Crohn's and Colitis For Dummies

Tauseef Ali, MD, is a consultant gastroenterologist and inflammatory bowel disease specialist. He is an assistant clinical professor at University of Oklahoma and Oklahoma State University. He is recognized internationally for his clinical work in the field of Crohn’s and colitis. You can find him on social media with twitter handle @ibdtweets.

Foreword xiii

Introduction 1

About This Book 1

Foolish Assumptions 2

Icons Used in This Book 2

Beyond the Book 3

Where to Go from Here 3

Part 1: The Who, What, and Why of Crohn’s and Colitis 5

Chapter 1: Crohn’s and Colitis One Step at a Time 7

Defining Crohn’s and Colitis 8

Getting the Treatment You Need 9

Recognizing That You’re Not Powerless 9

Living a Full Life with the Disease 10

Managing Special Cases: Advice for Pregnant Women and Kids 11

Chapter 2: Defining Crohn’s and Colitis 13

Figuring Out What Crohn’s and Colitis Are 13

Looking at the big picture: Inflammatory bowel disease 14

Zeroing in on Crohn’s and colitis 15

Noticing the Signs and Symptoms 20

Blood in stool 22

Diarrhea 23

Abdominal pain 24

Urgency 24

Tenesmus 24

Other symptoms 24

Identifying Other Parts of the Body Involved in Crohn’s and Colitis 25

Bones 25

Joints 26

Skin 28

Liver and gallbladder 28

Kidneys and bladder 30

Eyes 30

Complicating Things 31

Intestinal complications 31

Nutritional complications 35

The cancer connection 38

Chapter 3: How the Digestive System Works 41

Tracking the Journey of Food inside the Gastrointestinal Tract 42

The oral cavity (or mouth) 42

The esophagus 44

The stomach 44

The small intestine 45

The large intestine 46

The anus 46

Getting Help from the Liver, Pancreas, and Gallbladder 46

Liver 46

Pancreas 47

Gallbladder 47

Understanding How Inflammation Affects the Digestive Process 48

Gastritis: Inflammation of the stomach 48

Enteritis: Inflammation of the small intestine 49

Colitis: Inflammation of the large intestine 50

Proctitis: Inflammation of the rectum 51

Chapter 4: Who Gets Crohn’s and Colitis and Why 53

Who Gets Crohn’s and Colitis 54

The Role of the Immune System in Crohn’s and Colitis 54

An immune system primer 55

When your gut’s immune system goes awry 57

Environmental Factors 58

Food 59

Air 60

Hygiene 60

Other environmental factors 61

Genes Gone Bad: The Role of Genetics 63

Considering family history 64

Calling out key genes for Crohn’s and colitis 64

Getting a genetic test 65

Part 2: Getting Medical Help 67

Chapter 5: Assembling Your Healthcare Team 69

Finding the Right Doctor for You 69

Why you need a specialist 70

How to choose among the specialists in your area 70

When you get to your first visit 71

Rounding Up Other Key Players 73

Your primary care physician 73

Nurses 74

Physician assistants 75

Registered dietitians 76

Psychiatrists 76

Surgeons 77

Friends and family 77

Chapter 6: Getting a Diagnosis 79

Preparing for Your First Visit 79

Charting your signs and symptoms 80

Assembling your medical records 84

Talking to Your Doctor 85

Getting over the embarrassment 85

Communicating your symptoms 85

Being realistic about your expectations 86

Knowing What to Expect during a Physical Exam 86

General physical exam 87

Focused physical exam 87

Rectal exam 87

Being Poked and Prodded for Medical Tests 88

Blood tests 88

Stool tests 89

Scans 91

Endoscopy 92

Identifying Other Diseases That Mimic Crohn’s and Colitis 93

Chapter 7: Achieving Remission with Medications 95

Rejoicing for Remission 96

Types of Remission 96

The role of symptom control 97

Using Steroids 98

Types of steroids 99

Side effects of steroids 100

Turning to Aminosalicylates 101

Types of aminosalicylates 102

Side effects of aminosalicylates 104

Getting Involved with Immunomodulators 104

Types of immunomodulators 105

Side effects of immunomodulators 105

Battling Your Disease with Biologics 107

Types of biologics 107

Side effects of biologics 109

Loss of response to anti-TNF therapy 110

Benefits of biologics 111

Targeting Crohn’s and Colitis with Small Molecules 112

Types of small molecules 112

Side effects of small molecules 113

Attacking Your Illness with Antibiotics 113

Types of antibiotics 113

Side effects of antibiotics 114

Considering Other Medications 114

Antidiarrheals 115

Bile salt binders 116

Analgesics 116

Iron 117

Calcium and vitamin D 117

Vitamin B12 118

Chapter 8: Considering Surgery 119

Determining When You May Need Surgery 119

For Crohn’s disease 120

For ulcerative colitis 121

Understanding the Types of Surgery 121

Resectioning the small intestine 121

Repairing a stricture 123

Treating fistulas 123

Draining abscesses 124

Resecting the colon 126

Pouch surgery 128

Considering Complications from Surgery 130

Short-term complications 130

Long-term complications 132

Defining Ostomy: What It Is and How to Deal with It 135

Types of ostomy 135

When you may need ostomy 136

How to care for your stoma 137

Your ostomy pouch 137

Coming to terms with Ostomy complications 139

Listing Some Ostomy Resources 140

Part 3: Healing and Dealing with the Disease 143

Chapter 9: Paying Attention to hat You Eat 145

Considering the Impact of Nutrition 146

The impact on your immune system 146

The impact on wound healing 147

Identifying the Nutrients You Need 147

Macronutrients 148

Micronutrients 152

Wondering about Fiber 156

Types of fiber 156

Why fiber matters 157

Fiber’s role in Crohn’s and colitis 158

Considering Specialized Diets for Crohn’s and Colitis 159

Liquid diets 159

Low-residue diets 160

Lactose-free diets 162

Elemental diets 163

Specific Carbohydrate Diet 163

Mediterranean diet 164

Low FODMAP diet 164

Choosing a diet that suits your body’s needs 165

Getting Nutritional Support: When You Can’t Go It Alone 166

Feeding through a tube 166

Feeding directly into your veins 167

Boosting your diet with supplements 168

Chapter 10: Preventing Health Problems 171

Getting Vaccinated 172

Why vaccination matters 172

Which vaccines you need 172

Caring for Your Skin: It’s Not Just Cosmetic 176

Identifying the skin complications you may face 177

Recognizing and reducing your risk of skin cancer 178

Caring for your skin “down there”: Perianal skin care 179

Boning Up on Bone Health 180

Opening up about osteopenia and osteoporosis 181

Seeing what Crohn’s and colitis can do to your bones 182

Managing bone loss 183

Screening for Cancers 184

Colon cancer 184

Cervical cancer 186

Chapter 11: Alternative and Complementary Therapies 187

Let’s Get Physical: Exercise 188

Looking at how exercise can help with Crohn’s and colitis 188

Gathering some useful exercise tips 190

Working Over-Thyme: Herbal Therapy 191

Healing with herbs 191

Identifying beneficial herbs for Crohn’s and colitis — and knowing which herbs to avoid 192

Homing in on Homeopathy 194

Exploring the pros and cons of homeopathy 195

Using homeopathic remedies for Crohn’s and colitis 195

Tapping into Traditional Chinese Medicine 196

Understanding traditional Chinese medicine 196

Controlling Crohn’s and colitis with traditional Chinese medicine 196

Mulling over Mind-Body Intervention 197

Cognitive behavioral therapy 198

Aromatherapy 198

Yoga and meditation 199

Support groups 199

T’ai chi and Qigong 199

Wondering about Worm Therapy 199

Putting worms to work for your health 200

Seeing how worms can help Crohn’s and colitis 200

Part 4: Living and Coping With Crohn’s and Colitis 203

Chapter 12: Living with Crohn’s and Colitis 205

Dealing with Your Diagnosis 205

Stage 1: Denial 206

Stage 2: Anger 207

Stage 3: Bargaining 209

Stage 4: Depression 209

Stage 5: Acceptance 210

Keeping Your Relationships Going Strong 211

So, what’s new with you? Telling people about your diagnosis 211

Come here often? Dating with Crohn’s and colitis 213

Like a horse and carriage: Keeping your marriage strong 214

Caring for a Loved One with Crohn’s or Colitis 216

Finding little things that help a lot 216

Helping during a flare 216

Helping after surgery 217

Getting the help you need for yourself 218

Chapter 13: Avoiding Triggers 219

Quitting Smoking 220

Deciding to Medicate 222

Non-steroidal anti-inflammatory drugs 222

Antibiotics 223

Stressing Out 223

Craving the culprit: Food, Glorious Food 225

Artificial sweeteners 225

High-fat foods 226

High-fiber foods 226

Caffeine 227

Dairy products 227

Alcohol 229

Inviting the Sandman 229

What sleep does for your immune system 229

The effect of sleep on Crohn’s and colitis 230

How to get a good night’s sleep 230

Traveling at High Altitudes 232

Chapter 14: Working and Traveling with Crohn’s and Colitis 233

Work It Out: Doing your job When You Have Crohn’s or Colitis 233

Coordinating your job hunt around your disease 234

Telling your employer and coworkers about your condition (or keeping it to yourself) 235

Starting your day off right 235

Planning your commute 236

Packing an emergency kit 237

Speed Bumps Ahead: Coping with Job-related Challenges 238

Responding to symptoms when they get in the way 238

Handling your coworkers’ less-than-understanding attitudes 238

Taking advantage of the Family and Medical Leave Act 239

On the Road Again: Traveling with Crohn’s and Colitis 240

Assembling a vacation survival guide 240

Getting immunized before you travel abroad 241

Packing for your trip 241

Avoiding traveler’s diarrhea 242

Finding a bathroom — fast! 244

Part 5: Considering Special Populations with Crohn’s and Colitis 245

Chapter 15: Kids with Crohn’s and Colitis 247

Identifying How Crohn’s and Colitis Are Different in Kids than they are in Adults 248

Sex 248

Symptoms 248

The impact on growth and development 249

Getting a Diagnosis 251

Managing Crohn’s and Colitis in Kids 252

Monitoring medications 252

Paying attention to nutrition 257

Vaccinating your child 257

Growing Up with Crohn’s and Colitis 259

Surviving school 259

Turning 18: Adulthood begins (at least in theory) 261

Going off to college 262

Chapter 16: Having Sex and Getting Pregnant with Crohn’s and Colitis 265

Sex and Fertility 266

Sexual activity 266

Contraception 267

Your menstrual cycle 269

Fertility 270

Pregnancy 271

Pregnancy planning 271

While you’re pregnant 273

The big day and beyond 277

Part 6: The Part of Tens 281

Chapter 17: Ten Myths about Inflammatory Bowel Disease 283

Myth#1: Diet Is the Cure 284

Myth#2: Kids Get It from Their Parents 284

Myth#3: It’s Caused by Stress 285

Myth#4: You Can’t Get Pregnant if You Have It 285

Myth#5: Steroids Are a Magic Potion 286

Myth#6: If You Have It, You’re Guaranteed to Get Cancer 286

Myth#7: You’re Responsible for Your Flares 287

Myth#8: Surgery Cures It All 287

Myth#9: You Can Stop Taking Your Medications if You Feel Better 288

Myth#10: You Have to Stop Taking Your Medications during Pregnancy 289

Chapter 18: Ten Reliable Resources 291

The Crohn’s and Colitis Foundation 291

The United Ostomy Associations of America 292

WebMD 292

Mayo Clinic 293

About IBD 294

IBD Passport 294

IBD School Videos 295

Nutritional Therapy for IBD 295

South Asian IBD Alliance (SAIA) 295

Trustworthy Twitter accounts 296

Index 297