actually causes inflammatory  bowel disease. But certain foods and beverages can aggravate your signs  and symptoms, especially during a flare-up. If you think eating certain  foods make your condition worse, keep a food diary to keep track of what  you're eating as well as how you feel. If you discover some foods are  causing your symptoms to flare, it's a good idea to try eliminating  those foods. Here are some suggestions that may help:  


*Limit dairy products.* Like many people with  inflammatory bowel disease, you may find that problems, such as  diarrhea, abdominal pain and gas, improve when you limit or eliminate  dairy products. You may be lactose intolerant ? that is, your body can't  digest the milk sugar (lactose) in dairy foods. If so, limiting dairy  or using an enzyme product, such as Lactaid, will help break down  lactose. 
*Try low-fat foods.* If you have Crohn's disease of  the small intestine, you may not be able to digest or absorb fat  normally. Instead, fat passes through your intestine, making your  diarrhea worse. Foods that may be especially troublesome include butter,  margarine, cream sauces and fried foods. 
*Limit fiber, if it's a problem food.* For most  people, high-fiber foods, such as fresh fruits and vegetables and whole  grains, are the foundation of a healthy diet. But if you have  inflammatory bowel disease, fiber may make diarrhea, pain and gas worse.  If raw fruits and vegetables bother you, try steaming, baking or  stewing them. You may also find that you can tolerate some fruits and  vegetables, but not others. In general, you may have more problems with  foods in the cabbage family, such as broccoli and cauliflower, and nuts,  seeds, corn and popcorn. 
*Avoid problem foods.* Eliminate any other foods that  seem to make your signs and symptoms worse. These may include "gassy"  foods such as beans, cabbage and broccoli, raw fruit juices and fruits,  spicy food, popcorn, alcohol, and foods and drinks that contain  caffeine, such as chocolate and soda. 
*Eat small meals.* You may find you feel better eating five or six small meals a day rather than two or three larger ones. 
*Drink plenty of liquids.* Try to drink plenty of  fluids daily. Water is best. Alcohol and beverages that contain caffeine  stimulate your intestines and can make diarrhea worse, while carbonated  drinks frequently produce gas. 
*Consider multivitamins.* Because Crohn's disease can  interfere with your ability to absorb nutrients and because your diet  may be limited, multivitamin and mineral supplements are often helpful.  Check with your doctor before taking any vitamins or supplements. 
*Talk to a dietitian.* If you begin to lose weight or your diet has become very limited, talk to a registered dietitian. 
 *
Smoking* 
Smoking increases your risk of developing Crohn's disease, and once you  have it, smoking can make the condition worse. People with Crohn's  disease who smoke are more likely to have relapses, need medications and  repeat surgeries. Quitting smoking can improve the overall health of  your digestive tract, as well as provide many other health benefits.  

*Stress* 
Although stress doesn't cause Crohn's disease, it can make your signs  and symptoms worse and may trigger flare-ups. Stressful events can range  from minor annoyances to a move, job loss or the death of a loved one.  

  When you're stressed, your normal digestive process changes. Your  stomach empties more slowly and secretes more acid. Stress can also  speed or slow the passage of intestinal contents. It may also cause  changes in intestinal tissue itself.  

  Although it's not always possible to avoid stress, you can learn ways to help manage it. Some of these include:  


*Exercise.* Even mild exercise can help reduce  stress, relieve depression and normalize bowel function. Talk to your  doctor about an exercise plan that's right for you. 
*Biofeedback.* This stress-reduction technique may  help you reduce muscle tension and slow your heart rate with the help of  a feedback machine. You're then taught how to produce these changes  without feedback from the machine. The goal is to help you enter a  relaxed state so that you can cope more easily with stress. Biofeedback  is usually taught in hospitals and medical centers. 
*Regular relaxation and breathing exercises.* One way  to cope with stress is to regularly relax and use techniques such as  deep, slow breathing to calm down. You can take classes in yoga and  meditation or use books, CDs or DVDs at home. 
 *
Alternative medicine* 
Many people with digestive disorders have used some form of  complementary or alternative therapy. Some commonly used therapies  include:  


Herbal and nutritional supplements 
Probiotics 
Fish oil 
Acupuncture 
 
Side effects and ineffectiveness of conventional therapies are primary reasons for seeking alternative care.  

  The majority of alternative therapies aren't regulated by the FDA.  Manufacturers can claim that their therapies are safe and effective but  don't need to prove it. In some cases that means you'll end up paying  for products that don't work. For example, studies done on fish oil and  on probiotics for the treatment of Crohn's haven't shown benefits to  using these products. What's more, even natural herbs and supplements  can have side effects and cause dangerous interactions. Tell your doctor  if you decide to try any herbal supplement.  

  Some people may find acupuncture or hypnosis helpful for the management  of Crohn's, but neither therapy has been well studied for this use.  

  Unlike probiotics ? which are beneficial live bacteria that you consume ?  prebiotics are natural compounds found in plants, such as artichokes,  that help fuel beneficial intestinal bacteria. An initial study on  prebiotics had promising results. More studies are under way.  

*Coping and support* 
Crohn's disease doesn't just affect you physically ? it takes an  emotional toll as well. If signs and symptoms are severe, your life may  revolve around a constant need to run to the toilet. In some cases, you  may barely be able to leave the house. When you do, you might worry  about an accident, and this anxiety only makes your symptoms worse.  

  Even if your symptoms are mild, gas and abdominal pain can make it  difficult to be out in public. You may also feel hampered by dietary  restrictions or embarrassed by the nature of your disease. All of these  factors ? isolation, embarrassment and anxiety ? can severely alter your  life. Sometimes they may lead to depression.  

*Educate yourself, and connect* 
One of the best ways to be more in control is to find out as much as  possible about Crohn's disease. Organizations such as the Crohn's and  Colitis Foundation of America (CCFA) have chapters across the country to  provide information and access to support groups. Your doctor, nurse or  dietitian can locate the chapter nearest you, or you can contact the  organization directly at 888-MY-GUT-PAIN (888-694-8872) or on its  website.  

  Although support groups aren't for everyone, they can provide valuable  information about your condition as well as emotional support. Group  members frequently know about the latest medical treatments or  integrative therapies. You may also find it reassuring to be among  people who understand what you're going through.  

  Some people find it helpful to consult a psychologist or psychiatrist  who's familiar with inflammatory bowel disease and the emotional  difficulties that it can cause. Although living with Crohn's disease can  be discouraging, research is ongoing and the outlook is brighter than  it was a few years ago.  

*Managing complications and symptoms* 

Diarrhea 
Intestinal obstruction 
Capsule endoscopy 
Bone health: Tips to keep your bones healthy 
Meditation: A simple, fast way to reduce stress 
 
*References* 

Crohn's disease. National Institute of Diabetes and Digestive and  Kidney Diseases.  http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/Crohns.pdf   Accessed June 20, 2011. 
Management of Crohn's disease in adults. Bethesda, Md.:American  College of Gastroenterology.  http://www.acg.gi.org/physicians/guidelines/CrohnsDiseaseinAdults2009.pdf   Accessed June 20, 2011. 
Living with Crohn's disease. The Crohn's and Colitis Foundation of  America. http://www.ccfa.org/frameviewer/?url=/media/pdf/crohns2005.pdf   Accessed June 20, 2011. 
Crohn's disease. The Merck Manuals: The Merck Manual for Healthcare  Professionals.  http://www.merckmanuals.com/professional/print/sec02/ch018/ch018b.html   Accessed June 20, 2011. 
Peppercorn MA. Clinical manifestations, diagnosis and natural  history of Crohn's disease in adults.  Evidence-Based Clinical Decision Support at the Point of Care | UpToDate Accessed June 20, 2011. 
Smoking and your digestive system. National Institute of Diabetes  and Digestive and Kidney Diseases.  http://digestive.niddk.nih.gov/ddiseases/pubs/smoking/DD-52.pdf   Accessed June 23, 2011. 
Burakoff R, et al. Inflammatory bowel disease. In: Greenberger NJ,  et al. _Current Diagnosis & Treatment: Gastroenterology, Hepatology,  & Endoscopy_. New York, N.Y.:  The McGraw Hill Medical Companies;  2009. Content Not Found  Accessed  June 20, 2011. 
Ford AC, et al. Glucocorticosteroid therapy in inflammatory bowel  disease: Systematic review and meta-analysis. _American Journal of  Gastroenterology_. 2011;106:590. 
Colombel JF, et al. Infliximab, azathioprine, or combination  therapy for Crohn's disease. _New England Journal of Medicine_.  2010;362:1383. 
Rutgeerts P, et al. Biological therapies for inflammatory bowel diseases. _Gastroenterology_. 2009;136:1182. 
Farrell RJ, et al. Medical management of Crohn's disease in adults.  Evidence-Based Clinical Decision Support at the Point of Care | UpToDate Accessed June 20, 2011. 
Korzenik JR. Investigational therapies in the medical management of  Crohn's disease. Evidence-Based Clinical Decision Support at the Point of Care | UpToDate Accessed June  20, 2011. 
Ford AC, et al. Efficacy of biological therapies in inflammatory  bowel disease: Systematic review and meta-analysis. _American Journal of  Gastroenterology_. 2011;106:644. 
Enck P. Acupuncture treatment in gastrointestinal diseases: A  systematic review. _World Journal of Gastroenterology_. 2007;13:3417. 
Markowitz J, et al. Patterns of complementary and alternative  medicine use in a population of pediatric patients with inflammatory  bowel disease. _Inflammatory Bowel Diseases_. 2004;10:599. 
Picco MF (expert opinion). Mayo Clinic, Jacksonville, Fla. July 12, 2011. 
Colorectal cancer screening guidelines. Centers for Disease Control  and Prevention.  CDC - Colorectal Cancer Screening Guidelines  Accessed July 12, 2011.


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## Retired (Dec 27, 2012)

Here is a list of resources dealing with Crohn's:



CCFA: Crohn's | Colitis | IBD



CCFA: What is Crohn's Disease | Causes of Crohn's



Crohn's disease - MayoClinic.com



Crohn's Disease - National Digestive Diseases Information Clearinghouse



Crohn's Disease: MedlinePlus



Crohn's disease: MedlinePlus Medical Encyclopedia



Crohn's Disease Symptoms, Medications, Diet, Causes, Treatment - MedicineNet.com



What Is Crohn's Disease? What Causes Crohn's Disease?



Crohn's Disease - American Society of Colon and Rectal Surgeons


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