Treating constipation in Crohn's disease
Doctors consider a person to have constipation if they have fewer than three bowel movements a week. Other symptoms of constipation can include hard or dry stools, pain or difficulty passing stools, and a feeling of incomplete evacuation.
In this article, we discuss potential causes of constipation in people with Crohn's disease, treatment options, and when to see a doctor.
Causes of constipation
There are several possible causes of constipation in people with Crohn's disease. These can include:
A variety of medications can cause constipation, including antidiarrheal drugs, iron supplements, calcium channel blockers, and certain pain relievers.
Doctors sometimes recommend a low-fiber diet for people experiencing a Crohn's flare-up.
However, reducing the intake of fiber while also taking antidiarrheal medications can lead to constipation in some individuals.
Eating fresh fruit can provide essential dietary fiber, which may help prevent constipation.
Crohn's disease can cause a section of the intestines to narrow, due to severe inflammation.
This section is called a stricture, and it can block or slow the passage of stool or digested food through the bowels, leading to constipation.
Strictures can also cause abdominal pain, bloating, and nausea and vomiting. It is important for people with symptoms of a stricture or another blockage to see a doctor.
Without treatment, a stricture can lead to potentially life-threatening complications. Doctors can often treat strictures with medications, but some people may require surgery, such as a strictureplasty or bowel resection.
Other causes of constipation in people with Crohn's disease may include:
- not drinking enough fluids
- eating too little food
- an inactive lifestyle
- irritable bowel syndrome
- proctitis, which is an inflammation of the rectum
Treatments for constipation
Treatments include dietary and lifestyle changes, medications, and bowel training. We discuss some of these options below:
Consuming more dietary fiber leads to more water absorption in the bowels. This makes stools softer and easier to pass.
Foods rich in fiber include:
- fresh or dried fruits, such as unpeeled apples and pears, prunes, berries, and oranges
- fresh or cooked vegetables, such as spinach, carrots, broccoli, sweet potatoes, and unpeeled potatoes
- legumes, such as lentils, beans, and peas
- nuts and seeds
- high-fiber breakfast cereals, which often include bran or whole grains
- whole-grain breads, pastas, and rice
Speak to a doctor or dietician before making significant dietary changes. People with strictures should not adopt high-fiber diets.
To prevent gas and bloating, it is best to gradually introduce high-fiber foods into the diet.
Drinking more fluids can help soften stools and make them easier to pass. Fluids can include:
- clear soups
- fruit and vegetable juices with no added sugar
- low-sugar sports drinks
- non-caffeinated beverages
Regular exercise can help support healthy bowel movements.
Getting more exercise can help stools move through the colon more quickly and increase the frequency of bowel movements.
Experts recommend doing at least 30 minutes of aerobic exercise on most days, or about 150 minutes per week. This can involve activities such as cycling, swimming, and brisk walking.
It may not always be easy or possible to exercise when symptoms flare up. Other ways to increase physical activity can include:
- Taking short walks
- using the car and elevator less
- taking regular breaks from desks and computers to walk around and stretch
Laxatives are a short-term option for the treatment of constipation. Longer-term use of these medications can make it difficult for a person to have a bowel movement without taking a laxative.
People with Crohn's disease should speak to a doctor before trying a laxative.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, the following types of laxatives are available over the counter:
- osmotic agents, such as milk of magnesia or Miralax
- bulk-forming agents, such as Citrucel or FiberCon
- stool softeners, such as Colace or Docusate
- lubricants, such as mineral oil
- stimulants, such as Correctol or Dulcolax
Doctors generally only recommend stimulant laxatives for people with severe constipation, or if other treatments have not worked.
For people with severe or difficult-to-treat constipation, a doctor may prescribe lubiprostone, linaclotide, or plecanatide.
Lubiprostone works by increasing fluid in the large intestine, which helps soften stool and lead to more frequent bowel movements.
Linaclotide and plecanatide can help restore regular bowel movements, but they may take up to 1 week to have an effect. These two medications may cause severe dehydration in some people, and children should not take them.
Doctors need to rule out any intestinal obstructions, such as from strictures, before a person starts taking these medications.
If a medication is causing a person's constipation, the doctor may recommend changing, reducing, or stopping the drug or supplement.
Doctors may recommend bowel training for some people with constipation.
This involves trying to have a bowel movement at the same time each day. Bowel training may also include changing the way a person sits on the toilet.
Over time, this can help a person have more regular bowel movements.
Biofeedback therapy can help treat constipation in people who have problems with their pelvic floor muscles.
It involves using electronic devices to provide feedback on the activity of specific muscles, which allows the person to retrain them and gain better control.
When to see a doctor
A person with Crohn's disease should see a doctor if they experience a high fever.
People with Crohn's disease should have regular check-ins with their doctor or other members of their healthcare team. Doing so allows healthcare professionals to monitor symptoms and recommend adjustments to the treatment plan.
Severe or sudden constipation, especially if it is associated with abdominal pain, may indicate a stricture or blockage in the bowels. Without treatment, blockages can lead to life-threatening complications, such as tearing in the intestine.
Symptoms of a stricture or blockage can include:
- severe abdominal pain, cramping, or bloating
- nausea and vomiting
- a high fever
- severe constipation
- an inability to pass gas
Anyone with these symptoms should speak to a doctor immediately.
Although Crohn's disease typically causes diarrhea during flare-ups, some people may also experience constipation. Causes of this constipation can include medications, strictures, lifestyle factors, and other health conditions.
Constipation treatments for people with Crohn's disease include making dietary and lifestyle changes, taking stool softeners or laxatives, and bowel training.
Consider speaking to a healthcare professional if symptoms do not improve.