Treatment plan for Crohn's disease
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.
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.
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
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
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.
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.
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
back to top
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.
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.
following list of questions is provided to help you prepare for your
consultation with your surgeon.
Questions to ask your surgeon
back to top
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
1. What are the benefits and risks involved with
Knowing what to expect both before and after the surgery will help you
prepare and plan ahead.
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.
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.
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.
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
are some general considerations to help you prepare for and recover from
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
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
may have some other points to discuss concerning your return home
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).
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.
may wish also to discuss various aspects of your current lifestyle.