One of the most common complications of Crohn’s disease is the development of an intestinal stricture. An intestinal stricture is a narrowing in the intestine that makes it difficult for food to pass through. Sometimes, it can lead to intestinal blockage. At least one-third of people with Crohn’s will develop a stricture within the first 10 years of a diagnosis.
If you have Crohn’s disease, it’s a good idea to familiarize yourself with the signs of an intestinal stricture in case you develop one. Read on to learn about what causes strictures, some of the symptoms and risk factors, and what the available treatments are.
There are two main classifications for intestinal strictures: inflammatory and fibrotic. Inflammatory strictures are caused by the inflammation of the digestive tract that accompanies a Crohn’s flare-up. Fibrotic strictures are the result of scar tissue building up in the bowel due to long periods of inflammation.
Most intestinal strictures from Crohn’s are a combination of both these classifications. Strictures that are predominantly fibrotic tend to be more severe and typically require more invasive forms of treatment.
The symptoms of an intestinal stricture can vary depending on the severity of the blockage. For mild to moderate strictures, symptoms typically include:
- abdominal cramping
- abdominal pain
- loss of appetite
In more severe cases, symptoms may include:
- severe abdominal pain
- abdominal bloating and distension
If you think you’re experiencing any of the more severe symptoms, contact your doctor immediately.
Several risk factors may increase your likelihood of developing a Crohn’s-related intestinal stricture. For instance:
- if you get a diagnosis of Crohn’s disease before the age of 40
- if you require steroid treatment during your first Crohn’s flare-up
- if you have perianal disease at the time of diagnosis
- if you had an appendectomy prior to diagnosis
Certain genetic factors may also make you more susceptible to intestinal strictures. Check with your doctor about whether your family's medical history increases your risk.
Smoking is a risk factor as well. If you’re a smoker, take steps to quit as soon as possible.
Treatment for intestinal strictures varies from person to person, depending on the type, length, and location of the stricture. Strictures mainly related to inflammation can sometimes be treated with prescription drugs, such as steroids, immunomodulators, and anti-TNF agents. However, since most Crohn’s-related strictures are a mix of inflammatory and fibrotic, these treatments aren’t always effective on their own.
For intestinal strictures that don't respond to medication, endoscopic treatment may help you delay or avoid surgery. Endoscopic balloon dilation (EBD) is when a balloon is used to expand the narrow part of the bowel. It's effective in treating single, short strictures that are accessible by endoscopy and free from complications. Unfortunately, the recurrence rate for intestinal strictures is quite high. There’s also a chance that you'll need another EBD within five years.
Intestinal strictures that don't respond to medication or aren't reachable by endoscopy are usually treated with surgery. For short, simple strictures, a bowel-preserving procedure called strictureplasty can be performed. In this procedure, the damaged portion of the bowel is cut open and reshaped. When strictures are longer and more complicated, resection surgery is performed. This involves completely removing the damaged part of the bowel.
If you have an intestinal stricture, you may need to temporarily modify your diet to avoid blocking up the narrowed part of your bowel. Try to eat small, frequent meals and make sure you chew your food thoroughly before swallowing. You might also want to avoid foods that are hard to digest, such as gristly meats, nuts, seeds, fruit and vegetable skins, and beans.
You should always consult with your doctor before making any major changes to your diet. Cutting certain things out could lead to vitamin and mineral deficiencies that may make your symptoms worse.
Although intestinal strictures are quite common among people with Crohn’s disease, if left untreated, they can cause life-threatening issues. If you think you might have a Crohn’s-related stricture, contact your doctor immediately.