For some people, Crohn's disease gradually gets worse as time goes by. One reason for this is the damage that long-lasting inflammation can do to your digestive tract.
To stop that from happening, your doctor will try to get your condition under control early on. They'll treat your symptoms and do what they can to reduce the inflammation in your body.
But Crohn's is unpredictable. You'll probably have flare-ups from time to time, followed by times when you have fewer symptoms (remissions). Your doctor's goal is to increase the time you're in remission, and decrease your flares.
They also want to prevent problems like:
- Ulcers (sores) in your digestive tract
- Fistulas, abnormal passages between your bowel and nearby organs
- Strictures, in which scar tissue narrows your intestine. This can lead to bowel obstructions, which block or slow down the passage of digested food.
- Anal fissures, tears in the tissue in and around your anus
- Abscesses, pockets of pus caused by infection. They can show up in your belly, pelvis, or near your anus.
- Malnutrition, which can happen when your body doesn't absorb enough nutrients or when you don't eat and drink enough
- Inflammation beyond your bowels. It can affect your eyes and many other organs
When Is Crohn's More Likely to Progress?
How much of your body is affected by Crohn’s disease, how old you are when it starts, and how active it is all play a role in how likely you are to develop serious problems. These things also guide your doctor’s treatment.
Your chances of the disease getting worse or causing serious complications are higher if:
- You were diagnosed as a child or teen
- Crohn's affects a larger area of your body. It often happens in certain parts of your colon and small intestine, but can cause inflammation anywhere in your digestive tract.
- You have fat deep in your abdomen and around your organs
- You have fistulas or bowel obstructions
- Your rectum and/or the area around your anus are badly affected
How Your Medications May Change
If you keep having symptoms or your Crohn's gets worse, your doctor might change your medication, the dosage, or how often you take it. They may also recommend lifestyle changes such as changing your diet or taking steps to reduce stress.
If remission isn’t possible, they'll try to make your disease less severe.
When your disease is mild, doctors often start with aminosalicylates, drugs that fight inflammation in your intestine. They may also prescribe antibiotics to kill bacteria in inflamed parts of your bowel. You might take anti-diarrhea medicines as well.
Your doctor may prescribe corticosteroids to help stop a flare. But you likely won't use these long-term, as they can have bothersome side effects.
If aminosalicylates don't work for you, your doctor may recommend a type of drug called an immunomodulator. These medicines suppress your immune system to keep inflammation in check.
If your Crohn's is moderate or severe and hasn't responded to other medicines, you may take a biologic drug. These are basically antibodies that keep your immune system from causing inflammation. You get them in a shot or through an IV. You might take a biologic and an immunomodulatory at the same time.
Other Treatments
At times when you're having serious symptoms, your doctor might recommend bowel rest to help your intestines repair. You may not eat or drink at all during this time. Or you'll consume a special liquid. You can get nutrients through a feeding tube in your stomach or small intestine, or through an IV. It can take a few days to a few weeks. You could do it at home or in the hospital.
Up to 75% of those with Crohn’s need surgery at some point. Your doctor may remove part of your bowel to treat your symptoms when medication isn't helping. Or they might do surgery to repair complications like blockages and fistulas.
Your doctor may take out part of your small or large intestine. Or they might remove your colon and rectum altogether.
If that happens, they create a permanent opening in your abdomen, called a stoma. It's connected to the end of your small intestine. An ostomy pouch attaches to it on the outside. Your poop now flows through the stoma into the bag.
Treatment for Complications
Even if you don't need surgery, your doctor might change your treatment to manage the complications of Crohn's.
If you have an abscess or fistula, your doctor may give you antibiotics to help with infection. They'll drain the abscess, too. You might also need to change your diet.
If you have anal fissures, home treatments like ointments and warm baths may help. Diet changes can, too.
If Crohn’s disease complications stop you from getting enough nutrients, your doctor could give you a feeding tube, IV fluids, or supplements.
