What is Crohn’s disease?
Crohn’s disease is a form of IBD (inflammatory bowel disease) that can affect regions along the entire digestive tract. This can range from the mouth to the anus. [Source: PubMed]
While most with this condition are more likely to experience diarrhoea, especially when in a flare-up, constipation can also be experienced by some. [Source: PubMed]
In this article, we’ll review the causes and symptoms of Crohn’s disease. We’ll also cover the reasons why constipation may be present and how to address it.
Is constipation common in Crohn’s disease?
While it is not a common symptom, some patients with Crohn’s disease experience trouble going to the toilet or constipation.
Research has found that approximately 5% of those with Crohn’s disease experience constipation when the condition is in remission. [Source: PubMed]
Further studies have reported that many with Crohn’s disease have to strain to pass a stool. While this may not be technically classified as constipation, it indicates that the bowel is not functioning normally. This can be due to inflammation or altered functioning of the bowel wall.
It’s also common that the feeling of incomplete evacuation is reported. This is where a stool is passed, but there is still the sensation or pressure in the bowel, or the need to go to the toilet again. [Source: PubMed]
Constipation may be more common during a period of remission of the disease. This may be due to scar tissue or structures in the bowel leading to constriction and constipation. [Source: PubMed]
It is also more common for patients with Ulcerative colitis (another form of inflammatory bowel disease) to experience constipation, than it is for those with Crohn’s disease. [Source: PubMed]
What is the root cause of Crohn’s disease?
Crohn’s disease is one of the main forms of inflammatory bowel disease, the other being Ulcerative Colitis. While this is different to IBS, there can be a crossover in some of the symptoms.
These symptoms include:
- Abdominal pain
- Bloating
- Food reactions
- Diarrhoea
During a flare-up of Crohn’s disease, additional symptoms can appear. These include:
- Increased pain
- Blood in the stool
- Increased frequency of bowel movements
- Fever [Source: PubMed]
There is not a single cause that leads to Crohn’s disease and constipation. However, the onset of this gut condition is understood to be related to certain risk factors.
The risk factors for Crohn’s disease include:
- Alterations in the gut microbiome (the gut bacteria)
- Disruptions to the gut lining and the gut immune system
- Genetic factors
These risks can be present or increased following factors such as:
- The use of antibiotics
- The use of non-steroidal anti-inflammatory drugs
- Food poisoning
- Gastrointestinal infections
- Smoking
- Appendectomy
- Diet [Source: PubMed]
Rather than a single factor causing this gut condition, a combination can increase the chance or likelihood of this disease developing.
Does Crohn’s disease cause constipation?
The 3 most common symptoms of Crohn’s disease are:
- Abdominal pain
- Vomiting
- Diarrhoea
Over 40% of those with IBD can experience 3 or more stools per day, however, during a flare-up, this can be considerably higher.
Those with Crohn’s disease can experience constipation but it’s also common for there to be faecal incontinence. This is the accidental passing of stool.
One study found that 52% of those with Crohn’s disease experienced faecal incontinence. This can be in the form of stool leaking or a sudden urge and not making it to the toilet in time. This can lead to some patients with Crohn’s disease wearing incontinence pads. [Source: PubMed]
Crohn’s Disease, Constipation and Strictures
A complication of Crohn’s disease is strictures. These are caused by a narrowing of the bowel wall which is understood to develop in Crohn’s patients due to scar tissue accumulating. However, the underlying mechanism is not fully understood.
A high percentage of those with Crohn’s disease will develop strictures. Some research indicates that strictures develop in 70% of those with Crohn’s disease after 10 years of diagnosis. [Source: PubMed]
These narrowing may then contribute to reducing the passage of stool leading to constipation. [Source: MNT]
There are also additional causes of constipation that may impact bowel function in those with Crohn’s disease.
These can include:
- Dehydration
- Underactive thyroid
- Methane SIBO
- IBS
- Sedentary lifestyle [Source: PubMed. PubMed]
How many times a day do you poop with Crohn’s disease?
Bowel movements can vary from person to person depending on their bowel and the severity of Crohn’s disease. It can also depend on if someone is in an active flare-up of the disease or remission.
In remission, patients can report only needing to pass a single stool per day. While in flare-up, this can increase to over 6 bowel movements per day. In some cases, this may be higher still.
A recent study reported that 50% of those with Crohn’s disease had 3 or more bowel movements per day. While only approximately 10% have more than 6 per day.
In Crohn’s disease, the location of the disease in the bowel can greatly influence bowel movements and gut function. For example, involvement in the small intestine may lead to malabsorption contributing to diarrhoea whereas if the location of the disease is in the large intestine, this may lead to rigidity in the bowel wall and poor functioning. [Source: PubMed]
Is constipation an early warning sign of Crohn’s disease?
In Crohn’s disease, it’s common for symptoms to start slow leading to a gradual onset of the condition.
These symptoms can include:
- Weight loss
- Abdominal Pain
- Diarrhoea
- Weakness
- Fatigue
It’s also possible these early warning signs may be initially diagnosed as IBS. This can be a factor that contributes to the average time from symptom onset to diagnosis being 28 months. [Source: PubMed]
What are the 3 highest risk factors for Crohn’s disease?
There is no single cause or risk factor that leads to Crohn’s disease. There however a set of risks that can increase the likelihood of an individual developing Crohn’s disease.
The more of these risk factors present, the higher the chance of developing Crohn’s disease.
The risk factors for Crohn’s disease are:
- Low fibre diet
- Smoking
- Stress
- Poor hygiene
- Low physical activity
- Genetic susceptibility
- Microbiome Imbalances
- Medications
- Poor sleep [Source: PubMed]
Dyssynergic Defecation in Crohn’s Disease
Dyssynergic defecation is a known cause of constipation and refers to the altered and improper coordination of the muscles in the rectum. The poor functioning of these muscles leads to ineffective contractions making it harder to go to the toilet. [Source: PubMed]
This cause of constipation can be present in those with Crohn’s disease. It is also likely to present with discomfort in the rectum and the sense of incomplete evacuation. [Source: PubMed]
In Crohn’s disease, constipation caused by dyssynergic defecation can be the result of changes in bowel habits, disease activity in the anal region and well as the result of surgery.
Biofeedback therapy is often considered in these patients. However, it may be less beneficial in those with strictures of fissures. [Source: PubMed]
Treating Crohn’s disease constipation
The first considerations for treating constipation in those with Crohn’s disease are the same as would be considered in those without this gut condition.
These approaches include:
- Exercise and movement
- Appropriate fluid intake
- Soluble fibre
- Osmotic laxatives
When in remission, microbiome imbalance may also contribute to altered bowel function and constipation. This is commonly referred to as dysbiosis. [Source: PubMed]
Crohn’s disease patients are also at a higher risk of having SIBO, a bacterial overgrowth in the small intestine. This overgrowth may also contribute to constipation. [Source: PubMed, PubMed]
Conclusion
When treating gut conditions, including Crohn’s, a variety of factors may contribute to symptoms such as constipation.
An important consideration is the state of the disease and whether or not there is a flare in the condition. This can be assessed via non-invasive testing such as a calprotectin stool test.
Alongside the first line considerations (fluid, movement and fibre) understanding the balance of the microbiome, in the small and/or large intestine can provide information to guide an approach to resolve constipation.
