Crohn's disease

Treatment plan for Crohn's disease

Surgery

Mild disease is more often than not treated with appropriate medications - surgery is usually reserved for more severe cases, or if complications arise. If you do not need to have surgery, don't worry about the section about preparing for your surgery, and the questionnaire.

Surgery as a treatment option

Usually, treatment with medication is the first option for people with Crohn's disease. Surgery may be needed, however, if there are serious complications (eg, stenosing or stricturing disease) or to achieve remission (no symptoms) in people with inflammation or fistulas who have not had good results from medication. For optimum results, surgery is performed in patients who are less than 65 years of age.

More than half of people with Crohn's disease will benefit from surgery at some point. One benefit of surgery is that the resulting remission tends to be long-lasting, sometimes giving many years of symptom relief. Some people are even able to stop taking daily medicine for Crohn's disease. Even surgery, however, does not cure Crohn's disease and the inflammation may reappear elsewhere in the intestine later on.

Several different types of surgery may be performed, based on the type of complication, the severity of illness, and the part of the digestive system that is affected. The most common types of surgery used in people with Crohn's disease are described below.

Common types of surgery for Crohn's disease                      back to top

Resection: This is the most common type of surgery for people with Crohn's disease. With this procedure, the surgeon removes a part of the intestine that is diseased and joins together the two healthy ends. This procedure may also be used to remove a fistula that hasn't responded well to medication.

Strictureplasty: This surgery is used to open up a stricture (a narrowed part of the intestine). In this procedure, the surgeon makes an incision lengthwise along the stricture and closes it crosswise, widening the diameter of the diseased intestine.

Colectomy or proctolectomy: Complete removal of the colon and/or rectum. Some people with severe Crohn's disease need to have the entire colon removed. If the rectum is not affected, it may be possible to join the end of the small intestine (called the ileum) to the rectum to allow the person to pass stools normally. If the rectum is also removed, a stoma (opening) is usually created in the abdomen for the removal of waste from the small intestine (called an ileostomy). A bag must be worn on the abdomen to catch the waste. The stoma is usually created in the right lower abdomen near the belt line.

If you have an abscess (an infected mass filled with pus which is tender to the touch), it may need to be drained with the use of a needle inserted through the skin. The doctor will use an echography or a CT scan to guide the needle to the right place.

Preparing for your surgical consultation                         back to top

Making the decision to have surgery can be difficult. If you are feeling frightened or anxious at the thought of having surgery, it may help to have a good understanding of what to expect, both before and after. Sometimes it is helpful to meet other patients who had already had the same surgical procedure as they will be able to allay your concerns. Your surgical consultation will give you an opportunity to ask any questions that may be on your mind. In this appointment you will have a chance to meet your surgeon and discuss the procedure to be performed, including what you should do to prepare for it.

Some people fear surgery so much that they put if off for years or even tell their doctor they are feeling well when they really aren't. This can lead to unnecessary pain and could prevent you from getting in control of your Crohn's disease more quickly. Surgery can give ongoing relief from symptoms and may even help you stop taking your daily medicine. Also, remember that surgery may be your best chance of taking control of your disease and help get you back to doing the things you used to do as soon as possible and give you the best quality of life.

The following list of questions is provided to help you prepare for your consultation with your surgeon.

Questions to ask your surgeon                                                    back to top

Here are a few example questions you might want to ask your surgeon during the consultation. Use the space under each question on the PDF to write notes following your discussion. Click on the icon to open and print the PDF.

1. What are the benefits and risks involved with this procedure? Knowing what to expect both before and after the surgery will help you prepare and plan ahead.

2. If we decide together that surgery is the best option at this time, how long will I have to wait? Once you understand the potential benefits of surgery, you may want to get it done as quickly as possible. However, there may be reasons to wait a while - or have it very soon - so it is best to discuss timings with your doctor and set your expectations.

3. How long will it take before I start feeling better? This is important to consider so you can plan time off work and line up help from family and friends. It may take a few weeks before you are able to get entirely back on your feet and start moving around again as you used to.

4. When can I have sex again? Do not be afraid to ask this question of your surgeon. Even if your surgeon says you are well enough, you might not feel ready, so just take your time and communicate with your partner as well.

5. Will I have to make any lifestyle changes as a result of my surgery? If you have any concerns about whether you will be able to continue some of your existing activities (eg, sporting hobbies) then raise these with your surgeon and they will be able to give you lots of tips and advice.

Before and after surgery                                                                   back to top

Here are some general considerations to help you prepare for and recover from surgery.

• Before the surgery, your doctor may tell you that you need to build up your nutrition. He or she should give you instructions for how to do this.

• Allow others to help you, even with the simplest of tasks. If you need help carrying the groceries or lifting something heavy, ask for help. Most likely, family and friends will want to help but may not always know what you need them to do and would appreciate your telling them.

• You may have some other points to discuss concerning your return home after surgery.

• Once you get the clear signal from your doctor, try to start moving around again. This will help to get your bowels active again, and also help you feel better. Start gradually and don't push yourself to do too much too soon.

• Your doctor may place you on maintenance medication after surgery to prevent symptoms from coming back. Make sure you have a clear understanding of your dose and how often to take the medicine, including details such as whether to take it with/without food or at a certain time in the day (eg, just before bedtime).

• If your ileum (lower part of the small intestine) is removed, you may have bile salt diarrhoea. If your colon is removed, you may have diarrhoea because your body cannot absorb salts and water as usual.

• You may wish also to discuss various aspects of your current lifestyle.