The early signs of active Crohn’s inflammation — also known as a flare (or a relapse, if you’ve had active inflammation before) — include diarrhea, abdominal cramping, and rectal bleeding. Over time, other, more serious complications can develop.
That’s because the inflammation caused by Crohn’s disease doesn’t occur in just one layer of the bowel wall. “It can spread throughout all the layers,” says Adam Cheifetz, MD, director of the center for inflammatory bowel disease at Beth Israel Deaconess Medical Center and a professor of medicine at Harvard Medical School in Boston.
This can lead to perianal fistulas — or tunnels that lead from the anal canal (rectum) to an external opening in the skin near the anus. This complication affects around one-third of people with Crohn’s, according to research, while Black people with the disease face even higher rates and often develop more severe fistulas.
Inflammation can also cause strictures, in which scar tissue narrows the intestinal wall, and can eventually lead to bowel obstructions — they occur in up to 54 percent of people with Crohn’s within 20 years of being diagnosed.
Once Crohn’s has progressed to the stage at which fistulas or strictures form, surgery is often necessary. Surgery is not a cure, however, says Dr. Cheifetz.
Surgery may be necessary when scar tissue causes a potentially dangerous situation, as with strictures. “Medicine may work to heal inflammation, but it doesn’t work on scar tissue,” says Michele Rubin, MSN, an inflammatory bowel disease advanced practice nurse at University of Chicago Medicine.
The longer the disease goes untreated, the more dangerous the effects of chronic inflammation become. Without properly managing Crohn’s using medication, you’ll increase the risk of complications, hospitalizations, disability, time off from work, surgery, and a decreased quality of life.
If symptoms lead you to suspect you may have Crohn’s, ask for a referral to a gastroenterologist who specializes in IBD. “[Preventing complications by starting treatment] is why an early diagnosis of Crohn’s disease is essential,” says Rubin.
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