Can Crohn's disease cause constipation?

Causes of constipation in Crohn’s disease

Doctors consider a person to have constipation if they have fewer than three bowel movements a week. Potential causes of constipation in people with Crohn’s disease include the following:

Medications

Constipation can be a side effect of medication. Medication that a doctor might prescribe to someone with Crohn’s disease that could cause constipation includes:

• antidiarrheal drugs
• iron supplements
• certain pain relievers

Low fiber diet

Doctors may recommend a low fiber diet for people experiencing a Crohn’s flare-up.

However, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) suggests that not eating enough fiber can cause constipation.

Strictures

Crohn’s disease can cause a section of the intestines to narrow due to severe inflammation or scarring. 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.

Other symptoms of strictures include:

• abdominal pain
• bloating
• nausea and vomiting

People with symptoms of a stricture or another blockage need to speak with a doctor.

Without treatment, a stricture can lead to potentially life threatening complications. Doctors may be able to treat strictures with medications, but most people require surgery, such as a strictureplasty or bowel resection.

Other causes

Other causes of constipation in people with Crohn’s disease may include:

• not drinking enough fluids
• not eating enough food
• an inactive lifestyle
• irritable bowel syndrome
• proctitis, which is an inflammation of the rectum

Treatments for constipation

Treating constipation for someone with Crohn’s disease may depend on the underlying cause. Potential treatments include the below.

Increasing dietary fiber

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
  • oranges
• fresh or cooked vegetables, such as:
  • spinach
  • carrots
  • broccoli
  • sweet potatoes
  • unpeeled potatoes
• legumes, such as:
  • lentils
  • beans
  • peas
• nuts and seeds
• high fiber breakfast cereals, which often include bran or whole grains
• whole grain bread, pasta, and rice

People with Crohn’s disease need to speak with a doctor or dietitian before making significant dietary changes. Those with strictures also need to avoid following high fiber diets.

A person can help prevent gas and bloating, by introducing high fiber foods into their diet gradually.

Drink more fluids

Drinking more fluids can help soften stools and make them easier to pass. Fluids can include:

• water
• clear soups
• fruit and vegetable juices with no added sugar
• low sugar sports drinks
• noncaffeinated beverages

Exercise

Getting more exercise may help stools move through the colon more quickly and increase the frequency of bowel movements.

Most adults should aim to get at least 150 minutes of exercise per week. People can break this into smaller periods of activity.

Exercising during a Crohn’s flare-up can be challenging. However, individuals can include exercise in their routine by:

• taking short walks
• cycling to work
• taking the stairs when possible
• taking regular breaks from desks and computers to walk around and stretch

Try laxatives

Laxatives are a short-term option for treating constipation. However, people with Crohn’s disease need to speak with a doctor before trying a laxative.

According to the NIDDKD, the following types of laxatives are available over the counter:

• osmotic agents, such as milk of magnesia or polyethylene glycol 3350 (Miralax)
• bulk-forming agents, such as Citrucel or FiberCon
• stool softeners, such as docusate (Colace)
• lubricants, such as mineral oil
• stimulants, such as bisacodyl (Correctol, Dulcolax)

The NIDDKD suggests people should only use stimulant laxatives if they have severe constipation or if other treatments do not work.

Prescription medications

For people with severe or difficult-to-treat constipation, a doctor may prescribe certain medications.

Lubiprostone (Amitiza) increases fluid in the large intestine, which can help soften stool and cause more frequent bowel movements.

Linaclotide (Linzess) and plecanatide (Trulance) can also help restore regular bowel movements. These two medications may cause diarrhea and severe dehydration in some people. Children should not take them.

Doctors will rule out any intestinal obstructions, such as from strictures, before a person starts taking these medications.

Stopping medications

If a person’s medication causes constipation, their doctor may recommend changing, reducing, or stopping the drug or supplement.

People should never stop taking Crohn’s medication without consulting their doctor first.

Bowel training

Bowel training involves trying to have a bowel movement at the same time each day. It may also include changing the way a person sits on the toilet.

Over time, this can help individuals have more regular bowel movements.

Biofeedback therapy

Biofeedback therapy may help treat constipation in people with problems with their pelvic floor muscles.

It involves using electronic devices to provide feedback on the activity of specific muscles, which aims to help the person retrain them and gain better control.

When to consult a doctor about constipation

People with Crohn’s disease need to undergo regular check-ins with their healthcare team. Healthcare professionals can monitor symptoms and recommend adjustments to the treatment plan if someone experiences new symptoms, such as constipation.

Severe or sudden constipation, especially 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 needs to speak with a doctor immediately.

Frequently asked questions

Below are some answers to common questions about Crohn’s disease and constipation.

Is constipation common in Crohn’s disease?

According to a 2019 review, constipation among people with IBD is similar to the general population. However, constipation is more common among those with ulcerative colitis than Crohn’s disease.

What are bowel movements like with Crohn’s?

People with Crohn’s disease often experience diarrhea, which can cause loose, watery, and urgent bowel movements.

What is the best laxative for someone with Crohn’s disease?

People with Crohn’s disease need to consult a doctor to determine the best laxative for them. Some laxatives, such as stimulant laxatives, can increase the risk of dehydration.

Summary

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 those with Crohn’s disease include making dietary and lifestyle changes, taking stool softeners or laxatives, and bowel training.

People need to consult a healthcare professional if constipation does not improve with at-home treatments. A doctor may be able to make changes to medications or suggest alternative management strategies.

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