Colon Connections Archives

Crohn’s Disease

Crohn's disease is one among many digestive disorders in which the lining becomes inflamed. That inflammation produces ulcers (lesions or open sores in the lining) that produce abdominal pain and diarrhea. It is often progressive and leads to even more serious health consequences.

The cause(s) of the disease are not known, but an abnormal immune system response to a bacterium (known as MAP or Mycobacterium avium subspecies paratuberculosis) is suspected. Despite the lack of a clear cut culprit several risk factors are known. Diet and stress can affect the course and impact of the disease but have been ruled out as causes.

Genetics is near the top of the list, not surprisingly given the immune system response aspect of the disease. Roughly 20% of those with Crohn's have a parent or close relative similarly afflicted. Those with an affected sibling are 30 times more likely to develop Crohn's than the general population. Unlike many diseases, Crohn's tends to occur in younger people, usually between the ages of 20-30.

The intestinal inflammation of the disease produces diarrhea by causing cells to secrete large amounts of salt and water. The colon is unable to absorb all this fluid (part of its natural role in the digestive system). The result is diarrhea.

One effect is swelling of the intestinal tissue and scaring as the ulcers heal. That results in less efficient movement of the chyme (the semi-fluid mass of digested food) through the colon. The effects are felt as cramping and abdominal pain. In more advanced or severe cases nausea and vomiting are common. Bloody stool is common, as well, as moving chyme causes inflamed tissue to rupture, allowing blood to flow into the colon. The ulcers can become enlarged, moving deep into intestinal tissue, worsening the problem.

The net result, apart from the pain, is often reduced appetite and unhealthy weight loss. The symptoms lead to a desire not to eat, but the weight loss is exacerbated by less efficient digestion of food. In extreme circumstances such low intake and absorption of calories and nutrients leads to many secondary consequences.

Diagnosis is fairly straightforward. Blood tests check for anemia and during a colonoscopy a physician can see the distinctive signs directly. A biopsy (tissue samples that can be removed during the procedure) are used to confirm the presence of Crohn's.

A less invasive procedure known as a flexible sigmoidoscopy uses a lighted tube to examine only the lower two feet of the colon and rectum while a colonoscopy involves inserting a tube all the way into the intestine. It takes only a few minutes to complete.

A physician may recommend a barium enema as well. A safe, mildly radioactive barium fluid is introduced into the colon where it provides a contrast dye for an X-ray. The fluid coats the lining of the intestine to create a silhouette of the colon and rectum. In a variation, X-rays can also be taken if the patient ingests the barium fluid.

A more modern diagnostic procedure, known as capsule endoscopy, involves swallowing a tiny camera in the form of a pill, which makes its way down the digestive tract. It takes photos along the way, which the physician examines.

Unfortunately, there is no cure known for Crohn's disease as yet, but drug therapy to reduce inflammation is a common treatment. Surgery has helped many afflicted by removing ulcerated tissue (sometimes sections of the bowel), reducing symptoms. Unlike ulcerative colitis, Crohn's infected tissue may occur in spots with healthy tissue in between, not throughout an entire length. That allows for a more targeted repair of affected tissue.

Constipation-Causes and Treatment

constipation - an inability to have a bowel movement, frequently from excessively hard stools - is a normal condition when it occurs rarely or for short periods. Treatments range from doing nothing and allowing the condition to self-correct to use of mild laxatives or a change in diet.

Normally, bowel movements occur 2-3 times daily (typically fewer as individuals age) and without undue strain. When constipation becomes chronic, severe, or long-lived it signals a more serious health issue. The body has to eliminate waste from digestion and the inability to do so leads to numerous complications, with accompanying discomfort or worse. Fewer than one per week is usually a sign of serious trouble.

The causes of constipation are too numerous to list in a single article. They can be anything from inadequate fluid intake and improper salt balance to diverticulitis (an inflammation of the colon due to infection, producing pouches on the outside of the intestine). Irritable bowel syndrome (IBS) is another common cause. Tumors or colorectal cancer can be a cause of severe constipation. Medications or supplements, such as codeine or iron, can be the culprit, too.

Fortunately, treatments are equally wide ranging.

In many cases, as suggested above, time is all that's required. The body can normally re-balance fluid and salt levels. Constipation resulting from a habit of resisting bowel movements will disappear with a change in habits. Changes in diet, such as consuming additional fiber or cutting down on caffeinated beverages, can restore normal bowel movements.

Increasing fiber is easy by consuming more of the right kinds of fruits and vegetables. Oat bran is justly well-known as a good source of fiber. Fiber adds needed bulk to stools as well as naturally absorbing water that helps soften them. One common mild side effect, though, may be increased abdominal gas. The bacteria present in the colon partially digest the fiber that humans can not (for lack of the right enzyme). Their resulting digestion produces flatus, or gas.

Laxatives, whether in the form of supplements or as pills or liquid, should be taken with care and only for short periods. Saline laxatives (like Milk of Magnesia) are one type. Stimulant laxatives (Ex-Lax, and others) work by stimulating the muscles that produce bowel movements. Apart from the risk of the other extreme - diarrhea - excessive reliance on laxatives can lead to irregularity and dependence. Bowel movements, in so far as possible, should occur naturally except for brief periods of needed treatment.

There are exceptions, such as prescription laxatives like sorbitol and polyethylene glycol (Miralax), which are regarded as safe for long term use. But these are intended for treating medical conditions, not for relief of constipation that can be eliminated by changes in diet and lifestyle.

As with any severe health condition and proposed treatment, consult your physician for professional advice. Self-treatment that results in temporary relief is fine for temporary conditions. Long term self-treatment may mask, to a point, more serious underlying disease that warrants a professional diagnosis.

All About Colitis

Colitis refers to any condition which results in an inflamed colon.

There is Ischemic colitis, Crohn's, even chemically induced colitis (often as a result of medications), and many more. Still, the word is frequently used as a shorthand phrase for ulcerative colitis, one of the more common types of inflammatory bowel disease, as the category is known.

There are both similarities and differences with Crohn's disease, which it resembles. Crohn's often exists in isolated spots within the intestine.

 Ulcerative colitis tends to occur in continuous sections. UC also affects the innermost lining of the large intestine. Crohn's begins at another layer.

Symptoms of ulcerative colitis include rectal inflammation and sometimes bleeding (when it occurs in the last six inches of the large intestine). Pancolitis, by contrast, affects the entire length of the colon and produces bloody diarrhea and abdominal cramps. It may also include excessive and unusual weight loss, fatigue, and night sweats.

Colitis, particularly the ulcerative variety, can be a serious condition leading to even more serious complications.

 Toxic megacolon, for example, produces a paralyzed colon that prevents eliminating gas or having bowel movements. Waste material that isn't removed can cause the colon to rupture, introducing toxins into the bloodstream and causing peritonitis, just to name two possibilities.

Such an event requires emergency surgery, but even less severe though still serious secondary effects are not uncommon. A perforated colon, severe dehydration, liver disease, or inflammation of the skin or joints are only a few of the possibilities. While it doesn't cause colon cancer directly, IBD increases the odds somewhat, with the risk rising the longer the condition persists. Even so, only about 10 percent of IBD sufferers go on to contract colon cancer.

Like its 'cousin', Crohn's, the disease produces ulcers in the colon, which account for many of the symptoms listed. Also like that other condition, the cause(s) of the disease are not well understood. Some studies suggest that a bacterium or virus is the culprit and that the disease occurs when the immune system overreacts to fighting it.

Like Crohn's, heredity plays a large role in who is likely to acquire the disease. The risk is much higher for those with a close relative affected by the condition. Also like Crohn's, in contrast to many diseases, it tends more often to occur among younger individuals, generally in their 30s.

There are several diagnostic procedures for determining whether any IBD is present. Blood tests check for anemia or signs of infection. A colonoscopy - a procedure that uses a lighted tube inserted into the colon through the rectum - allows a direct inspection of the surface. It also may be used to capture tissue samples that can be analyzed later. Those samples can, for example, be checked for granulomas, which occur in Crohn's but not ulcerative colitis. X-ray diagnosis is also used, with the patient typically consuming or being flushed with a barium compound to make diseased areas visible.

Treatments range from drug therapy to surgery to removing ulcerated tissue - sometimes in spots, other times in entire sections. Anti-inflammatory drugs like Sulfasalazine or Mesalamine are effective for treatment of symptoms, though they often have undesirable side effects. Corticosteroids may be prescribed for short periods.

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