What If You Need Surgery for Crohn's Disease?
If you have Crohn’s disease, there’s a good chance you may need surgery at some point — up to 75 percent of people with Crohn’s eventually do have surgical procedures, according to the Crohn’s and Colitis Foundation (CCF). Surgery may help to reduce your symptoms and improve your quality of life, so if your doctor recommends it or you decide to go for it, it can be a good decision for your overall health. Here’s what you should know.
Elective surgery for Crohn's disease
Certain people opt for surgery because they can’t cope with their symptoms anymore: If other treatments can’t control their pain, cramping, diarrhea, or rectal bleeding, they may seek surgery to improve their quality of life, according to the CCF. Other people choose surgery when the medication they’ve been using stops working, or it begins to cause severe side effects, and they aren’t able to find another effective medication to control symptoms.
Emergency surgery for Crohn's disease
People with Crohn’s may need surgery quickly for different reasons. An intestinal blockage can be life-threatening if it isn’t addressed. Crohn’s can cause bowel walls to weaken, which could lead to holes (perforations) requiring surgical repair. Ulcers within bowel walls (fistulas) may wreak havoc; surgery can help. For an abscess, surgery is needed to drain pus. Rarely, excessive bleeding can only be controlled with surgery. And surgery may help when toxic megacolon strikes.
Common types of surgery related to Crohn's
If you have a damaged section of the small or large intestine, your doctor may remove it, leaving as much healthy tissue behind as possible, then connect the two healthy ends together (resection). Surgeons also do procedures to widen narrow areas (strictures) and remove the colon, with or without the rectum. If the colon and rectum are both removed, your surgeon will create a stoma (the end of your intestine protruding from your abdomen) to connect to an ostomy bag.
Minimally invasive surgery
Your doctor may perform minimally invasive surgery (also called laparoscopic surgery) through small incisions in the abdomen, which can reduce your pain and risk of infection during recovery and shorten your hospital stay, according to the CCF. You may be a candidate if you’re scheduled for elective surgery, aren’t obese, and haven’t had surgery before. Laparoscopic surgery may not be performed during emergency procedures, when your life is in danger.
Surgery to lower cancer risk
The risk of colorectal cancer is higher among people with Crohn’s disease whose colons are affected. Eight to 10 years after diagnosis, the chances of developing cancer becomes more likely, so doctors may prescribe colonoscopy with biopsy every year or two for people who have had Crohn’s for this long, according to the CCF. If any abnormal tissue is found, even if it isn’t cancer, people may decide to have the colon and rectum surgically removed to prevent the cancer from developing.
Complications from Crohn's-related surgery
With any surgery, there’s always a risk of complications. After you have surgery for Crohn’s disease, you may develop an infection. (If you’ve had surgery to remove your colon, an infection around the stoma is also possible.) Other complications after surgery include intestinal bleeding, abscess, fistula, intestinal blockage, and a surgical wound healing more slowly than desired. Hemorrhaging in the gut is rare but possible.
Depending on the type of surgery you have, you may need to adjust to life with an ostomy bag. You can learn how to care for your stoma, and how to empty or replace ostomy bags, while you’re in the hospital after surgery. It can be easy to learn but hard to accept your “new normal.” If you feel upset or alone, consider joining a local support group to meet other people who are living life — working, exercising, having sex — while wearing ostomy bags.
Treatment after surgery
It’s important to keep seeing your GI doctor after your procedure, because Crohn’s can’t be cured by surgery. If you’re told to eat a certain way or take medication afterward, following the advice can help. Your doctor may prescribe a powerful biologic drug like infliximab, which may help to keep your Crohn’s disease under control and lower your risk of needing surgery again in the future.
Changes to your diet
After surgery, you may have to eat differently, either for a short while or for the long term, according to the CCF. Listening to your doctor’s suggestions can help you avoid feeling ill. You may need to take supplements if the surgery impacted your ability to absorb nutrients from food. Drinking plenty of water and eating well-balanced meals with nutrient-rich foods is ideal. Spicy food, raw produce, or dried fruits may cause discomfort. Skipping meals or having an empty stomach may cause gas.
Hope for the future
Biologic drugs have helped some people with Crohn’s disease reverse gut inflammation to the point where they don’t have symptoms for long periods of time (remission). This helps to slow the disease’s progress in your body. Doctors are hopeful that as more Crohn’s treatment advances are made, people may be able to delay the need for surgery for longer periods of time, or even indefinitely.