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Signs and symptoms of Crohn's disease can range from mild to severe and may develop gradually or come on suddenly, without warning. You may also have periods of time when you have no signs or symptoms (remission). When the disease is active, signs and symptoms may include:

• Diarrhea. The inflammation that occurs in Crohn's disease causes cells in the affected areas of your intestine to secrete large amounts of water and salt. Because the colon can't completely absorb this excess fluid, you develop diarrhea. Intensified intestinal cramping also can contribute to loose stools. Diarrhea is the most common problem for people with Crohn's.
• Abdominal pain and cramping. Inflammation and ulceration may cause the walls of portions of your bowel to swell and eventually thicken with scar tissue. This affects the normal movement of contents through your digestive tract and may lead to pain and cramping. Mild Crohn's disease usually causes slight to moderate intestinal discomfort, but in more-serious cases, the pain may be severe and include nausea and vomiting.
• Blood in your stool. Food moving through your digestive tract may cause inflamed tissue to bleed, or your bowel may also bleed on its own. You might notice bright red blood in the toilet bowl or darker blood mixed with your stool. You can also have bleeding you don't see (occult blood).
• Ulcers. Crohn's disease can cause small sores on the surface of the intestine that eventually become large ulcers that penetrate deep into — and sometimes through — the intestinal walls. You may also have ulcers in your mouth similar to canker sores.
• Reduced appetite and weight loss. Abdominal pain and cramping and the inflammatory reaction in the wall of your bowel can affect both your appetite and your ability to digest and absorb food.

Other signs and symptoms
People with severe Crohn's disease may also experience:

• Fever
• Fatigue
• Arthritis
• Eye inflammation
• Skin disorders
• Inflammation of the liver or bile ducts
• Delayed growth or sexual development, in children

When to see a doctor
See your doctor if you have persistent changes in your bowel habits or if you have any of the signs and symptoms of Crohn's disease, such as:

• Abdominal pain
• Blood in your stool
• Ongoing bouts of diarrhea that don't respond to over-the-counter (OTC) medications
• Unexplained fever lasting more than a day or two

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

The exact cause of Crohn's disease remains unknown. Previously, diet and stress were suspect, but now doctors know that although these factors may aggravate existing Crohn's disease, they don't cause it. Now, researchers believe that a number of factors, such as heredity and a malfunctioning immune system, play a role in the development of Crohn's disease.

• Immune system. It's possible that a virus or bacterium may cause Crohn's disease. When your immune system tries to fight off the invading microorganism, the digestive tract becomes inflamed. Currently, many investigators believe that some people with the disease develop it because of an abnormal immune response to bacteria that normally live in the intestine.
• Heredity. Mutations in a gene called NOD2 tend to occur frequently in people with Crohn's disease and seem to be associated with a higher likelihood of needing surgery for the disease. Scientists continue to search for other genetic mutations that might play a role in Crohn's.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Risk factors for Crohn's disease may include:

• Age. Crohn's disease can occur at any age, but you're likely to develop the condition when you're young. Most people are diagnosed with Crohn's between the ages of 20 and 30.
• Ethnicity. Although whites have the highest risk of the disease, it can affect any ethnic group. If you're of Ashkenazi Jewish descent, your risk is even higher.
• Family history. You're at higher risk if you have a close relative, such as a parent, sibling or child, with the disease. As many as 1 in 5 people with Crohn's disease has a family member with the disease.
• Cigarette smoking. Cigarette smoking is the most important controllable risk factor for developing Crohn's disease. Smoking also leads to more severe disease and a greater risk of surgery. If you smoke, stop. Discuss this with your doctor and get help. There are many smoking-cessation programs available if you are unable to quit on your own.
• Where you live. If you live in an urban area or in an industrialized country, you're more likely to develop Crohn's disease. Because Crohn's disease occurs more often among people living in cities and industrial nations, it may be that environmental factors, including a diet high in fat or refined foods, play a role in Crohn's disease. People living in northern climates also seem to have a greater risk of the disease.
• Isotretinoin (Accutane) use. Isotretinoin (Accutane) is a powerful medication sometimes used to treat scarring cystic acne or acne that doesn't respond to other treatments. Although cause and effect hasn't been proved, studies have reported the development of inflammatory bowel disease with isotretinoin use.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Although these medications — ibuprofen (Advil, Motrin, others), naproxen (Aleve), diclofenac (Cataflam, Voltaren), piroxicam (Feldene), and others — haven't been shown to cause Crohn's disease, they can cause similar signs and symptoms. Additionally, theses medications can make existing Crohn's disease worse.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Crohn's disease may lead to one or more of the following complications:

• Bowel obstruction. Crohn's disease affects the entire thickness of the intestinal wall. Over time, parts of the bowel can thicken and narrow, which may block the flow of digestive contents through the affected part of your intestine. Some cases require surgery to remove the diseased portion of your bowel.
• Ulcers. Chronic inflammation can lead to open sores (ulcers) anywhere in your digestive tract, including your mouth and anus, and in the genital area (perineum) and anus.
• Fistulas. Sometimes ulcers can extend completely through the intestinal wall, creating a fistula — an abnormal connection between different parts of your intestine, between your intestine and skin, or between your intestine and another organ, such as the bladder or vagina. When internal fistulas develop, food may bypass areas of the bowel that are necessary for absorption. An external fistula can cause continuous drainage of bowel contents to your skin, and in some cases, a fistula may become infected and form an abscess, a problem that can be life-threatening if left untreated.
• Anal fissure. This is a crack, or cleft, in the anus or in the skin around the anus where infections can occur. It's often associated with painful bowel movements.
• Malnutrition. Diarrhea, abdominal pain and cramping may make it difficult for you to eat or for your intestine to absorb enough nutrients to keep you nourished. Additionally, anemia is common in people with Crohn's disease.
• Other health problems. In addition to inflammation and ulcers in the digestive tract, Crohn's disease can cause problems in other parts of the body, such as arthritis, inflammation of the eyes or skin, clubbing of the fingernails, kidney stones, gallstones and, occasionally, inflammation of the bile ducts. People with long-standing Crohn's disease also may develop osteoporosis, a condition that causes weak, brittle bones.

IBD and colon cancer
Having Crohn's disease increases your risk of colon cancer. Despite this increased risk, more than 90 percent of people with inflammatory bowel disease never develop cancer.

Your risk is greatest if you've had inflammatory bowel disease for at least eight years and if it has spread through your entire colon. The longer you've had the disease and the larger the area affected, the greater your risk of colon cancer. The risk of other cancers also is increased, including cancer of the anus.

Medications and cancer risk
Immune system suppressors also are associated with a small risk of cancer development. These include azathioprine, mercaptopurine, methotrexate, infliximab and others. The risk may be due to the immune system suppression that these medications cause. While these medications do increase risk, they may be necessary for people with Crohn's disease to improve quality of life and avoid surgery or hospitalization. Work with your doctor to determine which medications are right for you.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Symptoms of Crohn's disease may first prompt a visit to your family doctor or general practitioner. However, you may then be referred to a doctor who specializes in treating digestive disorders (gastroenterologist).

Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Ask a family member or friend to come with you to your appointment, if possible. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your visit. List your questions from most important to least important in case time runs out. For Crohn's disease, some basic questions to ask your doctor include:

• What's causing these symptoms?
• Are there other possible causes for my symptoms?
• What kinds of tests do I need? Do these tests require any special preparation?
• Is this condition temporary or long lasting?
• What treatments are available, and which do you recommend?
• Are there any medications that I should avoid?
• What types of side effects can I expect from treatment?
• Are there any alternatives to the primary approach that you're suggesting?
• I have other health conditions. How can I best manage them together?
• Do I need to follow any dietary restrictions?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?
• Is there a risk to me or my child if I become pregnant?
• Is there a risk of complications to my partner's pregnancy if I have Crohn's disease and father a child?
• What is the risk to my child of developing Crohn's disease if I have it?
• What are the best sources of information to learn about Crohn's disease?
• Are there support groups for people with Crohn's and their families?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or intermittent?
• How severe are your symptoms?
• Do your symptoms affect your ability to work or do other activities?
• Does anything seem to improve your symptoms?
• Is there anything that you've noticed that makes your symptoms worse?
• Do you smoke?
• Do you take nonsteroidal anti-inflammatory medications (ibuprofen, naproxen, diclofenac, others)?

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Your doctor will likely diagnose Crohn's disease only after ruling out other possible causes for your signs and symptoms, including irritable bowel syndrome (IBS), diverticulitis and colon cancer. To help confirm a diagnosis of Crohn's disease, you may have one or more of the following tests and procedures:

• Blood tests. Your doctor may suggest blood tests to check for anemia — a condition in which there aren't enough red blood cells to carry adequate oxygen to your tissues — or to check for signs of infection. Two tests that look for the presence of certain antibodies can sometimes help diagnose which type of inflammatory bowel disease you have, but not everyone with Crohn's disease or ulcerative colitis has these antibodies. While your doctor may order these tests, a positive finding doesn't mean you have Crohn's disease and a negative finding doesn't mean that you're free of the disease.
• Fecal occult blood test (FOBT). You may need to provide a stool sample so that your doctor can test for blood in your stool.
• Colonoscopy. This test allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis, which may help confirm a diagnosis. Some people have clusters of inflammatory cells called granulomas, which help confirm the diagnosis of Crohn's disease because granulomas don't occur with ulcerative colitis. In the majority of people with Crohn's, granulomas aren't present and diagnosis is made through biopsy and the location of the disease. Risks of colonoscopy include perforation of the colon wall and bleeding.
• Flexible sigmoidoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the sigmoid, the last section of your colon.
• Barium enema. This diagnostic test allows your doctor to evaluate your large intestine with an X-ray. Before the test, your receive an enema with a contrast dye containing barium. Sometimes, air also is added. The barium dye coats the lining of the bowel, creating a silhouette of your rectum, colon and a portion of your small intestine that's visible on an X-ray.
• Small bowel imaging. This test looks at the part of the small bowel that can't be seen by colonoscopy. After you drink a solution containing barium, X-ray, CT or MRI images are taken of your small intestine. The test can help locate areas of narrowing or inflammation in the small bowel that are seen in Crohn's disease. The test can also help your doctor determine which type of inflammatory bowel disease you have.
• Computerized tomography (CT). Sometimes you may have a CT scan, a special X-ray technique that provides more detail than a standard X-ray does. This test looks at the entire bowel as well as at tissues outside the bowel that can't be seen with other tests. Your doctor may order this scan to better understand the location and extent of your disease or to check for complications such as a partial blockages, abscesses or fistulas. Although not invasive, a CT scan exposes you to more radiation than a conventional X-ray does.
• Capsule endoscopy. If you have signs and symptoms that suggest Crohn's disease but other diagnostic tests are negative, your doctor may perform capsule endoscopy. For this test you swallow a capsule that has a camera in it. The camera takes pictures, which are transmitted to a computer that you wear on your belt. The images are then downloaded, displayed on a monitor and checked for signs of Crohn's disease. Once it's made the trip through your digestive system, the camera exits your body painlessly in your stool. Capsule endoscopy is generally very safe, but if you have a partial blockage in the bowel, there's a slight chance the capsule may become lodged in your intestine.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission. Treatment for Crohn's disease usually involves drug therapy or, in certain cases, surgery.

Doctors use several categories of drugs that control inflammation in different ways. But drugs that work well for some people may not work for others, so it may take time to find a medication that helps you. In addition, because some drugs have serious side effects, you'll need to weigh the benefits and risks of any treatment.

Anti-inflammatory drugs
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:

• Sulfasalazine (Azulfidine). Although this drug isn't always effective for treating Crohn's disease, it may be of some help for treating disease involving the colon. It has a number of side effects, including nausea, vomiting, heartburn and headache. Don't take this medication if you're allergic to sulfa medications.
• Mesalamine (Asacol, Rowasa). This medication tends to have fewer side effects than sulfasalazine has, but may cause nausea, vomiting, heartburn, diarrhea and headache. You take it in tablet form or use it rectally in the form of an enema or suppository, depending on which part of your colon is affected. This medication is generally ineffective for disease involving the small intestine.

• Corticosteroids. Corticosteroids can help reduce inflammation anywhere in your body, but they have numerous side effects, including a puffy face, excessive facial hair, night sweats, insomnia and hyperactivity. More serious side effects include high blood pressure, type 2 diabetes, osteoporosis, bone fractures, cataracts and an increased susceptibility to infections. Long-term use of corticosteroids in children can lead to stunted growth.

  Also, these medications don't work for everyone with Crohn's disease. Doctors generally use corticosteroids only if you have moderate to severe inflammatory bowel disease that doesn't respond to other treatments. A newer type of corticosteroid, budesonide (Entocort EC), works faster than do traditional steroids and appears to produce fewer side effects. Entocort EC is effective only in Crohn's disease that involves the lower small intestine and the first part of the large intestine .

  Corticosteroids aren't for long-term use. But, they can be used for short-term (three to four months) symptom improvement and to induce remission. Corticosteroids also may be used with an immune system suppressor — the corticosteroids can induce remission, while the immune system suppressors can help maintain remission.

  Occasionally your doctor may prescribe rectal steroids if you have disease in your lower colon or rectum. These also are only for short-term use.

Immune system suppressors
These drugs also reduce inflammation, but they target your immune system rather than directly treating inflammation. By suppressing the immune response, inflammation is also reduced. Immunosuppressant drugs include:

• Azathioprine (Imuran) and mercaptopurine (Purinethol). These are the most widely used immunosuppressants for treatment of inflammatory bowel disease. Although it can take two to four months for these medications to begin to work, they help reduce signs and symptoms of IBD in general and can heal fistulas from Crohn's disease in particular. If you're taking either of these medications, you'll need to follow up closely with your doctor and have your blood checked regularly to look for side effects.

• Infliximab (Remicade). This drug is for adults and children with moderate to severe Crohn's disease who don't respond to or can't tolerate other treatments. It works by neutralizing a protein produced by your immune system known as tumor necrosis factor (TNF). Infliximab finds TNF in your bloodstream and removes it before it causes inflammation in your intestinal tract.

  Some people with heart failure, people with multiple sclerosis, and those with cancer or a history of cancer can't take infliximab or the other members of this class (adalimumab and certolizumab pegol). Talk to your doctor about the potential risks of taking infliximab. Tuberculosis and other serious infections have been associated with the use of these drugs. If you have an active infection, don't take these medications. You should have a skin test for tuberculosis before taking infliximab and a chest X-ray if you lived or traveled extensively in areas where tuberculosis has been found. In addition, the Food and Drug Administration has issued a warning that children and adolescents taking infliximab and other TNF inhibitors have an increased risk of cancer.

• Adalimumab (Humira). Adalimumab works similarly to infliximab by blocking TNF for people with moderate to severe Crohn's disease. It's prescribed for people who haven't been helped by infliximab or other treatments. Adalimumab is given as an injection under the skin every other week, which you may be able to administer yourself. Adalimumab may reduce the signs and symptoms of Crohn's disease and may cause remission.

  However, adalimumab, like infliximab, carries a small risk of infections, including tuberculosis and serious fungal infections. Your doctor will administer a skin test for tuberculosis before you begin adalimumab treatment. The most common side effects of adalimumab are skin irritation and pain at the injection site, nausea, runny nose and upper respiratory infection.

• Certolizumab pegol (Cimzia). Approved by the Food and Drug Administration (FDA) for the treatment of Crohn's disease, certolizumab pegol works by inhibiting TNF. Certolizumab pegol is prescribed for people with moderate to severe Crohn's who haven't been helped by other treatments. You initially receive certolizumab pegol as one injection every two weeks. After a few injections, if your doctor determines it's working for you, you receive one injection a month. Common side effects include headache, upper respiratory infections, abdominal pain, nausea and reactions at the injection site. Like other medications that inhibit TNF, because this drug affects your immune system, you're also at risk of becoming seriously ill with certain infections, such as tuberculosis.
• Methotrexate (Rheumatrex). This drug, which is used to treat cancer, psoriasis and rheumatoid arthritis, is sometimes used for people with Crohn's disease who don't respond well to other medications. It starts working in about eight weeks or more. Short-term side effects include nausea, fatigue and diarrhea, and rarely, it can cause potentially life-threatening pneumonia. Long-term use can lead to scarring of the liver and sometimes to cancer. Avoid becoming pregnant while taking methotrexate. If you're taking this medication, follow up closely with your doctor and have your blood checked regularly to look for side effects.
• Cyclosporine (Gengraf, Neoral, Sandimmune). This potent drug, often used to help heal Crohn's-related fistulas, is normally reserved for people who don't respond well to other medications. Although effective, cyclosporine has the potential for serious side effects, such as kidney and liver damage, high blood pressure, seizures, fatal infections and an increased risk of lymphoma.
• Natalizumab (Tysabri). This drug works by inhibiting certain immune cell molecules — integrins — from binding to other cells in your intestinal lining. Blocking these molecules is thought to reduce chronic inflammation that occurs when they bind to your intestinal cells. Natalizumab is approved for people with moderate to severe Crohn's disease with evidence of inflammation and who aren't responding well to other conventional Crohn's disease therapies. Because the drug is associated with a rare, but serious, risk of multifocal leukoencephalopathy — a brain infection that usually leads to death or severe disability — you must be enrolled in a special restricted distribution program to use it. This program is called the Crohn's Disease-Tysabri Outreach Unified Commitment to Health (CD-TOUCH) Prescribing Program.

New medications are in development and in clinical trial. If your Crohn's disease isn't well controlled with current medications, ask your doctor if there are clinical trials available to you.

Antibiotics
Antibiotics can heal fistulas and abscesses in people with Crohn's disease. Researchers also believe antibiotics help reduce harmful intestinal bacteria and suppress the intestine's immune system, which can trigger symptoms. Frequently prescribed antibiotics include:

• Metronidazole (Flagyl). Once the most commonly used antibiotic for Crohn's disease, metronidazole can sometimes cause serious side effects, including numbness and tingling in your hands and feet and, occasionally, muscle pain or weakness. If these effects occur, stop the medication and call your doctor. Other side effects include nausea, a metallic taste in your mouth, headache and loss of appetite. You should avoid alcohol while taking this medication.
• Ciprofloxacin (Cipro). This drug, which improves symptoms in some people with Crohn's disease, is now generally preferred to metronidazole. Ciprofloxacin may cause nausea, vomiting, headache and, rarely, tendon problems.

Other medications
In addition to controlling inflammation, some medications may help relieve your signs and symptoms. Depending on the severity of your Crohn's disease, your doctor may recommend one or more of the following:

• Anti-diarrheals. A fiber supplement, such as psyllium powder (Metamucil) or methylcellulose (Citrucel), can help relieve mild to moderate diarrhea by adding bulk to your stool. For more severe diarrhea, loperamide (Imodium) may be effective. Use anti-diarrheals with caution and only after consulting your doctor, because they increase the risk of toxic megacolon, a life-threatening inflammation of your colon.
• Laxatives. In some cases, swelling may cause your intestines to narrow, leading to constipation. Talk to your doctor before taking any laxatives, because even those sold over-the-counter may be too harsh for your system.
• Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others). Avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen (Aleve). These are likely to make your symptoms worse.
• Iron supplements. If you have chronic intestinal bleeding, you may develop iron deficiency anemia. Taking iron supplements may help restore your iron levels to normal and reduce this type of anemia once your bleeding has stopped or diminished.
• Nutrition. Your doctor may recommend a special diet given via a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat your Crohn's disease.  This can improve your overall nutrition and allow the bowel to rest. Bowel rest can reduce inflammation in the short term. However, once regular feeding is restarted, your signs and symptoms may return. Your doctor may use nutrition therapy short term and combine it with other medications, such as immune system suppressors. Enteral and parenteral nutrition are typically used to get people healthier for surgery or when other medications fail to control symptoms.
• Vitamin B-12 shots. Vitamin B-12 helps prevent anemia, promotes normal growth and development, and is essential for proper nerve function. It's absorbed in the terminal ileum, a part of the small intestine often affected by Crohn's disease. If inflammation of your terminal ileum is interfering with your ability to absorb this vitamin, you may need monthly B-12 shots for life. You'll also need lifelong B-12 injections if your terminal ileum has been removed during surgery.
• Calcium and vitamin D supplements. Most people with Crohn's disease need to take a calcium supplement with added vitamin D. This is because Crohn's disease and steroids used to treat it can increase your risk of osteoporosis. Ask your doctor if a calcium supplement is right for you.

Surgery
If diet and lifestyle changes, drug therapy or other treatments don't relieve your signs and symptoms, your doctor may recommend surgery to remove a damaged portion of your digestive tract or to close fistulas or remove scar tissue.

In Crohn's disease, surgery can provide years of remission at best. At the least, it may provide a temporary improvement in your signs and symptoms. During surgery, your surgeon removes a damaged portion of your digestive tract and then reconnects the healthy sections. In addition, surgery may also be used to close fistulas and drain abscesses. A common procedure for Crohn's is strictureplasty, a procedure that widens a segment of the intestine that has become too narrow.

Even so, the benefits of surgery for Crohn's are only temporary. The disease often recurs, frequently near the reconnected tissue or elsewhere in the digestive tract. Nearly 3 of 4 people with Crohn's disease eventually need some type of surgery. Of those, as many as half will need a second procedure, or more. The best approach is to follow surgery with medication to minimize the risk of recurrence.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Sometimes you may feel helpless when facing Crohn's disease. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.

Diet
There's no firm evidence that what you eat actually causes inflammatory bowel disease. But certain foods and beverages can aggravate your signs and symptoms, especially during a flare-up in your condition. If you think there are foods that make your condition worse, try keeping a food diary to keep track of what you're eating as well as how you feel. If you discover certain foods are causing your symptoms to flare, it's a good idea to try eliminating those foods. Here are some suggestions that may help:

• Limit dairy products. Like many people with inflammatory bowel disease, you may find that problems, such as diarrhea, abdominal pain and gas, improve when you limit or eliminate dairy products. You may be lactose intolerant — that is, your body can't digest the milk sugar (lactose) in dairy foods. If so, limiting dairy or using an enzyme product, such as Lactaid, will help break down lactose.
• Try low-fat foods. If you have Crohn's disease of the small intestine, you may not be able to digest or absorb fat normally. Instead, fat passes through your intestine, making your diarrhea worse. Foods that may be especially troublesome include butter, margarine, cream sauces and fried foods.
• Experiment with fiber. For most people, high-fiber foods, such as fresh fruits and vegetables and whole grains, are the foundation of a healthy diet. But if you have inflammatory bowel disease, fiber may make diarrhea, pain and gas worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them. You may also find that you can tolerate some fruits and vegetables, but not others. In general, you may have more problems with foods in the cabbage family, such as broccoli and cauliflower, and nuts, seeds, corn and popcorn. Consult your doctor prior to starting a high-fiber diet.
• Avoid problem foods. Eliminate any other foods that seem to make your signs and symptoms worse. These may include "gassy" foods such as beans, cabbage and broccoli, raw fruit juices and fruits — especially citrus fruits, spicy food, popcorn, alcohol, and foods and drinks that contain caffeine, such as chocolate and soda.
• Eat small meals. You may find you feel better eating five or six small meals a day rather than two or three larger ones.
• Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.

• Consider multivitamins. Because Crohn's disease can interfere with your ability to absorb nutrients and because your diet may be limited, multivitamin and mineral supplements are often helpful. Check with your doctor before taking any vitamins or supplements.
• Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.

Stress
Although stress doesn't cause Crohn's disease, it can make your signs and symptoms much worse and may trigger flare-ups. Stressful events can range from minor annoyances to a move, job loss or the death of a loved one.

When you're stressed, your normal digestive process changes. Your stomach empties more slowly and secretes more acid. Stress can also speed or slow the passage of intestinal contents. It may also cause changes in intestinal tissue itself.

Although it's not always possible to avoid stress, you can learn ways to help manage it. Some of these include:

• Exercise. Even mild exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your doctor about an exercise plan that's right for you.
• Biofeedback. This stress-reduction technique may help you reduce muscle tension and slow your heart rate with the help of a feedback machine. You're then taught how to produce these changes without feedback from the machine. The goal is to help you enter a relaxed state so that you can cope more easily with stress. Biofeedback is usually taught in hospitals and medical centers.
• Regular relaxation and breathing exercises. One way to cope with stress is to regularly relax. You can take classes in yoga and meditation or use books, CDs or DVDs at home.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Many people with either Crohn's disease or ulcerative colitis have used some form of complementary or alternative therapy. Some commonly used therapies include:

• Herbal and nutritional supplements
• Probiotics
• Fish oil
• Acupuncture

Side effects and ineffectiveness of conventional therapies are primary reasons for seeking alternative care.

The majority of alternative therapies aren't regulated by the FDA. Manufacturers can claim that their therapies are safe and effective but don't need to prove it. In some cases that means you'll end up paying for products that don't work. For example, studies done on fish oil and on probiotics for the treatment of Crohn's haven't found benefit. What's more, even natural herbs and supplements can have side effects and cause dangerous interactions. Make sure your doctor is aware if you decide to try any herbal supplement.

Some people may find acupuncture or hypnosis helpful for the management of Crohn's, but neither therapy has been well studied for this use.

Unlike probiotics — which are beneficial live bacteria that you consume — prebiotics are natural compounds found in plants, such as artichokes, that help fuel beneficial intestinal bacteria. An initial study on prebiotics had promising results. More studies are under way.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Crohn's disease doesn't just affect you physically — it takes an emotional toll as well. If signs and symptoms are severe, your life may revolve around a constant need to run to the toilet. In some cases, you may barely be able to leave the house. When you do, you might worry about an accident, and this anxiety only makes your symptoms worse.

Even if your symptoms are mild, gas and abdominal pain can make it difficult to be out in public. You may also feel hampered by dietary restrictions or embarrassed by the nature of your disease. All of these factors — isolation, embarrassment and anxiety — can severely alter your life. Sometimes they may lead to depression.

Educate yourself, and connect
One of the best ways to feel more in control is to find out as much as possible about Crohn's disease. Organizations such as the Crohn's and Colitis Foundation of America (CCFA) have chapters set up across the country to provide information and access to support groups. Your doctor, nurse or dietitian can locate the chapter nearest you, or you can contact the organization directly at 888-MY-GUTPAIN (888-694-8872).

Although support groups aren't for everyone, they can provide valuable information about your condition as well as emotional support. Group members frequently know about the latest medical treatments or integrative therapies. You may also find it reassuring to be among people who understand what you're going through.

Some people find it helpful to consult a psychologist or psychiatrist who's familiar with inflammatory bowel disease and the emotional difficulties it can cause. Although living with Crohn's disease can be discouraging, research is ongoing and the outlook is brighter than it was a few years ago.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.