Diarrhea is usually at the top of the list for Crohn’s disease symptoms, but constipation is also known to happen. Crohn’s disease can affect any part of the gastrointestinal system, leading to a variety of symptoms.
One of the functions of your large intestine is to reabsorb water from digested foods. If your large intestine absorbs too much water, stool can become hard and difficult to move.
Constipation can be defined as passing stool fewer than three times per week or needing to strain in order to pass stool.
The main factors that can contribute to constipation in Crohn’s disease include:
- eating a diet low in fiber
- not drinking enough fluids
- not eating enough
- having a sedentary lifestyle
- ignoring the urge to have a bowel movement
- taking certain medications, including antidiarrheals, pain relievers, and antidepressants
Many people with Crohn’s avoid high-fiber foods, like raw fruits and vegetables, because these can irritate their stomachs. They may also be taking several medications and may not be drinking enough water to compensate for bouts of diarrhea. For these reasons, occasional constipation isn’t uncommon for those with Crohn’s disease.
One severe complication of Crohn’s disease is called stricture, which is when scar tissue begins to narrow a section of your intestine. This can lead to blockage or obstruction. Constipation can be a sign of an intestinal obstruction.
You should seek medical attention immediately if you develop:
- unmanageable nausea and vomiting
- persistent abdominal bloating
- prolonged constipation
Read on for some ways to ease constipation due to Crohn’s disease.
The simplest remedy for constipation is to eat foods higher in fiber, if you can tolerate them. But you shouldn’t increase your fiber intake too quickly, as that could lead to gas or stomach upset.
Gradually add fiber-rich foods to your diet, and keep a log of your symptoms to discuss with your doctor. High-fiber foods include:
- shredded wheat
- bran muffins
- whole wheat breads
- cooked vegetables, such as squash, sweet potatoes, spinach, and peas
- fruit, such as raspberries and prunes
Try to avoid processed snack foods, dairy, and meat. These foods have little to no fiber.
Also, avoid any foods that you know make your Crohn’s disease symptoms worse. For example, cooked vegetables may be easier on your stomach than raw vegetables.
Don’t increase your fiber intake if you have a stricture.
Increase your intake of water and other fluids like tea, clear soups, and low sugar drinks. Aim for at least 1.5 liters per day or more.
You should also limit your intake of caffeine and alcohol, as these tend to have a dehydrating effect.
Several types of laxatives are available for helping with constipation. Laxatives work in many different ways. Some are stronger than others.
Laxatives may interfere with your body’s absorption of certain medications and nutrients, so it’s important that you speak with your doctor before trying them.
Bulk-forming agents work by absorbing fluid in your intestines and bulking up your stool. A bulky stool triggers your bowel to contract and push out the stool.
Always drink a lot of water with a bulk-forming agent, or it could lead to a blockage in your bowel. Don’t take a bulk-forming agent if you think you have a bowel obstruction.
In general, these types of laxatives are the gentlest and safest on your body. However, you shouldn’t take a bulk-forming laxative if you have a stricture.
Examples of bulk-forming agents include:
Osmotic agents help retain the fluid in your stool. It’s important that you read the directions carefully, as taking too much of an osmotic agent can lead to cramping, diarrhea, dehydration, and a mineral imbalance.
Osmotic agents include:
- Milk of Magnesia
A stool softener helps add water to stool to soften it and make it easier to pass. These types of laxatives may take a couple days to start working.
An example of a stool softener is docusate (Colace, Surfak).
A bowel stimulant works by making your intestines contract. Only take a stimulant if your constipation is severe, you don’t have significant abdominal pain, and other treatments haven’t worked. These are the strongest types of laxatives and only take a few hours to start working.
Some examples of bowel stimulants include:
- bisacodyl (Dulcolax)
Lack of physical activity can cause your bowel movements to slow down. But if you have Crohn’s disease, you may not feel well enough to exercise.
Try to find ways to incorporate more movement into your life. Walk instead of using your car, take the stairs instead of the elevator, or try taking regular breaks from your desk to get up and move around.
If you’re able to, do some light exercise, like walking, biking, swimming, or yoga.
Certain types of medications can cause constipation. If you have diarrhea with your Crohn’s disease, your doctor may have recommended that you take an antidiarrheal medication such as loperamide (Imodium A-D).
Because loperamide acts by slowing down your bowel activity to stop diarrhea, it can occasionally work too well and lead to constipation. If you experience constipation while taking loperamide, stop taking it for a few days and see if your constipation improves.
Some doctors promote bowel retraining to help with regularity. This includes trying to have bowel movements at similar times each day and changing the way you sit on the toilet.
Raising your feet up with a foot stool so that your knees are above your hips is one way to encourage bowel movements.
When constipation is associated with pelvic floor issues (which includes the rectum, bladder, and, if applicable, the uterus), biofeedback therapy may help.
Biofeedback therapy is a form of physical therapy. A physical therapist will guide you in simulating a bowel movement in an effort to better understand how to use your abdominal wall muscles and anal sphincter.
This may also include breathing exercises and muscle training.
If you live with Crohn’s disease, it’s important to feel comfortable speaking openly with your doctor about your symptoms. With the right feedback, your doctor can monitor your treatment plan and make changes when necessary. Crohn’s disease is a life-long condition and requires ongoing treatment.
If constipation comes on suddenly, it could be a sign of a serious problem. You could have a blockage in your intestine or severe inflammation that narrows your intestine.
Speak with your doctor immediately if you experience symptoms of a bowel obstruction. You may require surgery to remove the affected portion of your bowel.
Symptoms of a blockage include:
- severe abdominal cramping
- a high fever
- inability to pass gas
While diarrhea is more common in Crohn’s disease, constipation can occur as a result of your diet, water intake, lack of exercise, or medications.
If you haven’t had a bowel movement for a few days, first try changing your diet to include more fiber and increase your fluid intake.
Talk with your doctor before taking a laxative for constipation.