Crohn's Disease and Intestinal Blockages

The most common complication of small bowel Crohn's disease is bowel obstruction due to swelling. However, in a patient with small bowel Crohn's, the wall becomes swollen due to chronic inflammation. Not only does it swell outward, it swells inward too. 

Other Types of Blockages

Strictures

The chronic intestinal inflammation that characterises Crohn's disease may also lead to the development of scar tissue in the intestinal tract. 

As the cycle of inflammation and scarring continue, a segment of the tract may be become narrowed in what is known as a stricture (sometimes called stenosis). If a stricture narrows far enough, it may eventually obstruct the intestinal tract. 

Alternately, if a person with an intestinal stricture eats something that is difficult to digest—for instance, raw vegetables, corn, popcorn, or nuts—the food itself may lead to a bowel obstruction. Acute inflammation on top of a stricture may cause the intestine to become blocked as well. 

Because Crohn's disease affects the entire thickness of the bowel wall, strictures are much more common than they are in ulcerative colitis, which typically affects only the inner lining. With strictures, bowel obstructions may be either acute (temporary) or chronic (permanent). 

Adhesions

Adhesions are bands of scar tissue that develop normally after a patient has surgery on the gastrointestinal (GI) tract. 

Adhesions will run from the point of the surgery to other parts of the intestine, other organs, or to the lining of the abdominal cavity (also known as the peritoneum). 

For most people, adhesions are painless and don't cause any problems at all. However, for some patients, the adhesion may cause the intestine to become "fixed." If a fixed intestine becomes twisted, it will cause an obstruction. 

Most bowel obstructions caused by adhesions will get better without surgery, although, rarely, surgery will be required to cut the adhesions and untwist the bowel. New adhesions will form but will likely not cause problems. 

Symptoms

The symptoms of a chronic blockage will be a "crampy" abdominal pain, bloating, and nausea, which occur shortly after a meal. The elapsed time between the meal and the symptoms will determine the site of the blockage. 

If it’ is less than one hour, the small intestine is usually the culprit. Longer than one an hour suggests the blockage is in the colon. If the symptoms happen all or most of the time after eating, it’ is likely the patient is dealing with strictures as well as swelling. 

In addition to the other symptoms, vomiting, increased diarrhoea, or alternately, constipation, may sometimes occur as well. 

Treatments

A person with acute small bowel obstruction will usually get better within 48 hours of beginning a clear fluid diet or taking prednisolone (a powerful anti-inflammatory). In more serious cases, steroids and a sterilized liquid (enteral) diet will usually help to reduce the swelling. 

However, when the blockage is predominantly due to strictures, drugs, are usually of limited effectiveness. In those more serious cases, the first option for many patients is an endoscopy. In an endoscopy, a doctor passes an inflatable balloon through an endoscope, thus dilating the area of scarring. Success rates are as high as 75 percent with the endoscopy procedure. An endoscopy may relieve symptoms for weeks, months, or even years for some people. However, if the area isn't accessible with an endoscope, surgery will be necessary.

Surgery

The two types of surgery performed on patients with small bowel Crohn's are resection, which involves removing the scarred area of the intestine, and strictureplasty, which is like plastic surgery on the intestine.

The two types of Crohn's patients who are candidates for strictureplasty include those who have had a previous resection, or for those for whom the disease is very severe. Many of those who receive a strictureplasty are able to stop taking medications that help heal the disease and maintain the remission of their Crohn's. 

Strictures that are opened with strictureplasty usually remain open as well, and patients will generally only require surgery again if new strictures form elsewhere in the small intestine or bowel. In addition, most people will begin to eat normally (prior to their blockage) and even gain weight after the operation.

Coping with the death of a loved one

Most people grieve when they lose something or someone important to them.  Grieving can feel unbearable, but it's a necessary process.  The way grief affects everyone differently and it all depends on a number of things, such as the nature of the loss i.e. death or a marriage ending, your upbringing, your beliefs or religion, your age, your relationship, and your physical and mental health. 

You can react in many ways to a loss. The main emotions of grief consist of anxiety, helplessness, anger and sadness.  By knowing that these emotions are extremely common in the grief process can help make the process normal.  But the most important thing is to be aware of the fact that it will pass but everyone and everyhgg situation is different so every person has a different time frame on when the process will start and every stage will be a different length to someone else going through the same situation which means everyone has a different grieving process time which can be days, weeks, months and years.  This means no one should judge anyone going through a grief by saying “are you not over that yet” or “you still grieving”.  Everyone is different and everyone takes different speeds and adjustment times in recovering from the grieving process.  Even asking for help from others or professionals i.e. a counsellor, or therapist, or even their GP is not unusual as every person is different.  Those who suffer from depression or anxiety usually ask for help as it can make their condition flare up with the loss of a loved one because of the intense feelings of their loss of a loved one.

Everyone should know there is no instant fix for grief and it just takes its own time to heal itself.  After the grief has subsided it is still there in your mind but it is not the first thing you think about and maybe not the last either.  There are ways to help yourself without asking for professional help during a time of loss:

• Express yourself – talking is the most common way to express yourself and you can do it with anyone to begin the healing process.  Drawing or writing is other ways of expressing yourself without communication with others if you do not wish to speak to other people about how you feel especially if it is to do with the death of an extremely close family member like a parent, sibling or grandparent.
• Have a good cry – allow yourself to feel sad and cry.  This is a healthy part within the grieving process as it allows you to accept the death or loss of a loved one and it enables you to remove and release the tension built up within your body.
• Keep to your normal routine as much as possible – by doing this it can help reduce the panicky feelings which grief can cause.  Also it is important to show yourself to the world as it can help reduce anxiety and the panicky feelings by maintaining a regular contact with other people.
• Sleep – emotional strain can be very tiring and exhausting.  If you are having trouble getting to sleep you can speak to a pharmacist to recommend an over the counter tablet to help or a GP can prescribe something as well.  Or if you would like something that is not a tablet lavender is known to help relax you and to help sleep.
• Diet – maintaining a healthy and well-balanced diet can help you to cope with your emotions as sugary foods and drink can make you comfort eat and alcohol can make the grieving process harder by causing depressed feelings or even a ‘numbing’ feeling as it can make the feelings worse when the effects wears off.

When there are children involved it can be extremely difficult as you may not want to show your feelings especially anger in a marriage breakdown as it can be hard for child to see the other parent suffering because the other is taking their anger out on them.  If the grieving process is due to a marriage breakdown, most children think it is to do with them and it is best to reassure that it was not their fault and it is normal and it is also best to keep their normal routine and keep them informed of what is happening so they do not get extremely confused.  However, if the grieving process is because of a death of a family member it is sometimes good to let the children see that it is normal to be sad and to cry sometimes.  When a child has lost a loved one i.e. a parent, grandparent or an aunt or uncle and they are showing signs of wanting to share their feelings to not ignore them, let them share their feeling either through talking, drawing or playing a game or whatever way they wish to express their feelings.  By doing this they will know that they are listened to.  It also helps if you let them take part in decisions or necessary events i.e. a funeral service, if it is appropriate to let them be there for those important details or events.

When should I get help?  During a personal crisis or loss there are lots of different support channels available today.  Please seek help if you:

• Cannot cope with overwhelming emotions or day-to-day life
• When the intense emotions do not subside
• You are not sleeping properly
• You are displaying symptoms of depression and/or anxiety
• You relationships with family and friends are suffering
• You are having sexual problems
• You are becoming more clumsy or accident-prone
• You are caring for someone and they are not coping well

Most people ask, where should I go to look for help professionally and the best place to start is with your GP surgery.  They can give you important advice about those services available and can help you chose the right one suited for your needs and requirements whether that be to refer you to a counsellor, prescribe medication or give you information on support groups within your local area.

In Loving Memory

In the last year and a half I have lost a total of four people and a pet.  All who I loved and cared about dearly.

It all started with my beloved father who passed away first in April 2015.  His death affected me really badly that it caused my depression to flare up prior giving birth to my first born Alisha, his first grandchild, who happened to be born a week later.  It also affected me the most as I loved my dad to pieces as I was a daddy’s girl even though my twin sister kept fighting over who loved him the most.  I was also unable to say goodbye to him or hold his hand in his final minutes before his death as I was 300miles away and heavily pregnant with complications.  He was the best dad I could ever have as he always done his best and was always there for me when I needed someone the most to talk to about difficult things like my illnesses and my hospital appointments.  I could never change anything even his yummy tomato stew he always made which mum always hated and I would always try and steal it before it was fully cooked.  He was a fighter until the end with his severe stroke but unfortunately this one was just too hard to come back from unlike the one he had on my 8^th birthday and made a full recovery with just some side effects from it.  With dad’s passing and me not being able to be there with him passing away or even the funeral I decided to write him a letter and posted it to mum to put inside his jacket pocket before the coffin was locked up.  By doing this it helped my grieving process and help calm my depression a bit but it was not enough which made me go and ask for help with the GP who put me on mild antidepressants to help numb the agony and she also referred me to cognitive behavioural therapy (CBT) to help manage my grieving process and help me with my day-to-day activities such as looking after my new born daughter.  No matter what happened with me he was my hero and always my advisor if I needed someone to help me. 

This is the last photo I have of myself with my dad before he passed away.

Secondly was my cat Felix.  He passed away on 26^th December 2015, exactly 3years and 2days after my first cat Onyx was found run over by a car.  He was my go to point when times were hard and I just wanted to talk to someone or something that could not talk back to me especially when my IBD team kept telling me my symptoms where all in my head about my Crohn’s disease.  He was always there when I needed him and he always climbed onto me when I was upset so he knew something was not right.

Thirdly was someone I had never met in person I had always spoken to her on Skype or on the phone.  Yes we had a massive language barrier between us but that never stopped us from having a chat.  This person is my other half’s mum, Alisha grandmother who lived in Pakistan.  We never got to meet in person because she was too poorly for a long time and in and out of hospital so she could not travel on the plane to see us when I was pregnant and scared of flying pregnant or for flying 8hours with and without a stopover in another city.  But we made the most of what we had to communicate and see each other until we were able to go over and see her but unfortunately it just was too late as she passed away in January 2016.  She had always the love and time for us just to speak to us even if she never got a proper conversation from Alisha apart from baba, mama and dada but it made her laugh no matter what.

Fourthly was my Granny, Alisha’s Great-Granny (which she hated being called) passed away on the 7^th April 2016.  She was always there for me as she was the longest living grandparent for myself as both my grandfathers had passed away before myself and my twin sister was born.  She was also the only great grandparent for Alisha and adored her and had enjoyed spending time with her when we went to visit.  She was loving and caring and always made time for us even if we did not have time for her.  The only thing I regret with her was not spending the most time we had left with her but she knew we were always busy with school, then university for myself and then work which was miles away to just jump in the car to go and visit her but no matter what she understood we had other things to do but she also knew we still cared about her.

This is the last and first picture I have with my Granny and Alisha

Fifthly was a very good friend of mine and a bit more closer to home as she also had Crohn’s disease as she was diagnosed at 18years old.  I first met her in high school through Peer Support, where I as a sixth former helped the first years to settle into school and had someone to go to if they ever wished to talk to someone who was not a friend or an adult.  She started out as a pain as she constantly followed me during break and lunch until she fully settled into school and made friends of her own age.  But as years passed she turned out to be one of the most special people in my life like she was a little sister I never had.  Jessica was one of the most kind, caring, strong and brave people I know.  Even though she was taken away so young at the age of 19years old she had a big part in my life.  She is one of the most inspirational people as she always got up to go out and enjoy herself even if she was in agony and dosed up on pain killers but she never once let the Crohn’s disease define her as a person.  Unfortunately she passed away on the 20^th July 2016 due to complications from an emergency surgery to get her Crohn’s disease under control.  No matter what she kept fighting until the end and I am proud of her for doing this.

A tribute which one of our fellow Crohn's warriors made in memory of Jessica

Suffering with an illness and losing a loved one can have its ups and downs.  With Crohn’s disease usually stress affects it but emotions are what can set a flare up off.  During all these passing’s they have had a massive effect on how I have felt and had set my tummy off but I had not let it get out of control as I had after dad’s death as it caused a flare up.  But after my CBT sessions ended I have found methods to deal with my emotions and to get them under control without upsetting my tummy which can be extremely hard to do if you do not know what to do.  The most important thing is to get yourself into a calm place and get yourself calm again but this does not always work for everyone as everyone is different.

Complications and IBD

Crohn’s disease can involve any part of your intestinal tract from your mouth to your anus. Inflammation from Crohn’s disease commonly causes abdominal pain and diarrhoea. This inflammation can affect all layers of tissue in the lining of the intestine, and can lead to a variety of complications which are discussed below. 

Intestinal Blockage

Blockages are the most common complication with Crohn’s disease. Swelling and scarring can narrow the passage through your intestines. This then causes constipation, discomfort, and abdominal pain.

Ulcers

Chronic inflammation of the lining of the intestine can cause open sores to develop and these are called ulcers. Ulcers may occur anywhere in your digestive tract, including your mouth and anus, and in the genital area.

Fistulas

Ulcers can penetrate deeply into the tissue of the intestinal wall. They can even form a tunnel all the way through the wall of the intestine and this is known as a fistula. Fistulas create abnormal connections between different parts of your intestine, your intestine and your skin, or your intestine and other organs such as your bladder or womb.

The following describes the different types of fistulas:

Abdominal abscess: If the fistula opens to an empty space in the abdomen, it can cause an infection and fills with pus (an abdominal abscess). Abdominal abscesses can cause high fevers as well as abdominal pain and tenderness.

Enteric-vesicular fistula: A fistula between the intestine and the bladder is called an enteric-vesicular fistula. This can cause frequent urinary tract infections. It may also cause you to pass gas and faeces during urination.

Enteric-cutaneous fistula: A fistula between the intestine and the skin is called an enteric-cutaneous fistula. This can cause an opening on the skin of the abdomen. Pus, bowel contents, and mucus may discharge from this opening.

Colonic-vaginal fistula: A fistula between the colon and the vagina is called a colonic-vaginal fistula. This can cause gas and faeces to pass through the vagina.

Anal fistula: A fistula from the intestines to the anus is called an anal fistula. Mucus and pus may discharge from the fistula’s opening around the anus.

Malabsorption

Malabsorption is common with Crohn’s disease. Scarred and damaged tissues do not absorb nutrients well. If you have chronic diarrhoea, your intestines may not have time to absorb nutrients. Malabsorption can cause nutritional deficiencies. These can lead to anaemia and malnutrition.

Osteoporosis

Osteoporosis is a weakening of the bones caused by a loss of calcium. This is especially common if you’ve been treated with corticosteroids.

Restless Leg Syndrome (RLS)

RLS is extreme discomfort in one or both legs when sitting or lying down. It may improve when your Crohn’s is treated, or it may need to be treated separately.

Increased Risk of Cancer

Crohn’s disease increases your risk of developing colon cancer. Regular screening is generally recommended.

Complications in Children

Children with Crohn’s disease may have impaired growth and delayed sexual development due to malnutrition and vitamin or mineral deficiencies.

Other Complications

Other complications caused by Crohn’s disease include:

• Arthritis
• Skin problems
• Inflammation in the eyes or mouth
• Kidney stones
• Gallstones
• Impaired liver function

Sorry for not posting much

Hey everyone

I am very sorry for not posting much recently.  I have had hardly anytime to myself as I have had a very sick baby on my hands and it has finally took me 10months just to be told my little one has a dairy and soya allergy but she is not fully 100% yet so I am assuming she has another allergy or intolerance we are unaware of.  So I have been back and forth with her to the GP and the hospital and our Health Visitor until we are blue in the face and we finally got something done for her.  But as I have said she is not fully 100% yet so I still have some running to do but not as much now unless my Crohn's decides to do something I do not want it to do.

I hope you are all doing well and are enjoying yourselves wherever you are in the world as I have noticed there is a large audience from across the whole world.  Thank you for reading my blog and if you have any questions or would like to have a chat about anything do not feel shy pop a comment on the blog or email me on smurfasaurus92@gmail.com