Crohn’s Disease and Constipation
Crohn’s disease is an inflammatory condition of the gastrointestinal tract. It is a type of inflammatory bowel disease that causes debilitating abdominal pain, severe diarrhea, weight loss, malnutrition, and fatigue. Inflammation that is caused by Crohn’s disease can affect any part of the digestive tract, right from your mouth to the anus.
Crohn’s is typically associated with severe diarrhea. However, constipation is also a rare symptom that affects some people with Crohn’s disease. This is because Crohn’s disease can affect any part of your digestive system, thus causing a wide variety of symptoms on different people.
Keep in mind that the primary function of your large intestine is to reabsorb water from digested foods. However, if the large intestine absorbs too much water, then your stool becomes hard, making it difficult to move. Constipation is medically defined as passing stool less than three times in a week or needing to strain quite a bit in order to pass stool. (1)
The main factors that lead to constipation include:
- Not having enough fluids
- Eating a low fiber diet
- Not eating adequately
- Having a sedentary lifestyle
- Ignoring the urge to pass stool
- Taking specific medications that can lead to constipation, including painkillers, antidepressants, and anti-diarrheal
- Irritable bowel syndrome
- Proctitis, a condition characterized by inflammation of the rectum
Most people who have Crohn’s disease tend to avoid eating high fiber food such as raw fruits and vegetables. This is because such foods irritate their stomachs. Crohn’s disease patients are also used to taking many medications during the day. They may even not be drinking sufficient water to compensate for the bouts of diarrhea. This is why the occasional bout of constipation is not very uncommon in people with Crohn’s disease.
Another severe side effect of Crohn’s disease, known as a stricture, involves the narrowing of a specific section of the intestine from scarring. This can cause blockage or obstruction of the intestine. You may need to undergo a strictureplasty to remove a stricture (2).
Constipation is also a symptom of intestinal obstruction. If an intestinal obstruction is suspected, then immediate medical attention is required. Some of the symptoms of intestinal obstruction may include:
Remember that intestinal obstruction can be a life-threatening condition and requires immediate medical assistance.
Remedies for Crohn’s Constipation
Let us have a look some of the remedies:
The easiest solution for constipation if you have Crohn’s disease is to increase your intake of foods that are high in fiber. However, you should be mindful not to increase your fiber intake too rapidly as this could cause stomach upset or gas. Start adding the following fibrous foods to your diet gradually and see if it helps with constipation:
- Bran muffins
- Beans or other legumes such as peas and lentils
- Shredded wheat
- Whole wheat breads
- Cooked vegetables such as spinach, peas, sweet potatoes, and squash
- High fiber breakfast cereals which include whole grains or bran
- Fruits such as prunes and raspberries
Also, avoid consuming processed snack foods, fast foods, dairy, and meat. These foods do not have much fiber and are likely to only add to your constipation. You should also avoid eating any foods that will worsen your Crohn’s symptoms. For example, if you know that eating raw vegetables will trigger your symptoms, then opt for having cooked vegetables.
Some of the foods that are known to worsen the symptoms of Crohn’s disease include (3):
- Alcoholic drinks
- Caffeinated beverages
- Highly sweetened drinks such as with corn syrup or sugar (very sugary beverages that lead to a flare-up of diarrhea)
- Wild rice
- Cheeses that contain seeds or nuts
- Salad dressings with poppy seeds
- Dried fruits such as raisins
- Fried meat
- Fried eggs
- Cookies or other sweets that are made from whole grain flour
- Do not increase your intake of fibrous foods if you are aware of a stricture.
Increasing your Fluid Intake
Increasing your consumption of water and other liquids will help. You should ideally aim for drinking at least 1.5 liters of fluids every day or even more depending on the severity of your constipation. Also, limit the intake of caffeinated beverages and alcohol, as these are going to have a dehydrating effect on your body.
You can opt for including the following fluids in your diet:
- Clear soups
- Low sugar sports drinks
- Non-caffeinated beverages
- Fruit and vegetable juices with no added sugar
Use of Laxatives
There are many types of laxatives available over-the-counter these days that are known to effectively help with constipation. Different laxatives work in different ways to treat constipation, and some tend to be harsher than others. Keep in mind that laxatives may disrupt your body’s absorption of certain nutrients and medications, so always consult your doctor before taking a laxative.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (4), here are some of the different types of laxatives that are available over-the-counter:
Bulk Forming Agents
This type of laxative works by absorbing the fluid present in your intestines to bulk up your stool. When you have a bulky stool, it acts as a trigger for your bowel to start contracting to push out the stool. When you take bulk-forming agents, it is essential to drink plenty of water, otherwise, it may cause a blockage in your bowel.
If you believe you may have a bowel obstruction, then avoid taking bulk-forming agents.
These types of laxatives are usually the safest and gentlest on the body, but they should be avoided if you have a stricture or even suspect you might have one.
Some of the common examples of bulk-forming agents include:
Osmotic agents are a type of laxative that helps retain the fluid in the stool. You must read the instruction label carefully before taking this type of laxative. Taking too much of an osmotic agent laxative can cause cramping, dehydration, diarrhea, as well as a mineral imbalance.
Some of the common osmotic agents include:
- Milk of Magnesia
A bowel stimulant laxative works by producing contractions in the intestines. You should only take a bowel stimulant if you are experiencing severe constipation, and none of the other types of laxatives or treatments have worked. Bowel stimulants are the harshest types of laxatives and start working within just a few hours of taking them.
Some of the common examples of bowel stimulants include:
- Bisacodyl (Dulcolax)
A stool softener is a laxative that adds water to your stool to soften it, making it easier to pass. However, this type of laxatives takes a couple of days to start working.
Example of a commonly used stool softener is Docusate (brand name: Surfak and Colace).
Living a sedentary lifestyle and lack of exercise can also lead to a slowdown in your bowel movements. However, if you have Crohn’s disease, then chances are that you do not feel well enough to exercise.
In spite of this, you should make an effort to try to find ways to incorporate some sort of physical activity into your daily life. For example, taking the stairs instead of the elevator, walking to short distances instead of using the car, and taking regular breaks from the desk to get up and move around.
Experts recommend (5) that you should try doing at least 30 minutes of aerobic exercise, at least on most days of the week, or approximately 150 minutes of exercise per week. Light exercises such as biking, swimming, yoga, or just walking, can also help with your bowel movements.
Adjustment To Your Medications
When you have Crohn’s disease, you are bound to be taking a lot of medications. There are certain types of medications that are known to cause constipation, and if you have diarrhea as one of your Crohn’s symptoms, then your doctor might have recommended anti-diarrheal medicines such as loperamide (brand name: Imodium A-D) (6).
The medicine loperamide works by slowing down bowel activity in order to stop diarrhea. Sometimes it works too well and thus leads to constipation.
So if you are taking loperamide and are experiencing constipation, then you can try stopping the medication for a couple of days and then see if there is any improvement in your constipation. However, make sure that you do not stop any medication without the recommendation of your doctor.
Consulting your Doctor
If you has Crohn’s disease, then you must already be aware of the importance of having open conversations with your doctor regarding your symptoms. This is essential as it allows your doctor to monitor your treatment plan and to make any changes as deemed necessary. Crohn’s disease is a life-long condition that requires proper management with ongoing treatment.
If you find yourself experiencing constipation all of a sudden, then it could be a sign of a potential problem. It might indicate that you have a blockage in your intestine, or there could be severe inflammation that has narrowed your intestine. You should immediately consult your doctor if you experience any symptoms of a bowel obstruction.
Keep in mind that bowel obstruction might require surgical intervention to remove the affected part of the bowel (7).
Here are the symptoms of an intestinal blockage:
- High fever
- Nausea and vomiting
- Severe abdominal pain or cramping
- Inability to pass gas
While moderate to severe diarrhea is a more common symptom in patients of Crohn’s disease, some people may also experience constipation as a result of your diet, lack of sufficient water intake, your medications, or simply because of a lack of exercise. So you do not have a bowel movement for a couple of days, you should begin by changing your dietary patterns to include more fibrous foods and also increase your fiber intake. You should also let your doctor know of this new symptom and do not start taking a laxative without the approval of your doctor.
- Information, H., Diseases, D., Facts, D., Constipation, D., Center, T. and Health, N. (2019). Definition & Facts for Constipation | NIDDK. [online] National Institute of Diabetes and Digestive and Kidney Diseases. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/definition-facts [Accessed 31 Oct. 2019].
- Tichansky, D., Cagir, B., Yoo, E., Marcus, S.M. and Fry, R.D., 2000. Strictureplasty for Crohn’s disease. Diseases of the colon & rectum, 43(7), pp.911-919.
- Mayberry, J.F., Rhodes, J., Allan, R., Newcombe, R.G., Regan, G.M., Chamberlain, L.M. and Wragg, K.G., 1981. Diet in Crohn’s disease. Digestive diseases and sciences, 26(5), pp.444-448.
- Information, H., Diseases, D., Constipation, T., Center, T. and Health, N. (2019). Treatment for Constipation | NIDDK. [online] National Institute of Diabetes and Digestive and Kidney Diseases. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/treatment [Accessed 31 Oct. 2019].
- Information, H., Management, W., Active, T., Activity, S., Activity, T., Center, T. and Health, N. (2019). Tips for Starting Physical Activity | NIDDK. [online] National Institute of Diabetes and Digestive and Kidney Diseases. Available at: https://www.niddk.nih.gov/health-information/weight-management/tips-get-active/tips-starting-physical-activity [Accessed 31 Oct. 2019].
- Galambos, J.T., Hersh, T., Schroder, S. and Wenger, J., 1976. Loperamide: a new antidiarrheal agent in the treatment of chronic diarrhea. Gastroenterology, 70(6), pp.1026-1029.
- Lee, E.C. and Papaioannou, N., 1982. Minimal surgery for chronic obstruction in patients with extensive or universal Crohn’s disease. Annals of the Royal College of Surgeons of England, 64(4), p.229.