What Are the Possible Complications of Inflammatory Bowel Disease (IBD)?

There are several serious complications that can occur as a result of having inflammatory bowel disease. This is where the danger lies. Some complications are common to Crohn's disease and ulcerative colitis, whereas others are unique to one form of IBD or the other. Generally, the complications can be divided into those that occur directly from the inflammation or ulceration that occurs in the intestine and those that occur in areas of the body that are not directly connected to the intestine or directly related to the intestinal inflammation.

 

 

Inflammation and ulcerations can lead to strictures, fistulas, and abscesses in the gut. If these complications are not properly managed, they can, in turn, lead to further tissue damage and uncontrolled infection. Death can occur if this happens. While these complications are often seen in Crohn's disease, they are very rare in ulcerative colitis.

 

 

 

Strictures are not necessarily a problem until they cause a bowel obstruction, commonly referred to as a blockage. Food or other material becomes caught in the narrowed stricture, preventing anything else from passing through. This produces back pressure in the intestine 'upstream' from the stricture, causing sharp, often crampy pain, a distended abdomen, and nausea and vomiting. Sometimes there may be warning signs that a stricture may be worsening or leading to an obstruction. These include frequent or recurrent pain in the center of the abdomen after eating, along with a feeling of distension or bloating of the abdomen.

 

 

 

Bowel Obstruction: Not everyone with a stricture develops intestinal obstruction. If you experience a bowel obstruction that is not severe and know the symptoms, you can sometimes manage it on your own by avoiding solid food and drinking only fluids for several hours or even a few days. If you have a stricture it is important that you avoid eating foods that aren't well digested and that, as a result, may get lodged in the narrowed part of the intestine. These foods include popcorn, nuts, seeds, corn, raw vegetables (particularly stringy ones like celery), and skins on fruits.

 

This complication can be an emergency situation. You will usually require monitoring in a hospital setting, with intravenous fluids given to prevent dehydration and possibly the insertion of a nasogastric tube (a plastic tube inserted through the nose and down the esophagus into the stomach) to take fluid and gas out of the stomach.

 

 

If the obstruction does not settle with these measures, then surgery is usually required to remove the strictured area of bowel. Fortunately, most obstructions that are due to Crohn's disease strictures settle without the immediate need for surgery, but repeated obstructions usually mean that surgery is required. In that instance, the surgery can be scheduled electively so that it is performed when you are well nourished, not sick, and not on medications that might affect healing and recovery after surgery. Medications are not very effective at relieving obstruction, particularly when the narrowing is due to scarring.

 

 

 

 

 

When a deep ulcer penetrates through all of the layers of the intestine, the contents of the intestine, primarily bacteria and fecal material, can leak out and into the abdominal cavity and tissues around the intestine. When a lot of this material leaks out suddenly, it can produce a serious, and occasionally fatal, infection called peritonitis.

 

In Crohn's disease, this leakage normally occurs very gradually, and the tissues around the intestine have a chance to react and to form a barrier against free leakage of the bacteria into the abdominal cavity. As a result, the bacteria accumulate in a localized area that is effectively walled off. The bacteria grow in the center of this walled-off region, causing a localized infection known as an abscess. An abscess typically contains pus in its center.

 

 

Fistulas are abnormal channels or tracts joining one part of the intestine to another part of the intestine or to another organ. When an area of the intestine becomes inflamed and ulcerated, the ulcer can penetrate through the full thickness of the intestine wall into an adjacent tissue. This is promoted by the fact that inflamed intestine tends to be 'sticky' on its outside surface and will attach to other adjacent segments of intestine, to surrounding organs, or to the undersurface of the abdominal wall. When a fistula forms between two segments of intestine, there may be no obvious bad consequences, but it is possible that the fistula can result in ingested food bypassing large segments of the intestine. This can cause decreased absorption of nutrients, leading to weight loss and malnutrition. Fistulas can pass from the intestines to adjacent organs, such as the bladder, which, in turn, leads to recurrent urinary infections.

 

Perianal Fistulas: The most common type of fistula occurs in the area around the anus. These anal fistulas are thought to arise from an infection in the glands just below the lining of the anal opening. The infection can burrow in various directions through the surrounding tissues and eventually open onto the skin in the area outside the anus. These types of fistulas, also called perianal fistulas or perineal fistulas, can be extremely distressing, and, for some individuals, dominate all other manifestations of their Crohn's disease.

 

Pain and Shame: When a fistula goes from the intestine to the skin of the abdominal wall or around the anus, intestinal fluid or stool comes out through the opening of the fistula on the skin. In addition to being unsightly, this intestinal fluid makes it difficult to keep the area clean and can be irritating to the surrounding skin,

 

Because of the location of some fistulas, they can also get in the way of some types of sexual activity. This is not simply a result from the pain that may be associated with a fistula but also from the potential embarrassment or shame of being 'unclean'. If you have these feelings, it is important to realize that you are not alone. Discussing your concerns with your partner will often help soothe some of your fears and concerns about being intimate. Together, you may even be able to come up with sexual activities or positions that you both find pleasurable and that you will not find painful or uncomfortable.

 

People with perianal fistulas can have ongoing episodes of pain around the area of the anus, along with swelling and drainage of mucus, pus, blood, and stool. In women, the inflammation and fistulas can extend from the area around the anus to the area of the vagina. When they are particularly severe, the symptoms related to fistulas can interfere with everyday activities, such as sitting, walking, exercising, and riding a bike.