The Crohn’s Complication You Need to Know About: Short Bowel Syndrome

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Crohn’s disease is no picnic, and on top of unpleasant symptoms, complications can make things even more, well, complicated. Short bowel syndrome is one of them, and it can occur if you have significant portions of your small intestine surgically removed. Between 10,000 and 20,000 Americans are living with the condition, but there’s good news, too: It can be managed with medication, nutrition, and/or surgery.

Here’s what you need to know.


Small intestine section in microscopy
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What Is Short Bowel Syndrome?

Your small intestine helps you digest your food; it absorbs most of the nutrients and water that keep your body running smoothly. Some people with Crohn’s disease have small sections of the small intestine surgically removed without incident. But if you’ve had at least half of your small intestine removed, the remaining portion of intestine may not be able to absorb enough water, vitamins, minerals, and nutrients to keep you healthy. This can be life-threatening for some people.


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What Causes Short Bowel Syndrome?

While many people with short bowel syndrome have had significant portions of small intestine surgically removed due to Crohn’s disease, that’s not always the cause. Some people are born with the condition, and it may develop in others due to illness, injury, or surgery if the small intestine is compromised. For example, some people who have had bariatric surgery, intestinal cancer, or radiation therapy affecting the small intestine may develop short bowel syndrome, according to the Crohn’s and Colitis Foundation of America.


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Symptoms

The most common symptom of short bowel syndrome is chronic diarrhea, which can lead to dehydration. You may also experience the following, according to Crohn’s and Colitis Foundation of America:

  • Stomach cramps
  • Bloating
  • Fatigue
  • Flatulence
  • Vomiting
  • Heartburn
  • Stool that smells foul or stool that’s greasy and pale

Some people also lose weight or experience swelling in the feet or legs. You may have vision problems, decreased bone mass, muscle spasms, tingly skin sensations, a tendency to bruise easily, or trouble breathing if the condition causes vitamin deficiencies.


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Diagnosis

If you’ve had portions of your small intestine surgically removed and you experience symptoms of short bowel syndrome, your doctor may examine you, offer blood tests, or examine your stool to diagnose the condition. During a physical exam, they’ll check for weight loss and signs of vitamin deficiency. Blood tests can show the vitamin and mineral content of your blood. Stool tests can show how much fat and other nutrients aren’t being absorbed by your body. Sometimes, X-ray or CT scan is used.


Kidney stones traveling down the ureter
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Complications

Yes, this complication can have its own complications — great. But if your small intestine doesn’t absorb enough nutrients, you may develop vitamin or mineral deficiencies, some of which can cause brain damage or skin or bone problems, according to the Crohn’s and Colitis Foundation of America.

Additionally, your electrolyte levels may become unbalanced, causing muscle problems or irregular heartbeat, or you may develop painful kidney stones. Bacteria may grow uncontrollably in your small intestine (which normally hosts very few bacteria), causing diarrhea or bloating.


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Treatment Is Possible

Thankfully, there are ways to treat short bowel syndrome and to minimize the risk of the complications above. Options include drugs, diet changes, surgery, and, in severe cases, transplant. Read on to learn more about each of these possible routes to relief.


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Treatment: Medication

A number of drugs may treat short bowel syndrome, according to the Crohn’s and Colitis Foundation of America. Anti-diarrheal medication can reduce the speed of food passing through the small intestine, allowing for more absorption time. Drugs that reduce gastric acid can help to relieve painful symptoms. Glutamine and growth hormone may help the small intestine absorb nutrients more efficiently. If you receive nutrition intravenously, teduglutide may help reduce your dependence on IV nutrition.


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Treatment: Diet Modification

Depending on the severity of your condition, you may receive nutrition by eating, through a feeding tube, intravenously (through an IV) or by more than one means. If you’re able to eat, the foods your doctor or registered dietitian recommend will be based on several factors, including whether or not your colon has been removed. You may be told to avoid caffeine and alcohol, eat small meals, and chew your food well. Water or oral rehydration drinks may help you get enough fluids. You may also need supplements.


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Treatment: Surgery

About half of people with short bowel syndrome need to have surgery to help the remaining portion of small intestine absorb nutrients and water more effectively. Some procedures are done to prevent blockages within the small intestine. Other procedures preserve the existing length of small intestine or extend its length. Still other procedures slow the speed of food traveling through the small intestine so that there’s a greater opportunity for it to absorb nutrients.


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Treatment: Transplant

Intestinal transplant is usually reserved for people receiving nutrition through an IV (bypassing the digestive tract) who develop with life-threatening problems. A full, healthy small intestine may be transplanted from a donor, or a living donor may provide a portion of small intestine for a transplant, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Transplantation risks include infection, liver failure, and rejection of the new intestine.


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Prevention

Unfortunately, there isn’t much that can be done on a day-to-day basis to prevent short bowel syndrome. For example, there’s no evidence that changing up your diet can reduce your risk, per the NIDDK.

However, if you have Crohn’s and are concerned about getting short bowel syndrome after repeated surgeries to the small intestine, talk to your doctor: There may be ways they can reduce your risk of short bowel syndrome by minimizing scar tissue during your surgeries, lowering the odds of a future operation, according to the National Institute of Diabetes and Digestive and Kidney Diseases. It may also be possible for your doctor to widen your small intestine, which may also reduce the need for multiple surgeries. Reducing your number of surgeries along with catching complications early can help lower your chances of developing short bowel syndrome.