Embarrassing Illnesses

The two most common complications that are associated with Crohn’s disease are:

• bowel obstruction - due to intensive inflammation, sections of the bowel can narrow and harden, leading to bowel contents becoming stuck in the bowel, and
• fistula - a fistula is an abnormal channel that develops between two sections of the digestive system.

These complications are discussed in more detail below.

Bowel obstruction

If your bowel becomes obstructed, you will either not be able to pass any stools at all, or you will only be able to pass watery stools because only liquid will be able to get past the point of obstruction.

Other symptoms of bowel obstruction include:

• abdominal pain and cramping,
• vomiting,
• bloating, and
• an uncomfortable feeling of fullness in your abdomen.

A bowel obstruction requires immediate medical treatment. Left untreated, there is a risk that the bowel could rupture (split) which in turn can lead to internal bleeding and wide-spread infection.

If you suspect that you have an obstructed bowel, you should contact your GP as soon as possible. If this is not possible, telephone NHS Direct on 0845 46 47.

If a bowel obstruction is suspected, it is likely that you will be admitted to hospital so that your health can be carefully monitored. In some cases, it may be possible to clear the bowel obstruction by switching you to a liquid-only diet and using medication to reduce inflammation. However, if this does not work, surgery will be required to unblock the bowel.

You may require a temporary colostomy while your bowel heals. A colostomy is an operation where a section of your colon is diverted, and attached to an opening in your abdominal wall. The opening is known as a stoma. A pouch is attached to the stoma to collect waste products, such as stools. Once your bowel has healed, the colon can be reattached and the stoma sealed.

If you experience repeated episodes of bowel obstruction, a permanent colostomy may be recommended.

Fistulas

If your digestive system becomes scarred as the result of excessive inflammation, ulcers (open sores) can develop.

Over time, the ulcers can expand into tunnels, or passageways, that can run from one part of the digestive system to the other or, in some cases, to the bladder, anus, or skin. These passageways are known as fistulas.

Small fistulas usually cause no symptoms. Larger fistulas can become infected and cause symptoms such as:

• a constant, throbbing pain,
• a high temperature (fever) of 38C (100F), or above,
• blood and/or pus in your faeces (stools), and
  generally feeling very unwell.

If a fistula develops on the skin (usually on, or near, the anus) it may release a foul smelling discharge.

Surgery is usually required to treat a fistula. During surgery, the surgeon will cut open the fistula, while you are under general anaesthetic. They will scrape and flush out the contents of the fistula which will be laid open and flattened out.