If you have Crohn's disease, you probably know that medication and diet can help control your symptoms to a great extent. But in reality, about 80% of people with the disease will have to undergo surgery at some point in their lives. It's normal to feel a little scared when you hear this, but with proper education, you can overcome that fear. Let's take a look at why this happens, what these surgeries are, and what benefits they can provide you.
Why does Crohn's disease require surgery?
Doctors usually first try to control the disease with medication. However, sometimes if complications arise or if medication is not able to control the disease, surgery may be recommended.
Simply put, there are several main reasons why your doctor might consider surgery.
Common reasons for undergoing surgery
- Intestinal strictures: Crohn's disease causes frequent sores in the intestines, which then heal and form scar tissue. This scarring causes certain areas of the intestine to narrow, making it difficult for food and stool to pass through. This is the main reason why Crohn's patients seek surgery.
- Fistulas and Abscesses: A fistula is simply an abnormal tunnel that forms between two parts of the body. For example, a part of the intestine can connect to the surface of the skin. An abscess is a pus-filled lump inside the abdomen. These require surgery to treat.
- Recurrence: If symptoms recur after treatment, surgery may be needed to remove the damaged part of the intestine that is causing them.
Relatively few reasons for resorting to surgery
- Gastrointestinal (GI) bleeding: If you have uncontrollable bleeding.
- Intestinal perforations: A hole in the intestinal wall caused by the disease.
- Peritonitis: An infection of the membrane lining the abdominal cavity. This can be caused by a perforation of the intestine.
- Cancerous or precancerous lesions: People with Crohn's disease are at increased risk of developing colorectal cancer. If you have this condition.
- Toxic megacolon: A serious condition in which inflammation of the colon causes its structure to collapse, causing it to enlarge and lose function.
Living with Crohn's disease can be frustrating at times. Symptoms can flare up and then subside. This uncertainty can be overwhelming. While surgery may not completely cure Crohn's disease, it can help reduce your pain and allow you to do the things you love again.
Main types of surgery for Crohn's disease
Your doctor will choose the most appropriate surgery for you based on your symptoms and condition. Below are some of the most common types of surgery.
| Type of surgery | Simply explained |
|---|---|
| Removing pus from an abscess | If you have an abscess (acute abdomen) caused by an infection in the abdominal cavity, a procedure is performed to drain the pus. |
| Bowel Resection | A procedure that involves cutting out a damaged or scarred section of the intestine and reconnecting the two healthy parts. This surgery is performed even if cancerous cells are present. |
| Fistula repair/removal | Closing or removing an abnormally formed tunnel (fistula). |
| Ostomy surgery | A stoma is an opening in the skin of the abdomen (abdomen) instead of the rectum to allow stool to pass through. The stool is collected through this opening into a bag that is placed in the abdomen. The most common types are colostomy and ileostomy. |
| Removal of the colon and rectum (Proctocolectomy) | Surgery to remove all or part of the colon and rectum. |
| Widening of narrowed areas in the intestine (Strictureplasty) | Parts of the intestine that are narrowed due to scarring are widened and sewn back together, rather than being cut out. This allows stool to pass more easily. |
How long does this surgery take?
The length of time this will take depends on the type of surgery you have, the severity of your condition, and which part of your bowel is affected. Your doctor will give you the exact details based on your situation.
What are the benefits of surgery?
With today's advanced technology, most Crohn's surgeries are performed laparoscopically, which means they are done through just a few small incisions. This means you don't have a large incision, there are fewer stitches, and there is less pain after the operation .
In addition, surgery may also provide these benefits:
- Decreased stomach pain.
- Reduction in symptoms such as fatigue, diarrhea, and vomiting.
- Reduced need for medication.
- Increased appetite.
- Revitalization of the body, increase in strength.
- Being able to go out and have a social life without fear.
- Improving the quality of life.
But remember, surgery is not a guarantee that symptoms will not return. About 20% of people who have surgery may need another surgery within the first five years.
What are the risks of these surgeries?
As with any surgery, Crohn's surgery carries some risks. Some of the possible complications include:
- Anastomotic leak: A leak where two parts of the intestine are reconnected (anastomosis).
- Bacterial infections: Infection of the surgical wound or abdominal cavity.
- Bowel obstruction: Reoccurrence of intestinal obstruction due to scarring after surgery.
- Excessive bleeding.
- Problems related to the stoma: Things like the ostomy bag not fitting properly to the skin.
- Vitamin B12 deficiency: This condition can occur if the part of the intestine that absorbs vitamin B12 has to be removed.
If any complications arise after surgery, your doctor will develop a treatment plan for them. This may include medication, other treatments, or even another surgery.
How long does it take to heal?
It can take four to twelve weeks to fully recover from Crohn's surgery. Most people can return to work in about six weeks.
The time it takes for you to recover depends on several factors:
- The type of surgery you had.
- How many surgeries have you had before?
- How much of the intestine was removed.
- Your body's ability to heal wounds.
- your age.
- Other illnesses you have.
How long do I have to stay in the hospital?
Most people have to stay in the hospital for about a week after surgery (some go home sooner, some stay longer).
While you are in the hospital, the medical team will do the following:
- Monitoring how your wounds are healing.
- If you are unable to eat or drink, give saline (IV fluids) through a vein in your arm.
- Starting a clear liquid diet at the appropriate time.
- When you are ready, transition to a soft food diet.
If you have had an ostomy, you will be taught how to use and clean your new bag in the hospital. You will be sent home only when you are confident that you can do it on your own.
Can surgery completely cure Crohn's disease?
No. Surgery cannot cure Crohn's disease. There is always a chance that symptoms will return even after surgery.
However, surgery and other treatments can control or reduce your symptoms. In many cases, it can significantly improve your quality of life. Your doctor will work with you to develop a treatment plan that is right for you.
If surgery doesn't cure the disease, why do we need to have surgery?
You may be wondering this too. The risks of not having surgery vary depending on your condition. But if Crohn's disease is left untreated, it can lead to:
- Persistent abdominal pain.
- Loss of appetite and unexplained weight loss.
- Anemia.
- Very poor living conditions.
- Symptoms getting worse.
- The occurrence of cancerous changes in the intestine.
- Increased risk of side effects of medications.
- Having to undergo emergency surgery.
But there is good news. Fewer people need surgery now than they did two decades ago. That's because of early detection tests and new, improved treatments. Currently, only 1 in 5 people need surgery within the first five years of diagnosis. The only person who can tell you what's right for you is your doctor.
When to talk to the doctor after surgery
If you experience any of the following symptoms after going home after surgery, call your doctor immediately.
| Symptom | What to pay special attention to |
|---|---|
| Inability to pass stool | If you don't have a bowel movement for a few days after coming home from the hospital. |
| Nausea and vomiting | If you have persistent nausea or vomiting. |
| Severe pain | If the pain increases day by day instead of decreasing. |
| Change in stool | If there is blood in the stool or if the stool is black like tar. |
| Symptoms of blood clots | If you experience pain or swelling in your legs. |
| Ostomy problems | If stool has not passed from the ostomy opening for more than 24 hours, it may be a sign of a blockage. |
The idea of surgery can be daunting, especially if you've had surgery before. At times like these, it can be a great help to talk to others who have had similar experiences. If possible, join a support group for Crohn's patients. It can also be a great relief to know that you're not alone.
Take-Home Message
- Surgery for Crohn's disease is performed to treat complications caused by the disease, such as intestinal narrowing, fistulas, and abscesses.
- Surgery cannot completely cure Crohn's disease, but it can significantly improve your quality of life by reducing symptoms such as pain and fatigue.
- Talk openly with your doctor about whether you need surgery, and if so, what kind. Ask any questions you have.
- After surgery, be on the lookout for warning signs such as severe pain, vomiting, and blood in the stool. If this occurs, seek medical advice immediately.
- You are not alone in this journey. There are millions of people living with this disease. You can find strength in support groups.
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