Crohn’s disease is a chronic condition that causes irritation and inflammation of the gastrointestinal (GI) tract. The disease most often affects the small and large intestine. However, inflammation can occur anywhere in the GI tract, from mouth to anus.
The chronic inflammation of your intestines can cause them to become thicker, or edematous. The inside lining of your intestine can swell, giving your food or stool less room to move. This can put you at risk for blockages in your intestines.
The symptoms of a chronic blockage may include crampy abdominal pain, bloating, and nausea shortly after a meal. You can determine the site of the blockage based on how long after a meal you develop symptoms.
If it occurs less than one hour after eating, it’s likely that the blockage is in the small intestine. If it occurs longer than an hour after eating, it suggests the blockage is in the colon. If the symptoms happen all or most of the time after eating, you may have strictures as well as swelling.
Vomiting, diarrhea, or constipation may sometimes occur as well.
Types of Blockages
The types of blockages that can occur include:
The chronic intestinal inflammation that characterizes Crohn's disease may also lead to the development of scar tissue in your intestines.
As the cycle of inflammation and scarring continue, part of the intestinal tract may become narrow. This narrowed area is known as a stricture, or stenosis. If a stricture becomes too narrow, it may eventually block your intestinal tract.
If you have an intestinal stricture and you eat something that’s difficult to digest, the food you’ve eaten may lead to a bowel obstruction. Foods that can cause a bowel obstruction include raw vegetables, popcorn, or nuts.
The stricture itself can also become inflamed and cause blockages as well.
Crohn's disease affects the entire thickness of the bowel wall. This makes strictures more common in people who have ulcerative colitis, which typically affects only the inner lining of the bowel. Bowel obstructions with strictures may either be temporary or permanent.
Internal organs normally have slippery surfaces that keep them from sticking together while your body is moving. Adhesions are bands of tissue that form on the surface of your organs. They can make your organs stick together.
Adhesions are frequently caused by abdominal surgery. It’s estimated that 93 percent of people who have abdominal surgery develop adhesions.
For most people, adhesions are painless and don't cause any problems at all. However, for some people, the adhesion may cause the intestine to become fixed, or stuck on another organ. Additionally, the adhesions may form between different parts of the small or large bowel. If a fixed intestine becomes twisted, it can lead to an obstruction.
Most bowel obstructions caused by adhesions will get better without surgery. However, you may require the temporary placement of a nasogastric (NG) tube to alleviate symptoms related to the obstruction. This involves placing a narrow plastic tube through your nose and into your stomach. The tube is then attached to a vacuum suction. It removes any excess gas or fluids in your stomach that are present because of the obstruction. In very severe and rare cases, surgery is required to cut the adhesions and untwist the bowel.
A person with temporary small bowel obstruction will usually get better within 48 hours of an NG tube placement. Eventually, they can advance to a clear fluid diet or take anti-inflammatory medications aimed at reducing the swelling and inflammation produced by inflammatory bowel disease.
In more serious cases, high-dose steroids and a sterilized liquid diet will usually help to reduce the swelling.
When the blockage is predominantly due to strictures, drugs often aren’t effective. In these cases, your doctor may perform endoscopy both to diagnose any strictures and to treat possible blockages.
During an endoscopy, your doctor passes an inflatable balloon through an endoscope, which is a long thin tube with a camera on the end. They pass it through your mouth and into your stomach and small intestine to dilate the area of scarring. Success rates are very high for this procedure. An endoscopy may relieve symptoms for weeks, months, or even years for some people.
If the area isn't accessible with an endoscope, surgery may be necessary. Surgery is generally reserved for people who continue to experience bowel obstruction despite the conservative therapies mentioned above. Also, if you develop a severe complication of obstruction such as bowel necrosis or perforation, it’s likely that you’ll need emergency surgery.
The two types of surgery performed on people with Crohn's disease of the small bowel are resection, which involves removing the scarred area of the intestine, and strictureplasty, which involves restructuring the area of the stricture to make it wide again and allow the passage of stool and intestinal contents.
The people who are the best candidates for strictureplasty are those who’ve had a resection before or who have very severe Crohn’s symptoms. Many of those who receive strictureplasty are able to stop taking medications and stay in remission from Crohn's.
Strictures that are opened with strictureplasty usually remain open. People who have the procedure will generally only require surgery again if new strictures form elsewhere. Most people who’ve had the surgery will begin to eat normally and even gain weight after the operation.
When to See Your Doctor
Call your doctor right away if you’re experiencing:
- abdominal pain, which may be crampy
- a high fever
- intractable vomiting
- an inability to pass gas or stool
Intestinal blockage is very treatable. However, if you don’t receive prompt treatment, the blocked parts of the intestine can start to die. Not getting prompt treatment can lead to very serious complications, such as a life-threatening infection called sepsis.