Medicines or steroids are often used as treatment when Crohn’s disease first develops to reduce inflammation in the gut. These are usually taken in oral tablet form, or as an enema if the rectum or lower part of the colon are affected.
If the symptoms are severe, a course of steroids may be recommended for a few weeks. In the majority of cases, the symptoms improve within four weeks of starting steroids. Once the symptoms improve, the dose is gradually reduced, and then stopped. Steroids can cause side effects if used over extended periods so they are not usually used as a long-term treatment.
As an alternative to steroids, 5-aminosalicylate medicines can be used to treat mild to moderate symptoms. These types of medicine include sulfasalazine, mesalazine, of salazine, and balsalazide. However, they do not always work and switching to steroids may be necessary if the symptoms are severe.
Some people with Crohn’s disease do not respond well to steroids or 5-aminosalicylate medicines. In these cases, a specialist may advise use of antibiotics to combat infection and immunosuppressive medicines or a combination of these treatments.
If the symptoms are particularly bad and cannot be controlled using medicines, a strict diet may be advised. In most cases, after sticking to the diet for a few weeks, the symptoms improve and a normal diet can be gradually resumed. The reasons why this works are not fully understood, but it is believed that some foods, such as dairy products, may trigger the symptoms and that resting the gut may help.
As a very last resort, if other treatments have not worked, surgery may be required to remove the affected part of the gut. The affected part is removed and the two ends are sewn together. Surgery may also be required to treat complications such as obstructions, abscesses, or damage to the gut.
Other measures may be advised to treat some of the milder symptoms such as anti-diarrhoeal medicines to firm up stools or iron tablets prescribed if anaemia develops. Also, if the gut is not absorbing food properly vitamin supplements may help the body maintain the required vitamin levels.
Painkillers may be needed at times if the symptoms are particularly bad.
On a positive note, giving up smoking will often decrease the frequency of symptoms.
There are a number of tests that can be carried out to diagnose Crohn’s disease. The ones used will depend on the part of the gut that is affected. Tests that may be used include:
* Stool tests
* Blood tests – to check for anaemia and other deficiencies
* Biopsy – analysis of a small sample of the gut lining
* Sigmoidoscopy – an investigation of the lower bowel using a short, flexible telescope
* Colonoscopy – investigation of the colon using a long, flexible telescope.
Also if you have symptoms in the upper part of your gut, an endoscopy may be conducted. This involves using an endoscope (a thin, flexible telescope) which is passed down the oesophagus enabling investigation of the stomach.
Another common technique in diagnosing Crohns disease is the use of a barium X-ray, either of the large intestine (barium enema) or small intestine (barium meal). Barium is usually given in liquid form and will appear white on X-rays, highlighting which parts of the gut are affected.
Further tests and scans may be carried out if a diagnosis of Chrohn’s disease is still in doubt.
The symptoms of Crohn’s disease appear when the wall of the affected part of the gut becomes inflamed. The inflammation generally causes one or more of the following:
• Pain – Different people experience different severities of pain. The location of the pain depends on which part of the gut is affected, and will often be on the lower right side of the abdomen as the condition commonly occurs at the lower end of the small intestine (ileum).
• Ulcers – A raw area of the gut wall may bleed. If this happens, blood may be noticed in the faeces. Mouth ulcers are also common.
• Diarrhoea – this can vary from mild to severe, and may contain mucus, pus or blood. Also tenesmus is common which is the feeling a frequent need to go to the toilet, but a lack of anything to pass.
• Feeling generally unwell – Fever and extreme tiredness.
• Loss of appetite – loss of appetite and subsequent weight loss.
• Anaemia – this can occur if a large amount of blood is lost due to other symptoms.
• Anal fissures and rectal bleeding – the skin of the anus may become cracked, bleed and be painful.
• Additional symptons – other symptoms can be experienced, particularly arthritis (inflammation of the joints), inflammation of the eye and inflammation of the liver. Skin rashes can also occur. It is thought that these symptoms may be a reaction by the immune system to Crohn’s.
The level of symptoms may be related to the level of inflammation of the gut.
Following our look at IBS last week we were contacted by a customer asking if we were able to provide some information on Crohn’s disease, so we though it might also be worth publishing this for everyone to view as well.
Approximately 1 in 1,500 people have Crohns disease, and the condition, as with many similar conditions affects slightly more women than men. It can appear at any age, but most often starts between the ages of approximately 15 and 40 years old.
The specific cause of Crohns disease is still unknown, though it is thought that the cause of Crohns disease may be a bacterium or virus (germ).
Some people believe that there may be a genetic link as there is some evidence that the condition runs in families, approximately 1 in 10 people with the condition having a close relative who also has it. Some scientists think that in people who are genetically prone to the condition, a germ may trigger the immune system to cause inflammation in parts of the gut. Crohns disease is more common in smokers and in women who use the combined oral contraceptive pill.
Crohns disease causes inflammation of the gastrointestinal tract (gut). This consists of the oesophagus (gullet), stomach, and small and large intestine.
Crohns disease can affect any part of the gut. However, it most commonly occurs at the lower end of the small intestine, known as the ileum. Typical symptoms include, pain, ulcers and diarrhoea. The outlook for people with Crohns disease varies depending on which part of the gut is affected, and the severity and frequency of the symptoms.
The majority of people experience moderate symptoms from to time to time and daily medication can be taken to relieve the symptoms, but many people will require, surgery at some point. Rare complications, such as a perforated gut, can be life-threatening.
Following significant coverage for our Carer’s guide to incontinence we’ve been inundated with requests for these both from carers and also from health professionals.
As well as being available via download we can also post paper copies to you. The guide is full of helpful tips on how to reduce episodes of incontinence as well as information on how to minimise their impact beyond simply using the right incontinence pad and pant products.
The guide is used by a number of continence services and a large number of doctor’s surgeries.
A comment recently received from a customer about a lady she attends “Incontinence was becoming a major concern for my friend, thanks to your leaflet I’ve been able to discuss this more openly with her and made a few small changes that have helped both of us a lot, many thanks!”
The leaflet can be downloaded by visiting our website at http://www.allaboutincontinence.co.uk or by emailing us at firstname.lastname@example.org making sure you mention Carer’s leaflet in your email.
Although there is no specific cure for IBS, there are a number of things that can be done to help.
For most people with IBS, self-help is the initial step to try to improve symptoms.
People whose main symptom is diarrhoea should avoid irritants such as tea, coffee, alcohol and spicy food. Some people also find that sorbitol, an artificial sweetener can also cause diarrhoea.
For people with constipation, it is important to eat plenty of fibre, such as fruit and vegetables. On the other hand, if bloating or wind is a problem, cutting out gas-producing foods such as beans can help significantly.
If you are uncertain if specific foods are triggers for IBS, it may help to cut out these foods to see if symptoms improve, then reintroduce them, to see if symptoms return.
It’s also important to maintain your fluid intake, (around six to eight glasses of water a day or so that your urine is no darker than straw coloured). For people with constipation this also helps the fibre to work and for people with diarrhoea it replaces lost fluids.
Taking regular, moderate exercise helps maintain bowel habit and can alse help reduce stress which can be a trigger for some people.
If stress is the trigger for IBS, psychological treatment or learning stress management techniques can be beneficial. It may help to keep a diary comparing symptoms with life events to see if this is the case.
There are also some over-the-counter treatments available, although there is no one medicine that improves IBS in the long term, but they may relieve some symptoms in the short term.
For people with diarrhoea, using anti-diarrhoea medicines such as loperamide (eg Imodium) may help in the short term. They should be taken as needed, not on a regular basis.
For constipation, a bulk-forming laxative, such as bran or ispaghula husk (eg Fybogel), can be helpful if it is hard to get enough fibre. Lactulose is also an alternative to bulk-forming agents, it increases the amount of water absorbed in the large bowel. Laxatives that stimulate the bowels (eg senna) should not be used for more than a week at a time, because they can cause constipation in the long term. Antispasmodic medicines, such as mebeverine hydrochloride (eg Colofac) and peppermint oil capsules, may help with pain and wind.
If self-help treatments do not control the symptoms, it may help to seek advice from a GP. He or she may prescribe other medicines or make a referral to a dietician when this is appropriate.
For symptoms associated with anxiety or depression, a GP may make a referral to a specialist, for psychological therapy or stress management. Antidepressants or medicines which are used to reduce anxiety may also be recommended
Health professionals usually diagnose IBS after discussing someone’s symptoms and examining them. If the diagnosis is uncertain further tests may be advised.
One of these tests is called a sigmoidoscopy which is an examination of the lower part of the colon. Alternatively a biopsy may be done by removing a small piece of tissue from the bowel lining for examination. A biopsy can help to exclude inflammatory bowel disease, and certain symptoms mean that more tests are needed to rule out other conditions.
These symptoms can include weight loss, passing blood or mucus or general ill.
Another test that may be recommended is a colonoscopy, which allows the doctor to see the lining of the large bowel directly. Other tests include stool testing and X-rays of the bowel, taken after a barium enema (when the colon is filled with a liquid that shows up on X-rays).
The exact cause of IBS is not yet established. It is a functional disorder meaning that the way the bowel works is affected, but tests on the bowel find no specific physical abnormalities that can explain the symptoms.
Symptoms are thought to be caused by muscle contractions in the bowel wall which are generally higher in frequency and stronger for people experiencing IBS. These contractions can be most troublesome after food (especially as intolerance of specific foods such as tea, coffee or dairy products can be the trigger for the symptoms) and in stressful situations. IBS can also develop after gastroenteritis.
We’ve had a few enquiries recently from people who experience Irritable Bowel Syndrome rather than incontinence, and therefore we thought it was worth covering this over a couple of our regular updates as it may be relevant to many others.
Irritable bowel syndrome or IBS as it is often referred to is one of the most common disorders of the digestive tract, with about a fifth of people in the UK experiencing occasional symptoms. IBS can develop at any age, but most people experience their first symptoms between the ages of 15 and 40. The main symptoms of IBS are pain in the abdomen and an upset of normal bowel habit.
Many people’s symptoms are very mild so they don’t feel it is necessary to see a doctor about them. However, other people can have symptoms that are more extreme, especially abdominal cramps, bloating and diarrhoea. People with more severe IBS are usually affected by one symptom more than the others – either pain, constipation or chronic diarrhoea.
The most common symptom is abdominal pain which may be mild or severe, and may be made either better or worse by opening the bowels, passing wind or eating. Pain may recur at a particular time of day, often in the evening.
People with IBS often feel an urgent need to open their bowels, especially after eating first thing in the morning. Their stools may vary in consistency from hard and pellet-like to loose and watery and afterwards, there may be a sense that the bowels have not been completely emptied. Other symptoms include a bloated abdomen, excess wind, nausea, vomiting and indigestion. Some people also experience a sense of fullness. If the main symptom is diarrhoea, food passes through the digestive system faster than usual.
There can also be associated problems, such as back pain, tiredness, disturbed sleep and a tendency to urinate more frequently. The need to pass water is sometimes very urgent which is why it is sometimes confused with urge incontinence and doing so can be painful as well.
For those still unsure which incontinence product is best for your needs, don’t forget to check out our sample packs which contain individual samples of the different types of disposable products (e.g. All in one pads, shaped pads, incontinence pants). The packs are available for different levels of incontinence and each contains at mix of suitable products such as Tena Slip, Tena Flex, Tena Pants, Tena for Men and Lille Slip-on amongst others.
Packs cost from only £1.50 (plus post & packing if appropriate) and each pack has a voucher for 20% discount on your following order so that you will easily save the cost of the pack and more when you come to order (N.B. discount can only be applied to one order).
For more information see the sample packs section of our website.