crohn's

Crohn's disease is a chronic (long-lasting) disease that causes inflammation in your digestive tract. It can affect any part of your digestive tract, which runs from your mouth to your anus. But it usually affects your small intestine and the beginning of your large intestine.

Crohn's disease is an inflammatory bowel disease (IBD). Ulcerative colitis and microscopic colitis are other common types of IBD.

The cause of Crohn's disease is unknown. Researchers think that an autoimmune reaction may be one cause. An autoimmune reaction happens when your immune system attacks healthy cells in your body. Genetics may also play a role, since Crohn's disease can run in families.

Stress and eating certain foods don't cause the disease, but they can make your symptoms worse.

There are certain factors that may raise your risk of Crohn's disease:

• Family history of the disease. Having a parent, child, or sibling with the disease puts you at higher risk.
• Smoking. This may double your risk of developing Crohn's disease.
• Certain medicines, such as antibiotics, birth-control pills, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. These may slightly increase your chance of developing Crohn's.
• A high-fat diet. This may also slightly increase your risk of Crohn's.

The symptoms of Crohn's disease can vary, depending where and how severe your inflammation is. The most common symptoms include:

• Diarrhea
• Cramping and pain in your abdomen
• Weight loss

Some other possible symptoms are:

• Anemia, a condition in which you have fewer red blood cells than normal
• Eye redness or pain
• Fatigue
• Fever
• Joint pain or soreness
• Nausea or loss of appetite
• Skin changes that involve red, tender bumps under the skin

Stress and eating certain foods such as carbonated (fizzy) drinks and high-fiber foods may make some people's symptoms worse.

Crohn's disease can cause other problems, including:

• Intestinal obstruction, a blockage in the intestine
• Fistulas, abnormal connections between two parts inside of the body
• Abscesses, pus-filled pockets of infection
• Anal fissures, small tears in your anus that may cause itching, pain, or bleeding
• Ulcers, open sores in your mouth, intestines, anus, or perineum
• Malnutrition, when your body does not get the right amount of vitamins, minerals, and nutrients it needs
• Inflammation in other areas of your body, such as your joints, eyes, and skin

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A family history
• A physical exam, including:
  • Checking for bloating in your abdomen.
  • Listening to sounds within your abdomen using a stethoscope.
  • Tapping on your abdomen to check for tenderness and pain and to see if your liver or spleen is abnormal or enlarged.
• Various tests, including:
  • Blood and stool tests.
  • A colonoscopy.
  • An upper GI endoscopy, a procedure in which your provider uses a scope to look inside your mouth, esophagus, stomach, and small intestine.
  • Diagnostic imaging tests, such as a CT scan or an upper GI series. An upper GI series uses a special liquid called barium and x-rays. Drinking the barium will make your upper GI tract more visible on an x-ray.

There is no cure for Crohn's disease, but treatments can decrease inflammation in your intestines, relieve symptoms, and prevent complications. Treatments include medicines, bowel rest, and surgery. No single treatment works for everyone. You and your provider can work together to figure out which treatment is best for you:

• Medicines for Crohn's include various medicines that decrease the inflammation. Many of these medicines do this by reducing the activity of your immune system. Certain medicines can also help with symptoms or complications, such as nonsteroidal anti-inflammatory drugs and anti-diarrheal medicines. If your Crohn's causes an infection, you may need antibiotics.
• Bowel rest involves drinking only certain liquids or not eating or drinking anything. This allows your intestines to rest. You may need to do this if your Crohn's disease symptoms are severe. You get your nutrients through drinking a liquid, a feeding tube, or an intravenous (IV) tube. You may need to do bowel rest in the hospital, or you may be able to do it at home. It will last for a few days or up to several weeks.
• Surgery can treat complications and reduce symptoms when other treatments are not helping enough. The surgery will involve removing a damaged part of your digestive tract to treat:
  • Fistulas
  • Bleeding that is life threatening
  • Intestinal obstructions
  • Side effects from medicines when they threaten your health
  • Symptoms when medicines do not improve your condition

Changing your diet can help reduce symptoms. Your provider may recommend that you make changes to your diet, such as:

• Avoiding carbonated drinks
• Avoiding popcorn, vegetable skins, nuts, and other high-fiber foods
• Drinking more liquids
• Eating smaller meals more often
• Keeping a food diary to help identify foods that cause problems

In some cases, your provider may ask you to go on a special diet, such as a diet that is:

• High calorie
• Lactose free
• Low fat
• Low fiber
• Low salt

If you are not absorbing enough nutrients, you may need to take nutritional supplements and vitamins.

National Institute of Diabetes and Digestive and Kidney Diseases

Colorectal cancer is cancer that develops in the tissues of the colon or rectum. Your colon and rectum are part of your digestive system:

• Your colon is the first and longest part of your large intestine. It absorbs water and some nutrients from foods. It also changes the leftover waste products into stool (poop).
• Your rectum is the lower part of your large intestine. It's where your body stores stool.

Cancer that begins in the colon is called colon cancer, and cancer that begins in the rectum is called rectal cancer. Cancer that affects either of these parts may also be called colorectal cancer.

Colorectal cancer happens when there are changes in your genetic material (DNA). These changes are also called mutations or variants. Often, the genetic changes that lead to colorectal cancer happen during your lifetime and the exact cause is unknown. But certain genetic changes that raise your risk for colorectal cancer are inherited, meaning that you are born with them.

Besides genetics, other factors, including your lifestyle and the environment, can affect your risk of colorectal cancer.

Anyone can get colorectal cancer, but certain factors make you more likely to develop it:

• Being older; your risk of getting colorectal cancer increases as you age.
• Having a personal or family history of colorectal cancer.
• Having a history of adenomas. Adenomas are colorectal polyps (growths) that look abnormal under a microscope or are 1 centimeter or larger. Adenomas are not cancer, but they can sometimes turn into cancer over time.
• Having a genetic syndrome such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colorectal cancer).
• Having chronic ulcerative colitis or Crohn disease for 8 years or more.
• Having three or more alcoholic drinks per day.
• Smoking cigarettes.
• Being Black; Black people have an increased risk of colorectal cancer and death from colorectal cancer compared to other races.
• Having obesity.

Colorectal cancer may not always cause symptoms, especially at first. If you do have symptoms, they could include:

• A change in bowel habits that lasts more than a few days, such as:
  • Diarrhea
  • Constipation
  • Feeling that the bowel does not empty completely
  • Your stool is narrower or has a different shape than usual
• Blood (either bright red or very dark) in the stool
• Frequent gas pains, bloating, fullness, or cramps
• Weight loss for no known reason
• Fatigue

Because colorectal cancer may not cause symptoms at first, it's important to have screening tests for colorectal cancer. Screening tests look for signs of a disease before you have any symptoms. They can help find cancer early, when it may be easier to treat.

Most experts recommend that start screenings at 45 and continue until at least age 75. People over 75 and those who are at high risk should talk to their providers about how often you need screening and what type of test they should get.

The types of tests include different stool tests and procedures such as colonoscopies and flexible sigmoidoscopy. Talk with your provider about how often you need screening and what type of test you should get.

If you have symptoms that could be caused by colorectal cancer or if your screening test results are abnormal, you may need to have more tests to find out if you have cancer. Possible tests include:

• A physical exam.
• A digital rectal exam. For this exam, your provider inserts a lubricated, gloved finger into your rectum to feel for lumps or anything unusual.
• The tests that are also used for screening (colonoscopy, stool tests, etc.) and biopsy, if you have not already had them.
• Other blood and tissue tests.

Your treatment options usually depend on your age, your general health, how serious the cancer is, and which type of cancer you have.

For colon cancer, your treatment may include one or more of these options:

• Surgery.
• Radiofrequency ablation, a procedure that uses radio waves to heat and destroy abnormal cells. The radio waves travel through electrodes (small devices that carry electricity).
• Cryosurgery, a procedure in which an extremely cold liquid or an instrument called a cryoprobe is used to freeze and destroy abnormal tissue.
• Chemotherapy.
• Radiation therapy.
• Targeted therapy, which uses drugs or other substances that mainly attack specific cancer cells and cause less harm to normal cells.
• Immunotherapy.

For rectal cancer, your treatment may include one or more of these options:

• Surgery.
• Radiation therapy.
• Chemotherapy.
• Active surveillance, which means having regular tests to see if your rectal cancer has changed. If the tests show the cancer is starting to grow, then you will have treatment to try to cure the cancer.
• Targeted therapy, which uses drugs or other substances that mainly attack specific cancer cells and cause less harm to normal cells.
• Immunotherapy.

Avoiding the risk factors that you have control over may help prevent some cancers. That includes:

• Not smoking
• Limiting alcohol to under three drinks per day
• Managing your weight

There are also other steps you can take to try to prevent colorectal cancer. They include:

• Getting regular colorectal cancer screenings
• Having polyps removed before they can become cancerous
• Getting regular exercise

Diarrhea is loose, watery stools (bowel movements). You have diarrhea if you have loose stools three or more times in one day. Acute diarrhea is diarrhea that lasts a short time. It is a common problem. It usually lasts about one or two days, but it may last longer. Then it goes away on its own.

Diarrhea lasting more than a few days may be a sign of a more serious problem. Chronic diarrhea -- diarrhea that lasts at least four weeks -- can be a symptom of a chronic disease. Chronic diarrhea symptoms may be continual, or they may come and go.

The most common causes of diarrhea include:

• Bacteria from contaminated food or water
• Viruses such as the flu, norovirus, or rotavirus . Rotavirus is the most common cause of acute diarrhea in children.
• Parasites, which are tiny organisms found in contaminated food or water
• Medicines such as antibiotics, cancer drugs, and antacids that contain magnesium
• Food intolerances and sensitivities, which are problems digesting certain ingredients or foods. An example is lactose intolerance.
• Diseases that affect the stomach, small intestine, or colon, such as Crohn's disease
• Problems with how the colon functions, such as irritable bowel syndrome

Some people also get diarrhea after stomach surgery, because sometimes the surgeries can cause food to move through your digestive system more quickly.

Sometimes no cause can be found. If your diarrhea goes away within a few days, finding the cause is usually not necessary.

People of all ages can get diarrhea. On average, adults In the United States have acute diarrhea once a year. Young children have it an average of twice a year.

People who visit developing countries are at risk for traveler's diarrhea. It is caused by consuming contaminated food or water.

Other possible symptoms of diarrhea include:

• Cramps or pain in the abdomen
• An urgent need to use the bathroom
• Loss of bowel control

If a virus or bacteria is the cause of your diarrhea, you may also have a fever, chills, and bloody stools.

Diarrhea can cause dehydration, which means that your body does not have enough fluid to work properly. Dehydration can be serious, especially for children, older adults, and people with weakened immune systems.

Although it is usually not harmful, diarrhea can become dangerous or signal a more serious problem. Contact your health care provider if you have:

• Signs of dehydration
• Diarrhea for more than 2 days, if you are an adult. For children, contact the provider if it lasts more than 24 hours.
• Severe pain in your abdomen or rectum (for adults)
• A fever of 102 degrees or higher
• Stools containing blood or pus
• Stools that are black and tarry

If children have diarrhea, parents or caregivers should not hesitate to call a health care provider. Diarrhea can be especially dangerous in newborns and infants.

To find the cause of diarrhea, your health care provider may:

• Do a physical exam
• Ask about any medicines you are taking
• Test your stool or blood to look for bacteria, parasites, or other signs of disease or infection
• Ask you to stop eating certain foods to see whether your diarrhea goes away

If you have chronic diarrhea, your health care provider may perform other tests to look for signs of disease.

Diarrhea is treated by replacing lost fluids and electrolytes to prevent dehydration. Depending on the cause of the problem, you may need medicines to stop the diarrhea or treat an infection.

Adults with diarrhea should drink water, fruit juices, sports drinks, sodas without caffeine, and salty broths. As your symptoms improve, you can eat soft, bland food.

Children with diarrhea should be given oral rehydration solutions to replace lost fluids and electrolytes.

Two types of diarrhea can be prevented - rotavirus diarrhea and traveler's diarrhea. There are vaccines for rotavirus. They are given to babies in two or three doses.

You can help prevent traveler's diarrhea by being careful about what you eat and drink when you are in developing countries:

• Use only bottled or purified water for drinking, making ice cubes, and brushing your teeth
• If you do use tap water, boil it or use iodine tablets
• Make sure that the cooked food you eat is fully cooked and served hot
• Avoid unwashed or unpeeled raw fruits and vegetables

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

A fistula is an abnormal connection between two parts inside of the body. Fistulas may develop between different organs, such as between the esophagus and the windpipe or the bowel and the vagina. They can also develop between two blood vessels, such as between an artery and a vein or between two arteries.

Some people are born with a fistula. Other common causes of fistulas include:

• Complications from surgery
• Injury
• Infection
• Diseases, such as Crohn's disease or ulcerative colitis

Treatment depends on the cause of the fistula, where it is, and how bad it is. Some fistulas will close on their own. In some cases, you may need antibiotics and/or surgery.

Your digestive or gastrointestinal (GI) tract includes the esophagus, stomach, small intestine, large intestine or colon, rectum, and anus. Bleeding can come from any of these areas. The amount of bleeding can be so small that only a lab test can find it.

Signs of bleeding in the digestive tract depend where it is and how much bleeding there is.

Signs of bleeding in the upper digestive tract include:

• Bright red blood in vomit
• Vomit that looks like coffee grounds
• Black or tarry stool
• Dark blood mixed with stool

Signs of bleeding in the lower digestive tract include:

• Black or tarry stool
• Dark blood mixed with stool
• Stool mixed or coated with bright red blood

GI bleeding is not a disease, but a symptom of a disease. There are many possible causes of GI bleeding, including hemorrhoids, peptic ulcers, tears or inflammation in the esophagus, diverticulosis and diverticulitis, ulcerative colitis and Crohn's disease, colonic polyps, or cancer in the colon, stomach or esophagus.

The test used most often to look for the cause of GI bleeding is called endoscopy. It uses a flexible instrument inserted through the mouth or rectum to view the inside of the GI tract. A type of endoscopy called colonoscopy looks at the large intestine.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Hemorrhoids are swollen, inflamed veins around your anus or the lower part of your rectum. There are two types:

• External hemorrhoids, which form under the skin around your anus
• Internal hemorrhoids, which form in the lining of your anus and lower rectum

Hemorrhoids happen when there is too much pressure on the veins around the anus. This can be caused by:

• Straining during bowel movements.
• Sitting on the toilet for long periods of time.
• Chronic constipation or diarrhea.
• A low-fiber diet.
• Weakening of the supporting tissues in your anus and rectum. This can happen with aging and pregnancy.
• Frequently lifting heavy objects.

The symptoms of hemorrhoids depend on which type you have:

With external hemorrhoids, you may have:

• Anal itching
• One or more hard, tender lumps near your anus
• Anal pain, especially when sitting

Too much straining, rubbing, or cleaning around your anus may make your symptoms worse. For many people, the symptoms of external hemorrhoids go away within a few days.

With internal hemorrhoids, you may have:

• Bleeding from your rectum - you would see bright red blood in your stool, on toilet paper, or in the toilet bowl after a bowel movement
• Prolapse, which is a hemorrhoid that has fallen through your anal opening

Internal hemorrhoids are usually not painful unless they are prolapsed. Prolapsed internal hemorrhoids may cause pain and discomfort.

You can most often treat your hemorrhoids at home by:

• Eating foods that are high in fiber.
• Taking a stool softener or a fiber supplement.
• Drinking enough fluids every day.
• Not straining during bowel movements.
• Not sitting on the toilet for long periods of time.
• Taking over-the-counter pain relievers.
• Taking warm baths several times a day to help relieve pain. This could be a regular bath or a sitz bath. With a sitz bath, you use a special plastic tub that allows you to sit in a few inches of warm water.
• Using over-the-counter hemorrhoid creams, ointments, or suppositories to relieve mild pain, swelling, and itching of external hemorrhoids.

You should see your health care provider if you:

• Still have symptoms after 1 week of at-home treatment.
• Have bleeding from your rectum. Hemorrhoids are a common cause of bleeding, but other conditions can also cause bleeding. They include Crohn's disease, ulcerative colitis, colorectal cancer, and anal cancer. So it's important to see your provider to find the cause of the bleeding.

To find out if you have hemorrhoids, your health care provider:

• Will ask about your medical history.
• Will do a physical exam. Often providers can diagnose external hemorrhoids by looking at the area around your anus.
• Will do a digital rectal exam to check for internal hemorrhoids. For this, the provider will insert a lubricated, gloved finger into the rectum to feel for anything that is abnormal.
• May do procedures such as an anoscopy to check for internal hemorrhoids.

If at-home treatments for hemorrhoids don't help you, you may need a medical procedure. There are several different procedures that your provider can do in the office. These procedures use different techniques to cause scar tissue to form in the hemorrhoids. This cuts off the blood supply, which usually shrinks the hemorrhoids. In severe cases, you may need surgery.

You can help prevent hemorrhoids by:

• Eating foods that are high in fiber
• Taking a stool softener or a fiber supplement
• Drinking enough fluids every day
• Not straining during bowel movements
• Not sitting on the toilet for long periods of time

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Your small intestine is part of your digestive system. It is a long tube that connects your stomach to your large intestine. Intestinal cancer is rare, but eating a high-fat diet or having Crohn's disease, celiac disease, or a history of colonic polyps can increase your risk.

Possible signs of small intestine cancer include:

• Abdominal pain
• Weight loss for no reason
• Blood in the stool
• A lump in the abdomen

Imaging tests that create pictures of the small intestine and the area around it can help diagnose intestinal cancer and show whether it has spread.

Surgery is the most common treatment. Additional options include chemotherapy, radiation therapy, or a combination.

NIH: National Cancer Institute

Iron is a mineral that our bodies need for growth and development. Your body uses iron to make hemoglobin, a protein in red blood cells. Hemoglobin carries oxygen from the lungs to all parts of the body. Iron is also important for healthy muscles, bone marrow, and organ function. Your body also needs iron to make some hormones.

Iron is found naturally in many foods and is added to some fortified food products. Foods that are high in iron include:

• Lean meat, seafood, and poultry
• Iron-fortified breakfast cereals and breads
• White beans, lentils, spinach, kidney beans, and peas
• Nuts and some dried fruits, such as raisins

Iron is available in supplements, either on its own or as part of many multivitamin/mineral supplements.

Most people in the United States get enough iron. The amount that you need each day depends on your age, your sex, and whether you consume a mostly plant-based diet.

Sometimes people can have trouble getting enough iron. There can be many causes, including blood loss, a poor diet, or a problem absorbing enough iron from foods. Those who are more likely to have low iron include people who:

• Have heavy periods
• Are pregnant or breastfeeding
• Are infants (especially if they were born premature or low birth weight)
• Are frequent blood donors
• Have cancer, certain digestive diseases, or heart failure
• Are on kidney dialysis
• Have trouble absorbing iron because they:
  • Have a digestive condition such as celiac disease, ulcerative colitis, Crohn's disease, or Helicobacter pylori infection
  • Had weight loss surgery

If you have too little iron, you may develop iron-deficiency anemia. It may not cause symptoms at first, but over time, it can cause fatigue, shortness of breath, and trouble with memory and concentration. Treatment for low iron and iron-deficiency anemia is usually with iron supplements.

Too much iron can damage your body. For example, if you are healthy and take too many iron supplements, you may have symptoms such as constipation, nausea and vomiting, abdominal (belly) pain, and diarrhea. Higher iron levels can cause ulcers. Extremely high levels can lead to organ damage, coma, and death.

A disease called hemochromatosis can cause too much iron to build up in the body. Hemochromatosis is inherited (passed down through families). It is usually treated by removing blood (and iron) from your body on a regular basis.

National Institutes of Health, Office of Dietary Supplements

Your small intestine is the longest part of your digestive system - about twenty feet long! It connects your stomach to your large intestine (or colon) and folds many times to fit inside your abdomen. Your small intestine does most of the digesting of the foods you eat. It has three areas called the duodenum, the ileum, and the jejunum.

Problems with the small intestine can include:

• Bleeding
• Celiac disease
• Crohn's disease
• Infections
• Intestinal cancer
• Intestinal obstruction
• Irritable bowel syndrome
• Ulcers, such as peptic ulcer

Treatment of disorders of the small intestine depends on the cause.

Vitamins are substances that your body needs to grow and develop normally. Vitamin A plays a role in your:

• Vision
• Bone growth
• Reproduction
• Cell functions
• Immune system

Vitamin A is an antioxidant. It can come from plant or animal sources. Plant sources include colorful fruits and vegetables. Animal sources include liver and whole milk. Vitamin A is also added to foods like cereals.

Vegetarians, young children, and alcoholics may need extra Vitamin A. You might also need more if you have certain conditions, such as liver diseases, cystic fibrosis, and Crohn's disease. Check with your health care provider to see if you need to take vitamin A supplements.

NIH: National Institutes of Health Office of Dietary Supplements