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Intestinal IBD Complications

Some intestinal complications of inflammatory bowel diseases (IBD) occur in both ulcerative colitis (UC) and Crohn's disease, although they may occur more commonly in one than in the other.

Intestinal complications of UC

  1. Perforation (rupture) of the bowel. Occurs when chronic inflammation and ulceration of the intestine weakens the intestinal wall to such an extent that a hole develops. This complication is potentially life-threatening, and generally linked to toxic megacolon (see below). In Crohn’s disease, perforation may occur as a result of abscess or fistula (see below).
  2. Fulminant colitis. Affecting less than 10% of people with UC, fulminant colitis involves progressive inflammation and damage to the entire colon. When severe inflammation causes the colon to become extremely dilated and swollen, a condition called ileus (when the bowel is not moving) may develop — normal contractions of the intestine stop, and abdominal distension occurs. As the condition progresses, the colon becomes more distended (loses muscle tone and begins to expand). Abdominal X-rays reveal trapped gas inside the paralyzed sections of intestine. Fulminant colitis can occur suddenly.
  3. Toxic megacolon. Most serious, but relatively rare, complication of IBD (potentially life-threatening), and most extreme form of fulminant colitis. The colon loses its ability to contract properly and move intestinal gas along. Abdominal distension and illness is severe, causing high fever, abdominal pain and tenderness, and a high white blood cell count. Immediate medical attention is essential to try and "decompress" the bowel and prevent rupture. Urgent surgery may be needed if there is no improvement or if the condition worsens.
  4. Increased risk of colorectal cancer. There is an increased risk of colorectal cancer among people with IBD. About 5% to 8% of people with UC develop colorectal cancer within 20 years after diagnosis as compared to 3% to 6% for the general population, and the risk increases with duration and severity of disease. People with UC have a higher risk of colorectal cancer than those with Crohn's disease.

Intestinal complications of Crohn's disease

  1. Intestinal obstruction. Most common complication of Crohn's disease. An obstruction is caused by inflammation and formation of scar tissue in the intestinal wall. The bowel becomes blocked from scar tissue causing a narrowed area also known as a stricture. Symptoms include an inability to eat, crampy abdominal pain, nausea, vomiting, and bloating. Medications may relieve some inflammatory obstructions by reducing the intestinal swelling. If the obstruction recurs frequently or is severe, surgery may be necessary.
  2. Abscesses. Localized pus pocket caused by bacterial infection. May form in the intestinal wall, inside the abdomen or pelvis, or in areas next to inflamed intestine. Visible abscesses, such as those around the anus, look like boils and treatment often involves surgical drainage. Symptoms include fever, pain, swelling, and tenderness. Once the abscess is drained, symptoms usually resolve promptly. Antibiotics are usually given to help treat the infection.
  3. Fistulas. Abnormal passages that connect different parts of the intestine, which are caused by deep sores or ulcers within the intestinal tract. Fistulas may also tunnel into the surrounding tissues of the bladder, vagina or skin. Fistulas affect about 30% of people with Crohn's disease, and often become infected. If small, antibiotics and other medical treatment may be adequate. Surgery may be needed for large or multiple fistulas, especially if they cause persistent symptoms.
  4. Fissures. Tears or cracks in the lining of the anus. May be superficial or deep. Unlike fistulas, fissures are only in the anus area. Can cause mild-to-severe rectal pain and bleeding, particularly during and immediately after bowel movements. Generally treated with local care, including topical creams or sitz baths.
  5. Malabsorption and malnutrition. Related to deficiencies in nutrients, such as proteins, vitamins and fats. Crohn's disease usually affects the small intestine, which is the part of the gut that absorbs most nutrients. Malabsorption and malnutrition usually do not develop unless the disease is extensive or presents for a long period of time. Medical treatment is usually effective in the replacement of nutrients.
  6. Bile salt diarrhea. The ileum (lower end of the small intestine) is the part of the intestine most commonly involved in Crohn's disease. This is the principal area for intestinal absorption of bile acids/salts, compounds that help transport and absorb fats. If this absorption becomes deficient, fat malabsorption and diarrhea can result. An oral medicine called cholestyramine is usually prescribed.
  7. Small intestinal bacterial overgrowth (SIBO). With SIBO, excessive amounts of bacteria are present in the small intestine. As a result, bacteria break down or digest food higher up than normal in the GI tract, which produces gas, abdominal pain, bloating and diarrhea. SIBO, which also may occur in UC, usually improves after a course of antibiotics.

Many of these complications are rare, but if you notice a change in symptoms, be sure to see your doctor.

Reduce your risk

The following may help you reduce the risk of intestinal complications:

  • Stay on IBD medication to help control inflammation.
  • Maintain a healthy diet and physical activity.
  • See your doctor regularly and keep up with routine tests, like colonoscopies.
  • Detect complications early and treat them promptly.