In my 30 years of dealing with Crohns disease, the dreaded stricture has been the culprit behind my two surgeries. In fact, one of the most common complications of Crohn’s disease is the development of an intestinal stricture.
An intestinal stricture is a narrowing in the intestine that makes it difficult for food to pass through. At least one third of people with Crohn’s will develop a stricture within the first 10 years of diagnosis.
If you are newly diagnosed or want to know more about intestinal strictures, read on to learn about what causes strictures and how they can be treated.
The two main classifications for intestinal strictures are: inflammatory and fibrotic. Inflammatory strictures are caused by the inflammation of the digestive tract that accompanies a Crohn’s flare-up. Fibrotic strictures are the result of scar tissue building up in the bowel due to long periods of inflammation. It is possible for strictures to occur anywhere along the gastrointestinal tract but they are most often found in the last part of the small intestine and in the colon.
I am currently presiding in the “fibrotic strictures” classification, I have been in this situation for over tens years, I do have narrowing in a section of my small bowel, however, due to a strict diet (which followers of my blog know I am tortured by on a daily basis) and biologic medication I have managed to swerve the surgeons knife.
The symptoms of an intestinal stricture can vary depending on the severity of the blockage. For mild to moderate strictures, symptoms include: tummy cramping, fatigue, bloating, tummy pain, severe pain, nausea and vomiting. In my case, I tick all the boxes, this is why it's so hard to treat Crohns as we display so many of the same symptoms.
Treatment for intestinal strictures varies from person to person, depending on the type, length, and location of the stricture. The two strictures I had were both around 12” long, and have occurred in the areas of my previous surgery, which is the last part of the small intestine and in the colon. In my case, the strictures were first treated with steroids, then l began the anti-TNF agents.
For intestinal strictures that don’t respond to medication, endoscopic treatment may help delay or avoid surgery. Unfortunately, the recurrence rate for intestinal strictures is quite high, hence us IBD people have periods of remission followed by relapse.
Both strictures I had didn’t respond to medication so I opted for a resection of the small bowel. I was offered a strictureplasty, which is a procedure where the damaged portion of the bowel is cut open and reshaped. However, after research I opted for the resection as strictureplasty in my case was putting off the inevitable surgery.
If you have an intestinal stricture, you may need to temporarily modify your diet to avoid blocking up the narrowed part of your bowel.The protocol in the UK is for bowel rest, your IBD team may offer you an option of Fortisip which is a Food for Special Medical Purposes for use under medical supervision. Fortisip Compact is a nutritionally complete, high energy ready to drink, milkshake style nutritional supplement.
Fortisips come in a few different flavours, I personally couldn’t tolerate the milkshakes. I also struggled mentally with the challenge of not eating solid food for eight weeks and having to drink ten bottles of milkshake daily. Of course this is just my personal experience, I have spoken to others who tolerate the milkshakes.
As Crohns patients we are faced with some difficult decisions, steroids, medications that come with black box warnings, major surgeries. I guess you could say, it makes us stronger, that it gives us a better perspective on life, which I would agree with, however, if there was ever a choice between having this disease and not having it, I’d go with the second option!
If you have any questions about this blog please DM me.
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