Symptom Management

Symptom Management

Diarrhea and Constipation

The following are some ways of managing diarrhea, constipation, or both:

• Mild to moderate diarrhea may be reduced by taking one teaspoon of psyllium hydrophilic colloid (Metamucil) twice a day in a glass of water.
• Antidiarrheal drugs include loperamide (Imodium) and a combination of atropine and diphenoxylate (Lomotil). In very ill patients, large doses of some antidiarrheal drugs, such as Lomotil, can trigger the onset of toxic megacolon. Toxic megacolon is a life-threatening complication of other intestinal conditions. It is characterized by a very inflated colon, abdominal distention, and sometimes fever, abdominal pain, or shock.
• Opiates or drugs used to relax muscle spasms may help relieve mild to moderate diarrhea and abdominal cramps, but they should be used for very short periods and not for severe cases.
• Cholestyramine (Questran) has been found to be useful for reducing diarrhea in patients who have had ileal resections.
• Bulk-type laxatives can help constipation.

Treating Anemia

Iron supplements may be required for anemia. Intravenous iron with or without erythropoietin (a hormone that acts in the bone marrow to increase the production of red blood cells) is effective for severe anemia in IBD that does not respond to iron alone. Patients with Crohn's disease benefit most from the combination.

Antidepressants

Antidepressants may help relieve emotional problems. However, inflammatory bowel disease is not a psychologic disorder, and such drugs will not affect the basic illness.

Pain-Relievers

Acetaminophen (Tylenol) is the drug of choice for mild pain. Acetaminophen is not a nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include, among dozens of others, aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and Celebrex, the only Cox-2 inhibitor left on the market. NSAIDs have been thought to cause symptom flare-ups in patients with IBD. However, a comprehensive 2006 study concluded that these drugs are as safe for patients with IBD as for other people, and that they can help prevent relapse as well as provide short-term pain relief. Patients should discuss with their doctors whether NSAIDs are appropriate for them.

Stress Reduction

Although stress is not a cause of inflammatory bowel disease, there are reports of an association between stress and symptom flare-ups. Although no evidence exists to confirm that stress reduction techniques such as relaxation methods, meditation, or cognitive therapy, manage the disease, they might be helpful.

Exercise

The effects of exercise in Crohn's disease are uncertain. Some research indicates that moderate exercise may trigger excess production of chemicals that could cause flare-up. One small study, however, reported significant improvement in patients who had been sedentary and who then embarked on a 12-week exercise program. They walked a little over 2 miles three times a week. During that period there were no flare-ups, and they felt physically and emotionally better than before.