Crohn’s disease is a chronic inflammatory condition and a type of inflammatory bowel disease (IBD) that causes inflammation, ulceration, and swelling deep within the intestinal wall. It can affect any part of the digestive tract. The disease is frequently associated with symptoms like persistent diarrhea, abdominal pain, and urgent bowel movements. However, Crohn’s can also cause constipation. This article explores the specific ways Crohn’s can lead to this less common, yet potentially serious, symptom.
The Constipation Paradox: Understanding the Connection
While diarrhea is the classic and most common symptom of active Crohn’s disease, the condition can indeed cause constipation. This paradox often depends on the location of the inflammation and the long-term effects of the disease on the gut. Constipation is defined as having fewer than three bowel movements per week or passing stools that are hard, dry, or lumpy.
When inflammation is primarily located in the large intestine (colon), it disrupts the normal movement of waste, leading to slower transit time. Inflammation in the rectum (proctitis) can also cause a feeling of incomplete emptying. Furthermore, the overall inflammatory process can alter the gut’s motility, contributing to the development of constipation instead of diarrhea.
Mechanical and Functional Causes of Constipation in Crohn’s
One of the most serious ways Crohn’s leads to constipation is through structural damage known as strictures. Chronic inflammation and subsequent healing cause scar tissue to build up, thickening the intestinal wall and narrowing the bowel lumen. This physical narrowing physically impedes the passage of stool. Strictures are estimated to occur in a significant percentage of patients within ten years of diagnosis.
Constipation can also be a side effect of medications commonly used to manage Crohn’s or its related complications. Certain pain relievers, specifically opioid-based drugs, are known to slow down the movement of the gut. Additionally, iron supplements, which are often prescribed to treat anemia resulting from chronic blood loss, are a frequent cause of hardened stools.
Dietary changes adopted by patients can inadvertently contribute to the problem. Many people with Crohn’s restrict their intake of high-fiber foods due to a fear that they might trigger a flare-up or worsen abdominal pain. This reduction in dietary fiber, combined with insufficient fluid intake, removes the bulk and moisture necessary to maintain regular, soft bowel movements.
Recognizing Obstruction and When to Seek Medical Help
For a person with Crohn’s disease, new or worsening constipation must be carefully evaluated because it can signal a partial or complete bowel obstruction. An obstruction occurs when a stricture or severe inflammation creates a blockage that prevents food, gas, or stool from passing through the digestive tract. A complete intestinal blockage is a medical emergency that requires immediate intervention.
Warning signs that differentiate simple constipation from a dangerous obstruction include acute, severe cramping abdominal pain and vomiting. Other indicators of a serious blockage are significant abdominal swelling or distention, an inability to pass gas, and a high fever. If these acute symptoms appear alongside constipation, seeking emergency medical care is mandatory.
While some mild obstructions can be managed with medication and bowel rest, severe strictures often require urgent procedures. Treatment may involve endoscopic dilation to widen the narrowed section or surgical resection to remove the permanently damaged segment of the intestine.
Strategies for Managing Crohn’s-Related Constipation
For constipation that is not caused by an obstruction, a combination of lifestyle and medical strategies can help promote regular bowel movements. Increasing fluid intake is an effective first step, as proper hydration helps keep the stool soft and easier to pass. Men should aim for approximately 3.7 liters of total daily fluid, and women should aim for 2.7 liters, from both beverages and food sources.
When considering fiber, people with Crohn’s must approach it with caution. Insoluble fiber should be avoided if strictures are present, as it can worsen the blockage. Instead, doctors may recommend soluble fiber, which dissolves in water and forms a gel, helping to regulate stool consistency.
Gentle, non-stimulant laxatives are the preferred medical treatment for non-obstructive constipation. Osmotic laxatives, such as polyethylene glycol or lactulose, work by drawing water into the bowel, making the stool softer and easier to pass. Regular, gentle physical activity also helps by stimulating the intestinal muscles, promoting natural gut motility.