What Is Crohn’s Constipation?
You likely have constipation if it's hard for you to poop and you're having fewer bowel movements than you normally do. The same is true whether or not you have Crohn’s disease. The causes can also be the same, though some causes are unique to Crohn’s.
How common is constipation in Crohn’s disease?
The short answer: very.
“Constipation is a common problem irrespective of Crohn’s disease,” says gastroenterologist Shervin Rabizadeh, MD, MBA, chair of the Department of Pediatrics and associate director of Cedars-Sinai Guerin Children’s in Los Angeles.
About 2.5 million people go to the doctor for constipation every year, making it one of the most common stomach complaints.
“Patients with Crohn’s disease can have constipation at the same rate as the general population,” Rabizadeh says. “That said, there are specific situations in which Crohn’s patients have a higher rate of constipation.”
Is Crohn’s Constipation the Same as Crohn’s Blockage?
No, the two are different. Blockages, or obstructions, in Crohn’s happen when the bowel wall thickens due to swelling and/or scarring. This narrows the intestinal passage, forming what are called strictures. Strictures make it harder for things to pass through, but they don’t always cause constipation.
“Some patients with strictures have diarrhea, so this doesn’t always correlate,” says Adeeti Chiplunker, MD, a gastroenterologist at the Ohio State University Wexner Medical Center in Columbus, Ohio. “Patients with anal or rectal strictures, however, may complain of constipation as a result of this narrowing.”
Rabizadeh says such strictures and blockages can cause constipation-like symptoms when your poop can’t pass through your system normally. Other symptoms of strictures and blockages, he says, include vomiting and pain.
While constipation doesn't necessarily result directly from a blockage, a blockage can be an indirect cause. Rabizadeh says that blockages may lead people with Crohn’s to change their diets by limiting high-fiber foods.
“A decrease in fibrous foods increases the propensity for constipation,” he says.
What Causes Constipation in Crohn’s Disease?
If you have Crohn’s, you can get constipation for the same reasons as everyone else, including:
- Too little fiber in your diet
- Not drinking enough fluids
- Lack of exercise
- Changes to your daily routine
- Stress
A variety of medications – both over-the-counter and prescription – can also lead to constipation, including:
- Strong prescription pain medications like oxycodone (OxyContin) and hydromorphone (Dilaudid)
- Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen
- Certain types of antidepressants, such as SSRIs like fluoxetine (prozac) and tricyclics like amitriptyline (Elavil)
- Antacids that contain calcium or aluminum, including Tums
- Antihistamines like diphenhydramine (Benadryl)
- Some blood pressure medications, such as beta-blockers like atenolol (Tenormin) and calcium channel blockers like diltiazem (Cardizem), nifedipine (Procardia), and verapamil (Calan SR)
Talk to your doctor about the medications you take, but don’t stop taking any your doctor has prescribed without consulting them.
Crohn’s-specific causes of constipation
Your Crohn’s also may be responsible for your constipation for the following reasons:
Too little fiber. Chiplunker says that people with Crohn’s are often told to limit or avoid fiber in their diet, while others may avoid fiber because they’re afraid of it after a previous obstruction.
Post-inflammatory irritable bowel syndrome with constipation. This can develop in remission, when your Crohn’s is inactive.
“Prior inflammation in the gut causes the sensitivity of the GI nervous system to increase and overreact to stimuli like food, gas, and stool,” Chiplunker says. “This overreaction can take the form of symptoms like nausea, abdominal pain, and changes in bowel frequency like constipation.”
Pelvic floor dysfunction. An often overlooked complication of Crohn’s, Chiplunker says, this can happen when you make a habit of “holding it” when you have Crohn’s-triggered diarrhea. “When you no longer have to do this after achieving remission, it’s hard to break this habit,” she says.
Distal colonic inflammation. This is inflammation in the last part of your colon. It more commonly causes diarrhea, says Rabizadeh, “[but] since this is the area that sends the signal to have a bowel movement, inflammation here can lead to dysfunction, including constipation.”
Small intestine bacterial overgrowth (SIBO). Your gut is home to lots of bacteria and other microorganisms. In the right balance and amounts, they help support digestion, your immune system, and other bodily functions. But if your gut bacteria become too abundant, SIBO can result. Among other things, SIBO can cause constipation, and research suggests that SIBO and Crohn’s may be linked.
Baseline constipation. Chiplunker says that some people with Crohn’s may have had constipation before their disease developed, so it’s possible that it will come back once in remission. “It’s important to ask what someone’s bowel habits were like before they developed IBD,” she says.
What Does Crohn’s Constipation Feel Like?
Rabizadeh says that Crohn’s constipation feels no different from the way constipation feels to someone who does not have Crohn’s. The common symptoms of constipation include:
- Less frequent bowel movements, usually three or fewer per week
- Lumpy, dry, or hard poop
- Pain when trying to poop
- Needing to strain to poop
- A sense that you have not passed all the poop in your system
- Feeling like you have a blockage in your rectum
- The need to use a finger to coax out your poop
- Feelings of nausea and/or bloating
- Stomach cramps or stomachache
Rabizadeh says that some people with Crohn’s constipation have a drop in stool production rather than harder, more painful stools, which are common in constipation among those who don’t have Crohn’s.
How Is Crohn’s Constipation Treated?
In general, doctors treat Crohn’s constipation the same way they treat constipation for everyone else. It often can be managed with over-the-counter medications, including:
- Stool softeners like docusate calcium (Surfak) and docusate sodium (Colace)
- Osmotic laxatives like magnesium hydroxide (Phillips' Milk of Magnesia) and polyethylene glycol (MiraLAX)
- Bulk-forming laxatives like the fiber supplements methylcellulose (Citrucel), psyllium (Metamucil), and wheat dextrin (Benefiber)
- Stimulant laxatives like bisacodyl (Dulcolax) or senna (Senokot)
When OTC medications are not enough, your doctor may prescribe a guanylate cyclase-C (GC-C) agonist, like linaclotide (Linzess) and plecanatide (Trulance).
Chiplunker says your treatment will depend on whether or not you have a stricture. For example, she recommends stool softeners rather than stimulant laxatives for her patients with strictures. In the case of anal or rectal strictures, the narrowed passage can be stretched out – a procedure called serial dilation – to reduce constipation. This can be done at your doctor’s office, though some people do this themselves at home, Chiplunker says.
If your constipation results from pelvic floor dysfunction, your doctor will refer you to a pelvic floor physical therapist.
Diet Recommendations for Crohn’s Constipation
What you eat and drink plays a big part in constipation. Certain foods can trigger constipation or make it worse, while others can help to relieve it or prevent it from happening. Follow these dietary tips to get and stay regular.
Don’t be afraid of fiber
“Fiber is an important component to regulating bowel habits and bowel health,” Chiplunker says. She recommends focusing on foods with soluble fiber for constipation. It not only helps move things along; soluble fiber, she says, is a prebiotic that provides nutrients to your gut microbiome, helping maintain a healthy balance of gut bacteria. Foods with soluble fiber include:
- Apples
- Bananas
- Beans
- Carrots
- Citrus fruits
- Peas
- Oats
Insoluble fiber can help with constipation as well, Chiplunker says, but use care if you have a stricture, as it can get stuck and create a blockage. Sources of insoluble fiber include:
- Cauliflower
- Green beans
- Nuts
- Potatoes
- Whole-wheat flour
- Wheat bran
“Fiber can be incorporated into the [Crohn’s] diet, but often we have to change the texture so it more easily moves through the system,” says Chiplunker, who recommends making soups and smoothies with high-fiber fruits and veggies. “A blender is your best friend in this situation!”
Avoid constipating foods
Rabidazeh advises against overdoing it with rice, dairy products like cheese, and bananas, as these foods can add to constipation. Also, limit high-fat and greasy foods, deep-fried foods, processed meats, and store-bought baked goods. Fats don’t digest easily and can slow things down, worsening constipation.
Stay hydrated
Water helps to keep your poop soft and easier to pass, so drink an extra 2 to 4 cups a day. “Hydration is critical,” Rabidazeh says.
Drink hot liquids
Hot drinks can help get things moving, especially if they contain caffeine. Opt for coffee and tea.
Other Lifestyle Changes and Home Remedies for Crohn’s Constipation
Get moving
“Exercise on a regular basis can help stimulate the GI tract and counteract constipation,” says Rabidazeh. Your workout can be as simple as going for a walk. But Rabidazeh recommends including exercises that work your core. Think situps, planks, and other exercises that don’t require equipment or a gym.
Bowel training
Also called bowel retraining, this can help you get back on your normal poop schedule. Rabidazeh says it involves sitting on the toilet twice a day at consistent times for no more than 10 minutes. “Bowel training can help establish an evacuation rhythm that limits the effects of constipation,” he explains. You may need something to help stimulate movement prior to your training sessions, such as a meal or hot drink. Try a laxative, suppository, or enema only if your doctor recommends it.
Change your position
A simple shift in how you sit on the toilet can make a big difference. “Elevating your legs on a foot stand can help by improving the positioning of your body to a more optimal one for bowel movements,” says Rabidazeh.
When to Talk to a Doctor
While Crohn’s constipation can be uncomfortable, it rarely requires a trip to the doctor, especially if it’s a longstanding issue, Chiplunker says. But it can indicate something serious in some circumstances.
“I get concerned with sudden changes in symptoms or new-onset constipation when a patient previously was doing well in remission,” Chiplunker says.
She adds that symptoms like belly pain, nausea, and vomiting are red flags. “It’s important to check in with your doctor to exclude a stricture or narrowing as the cause.”
Rabidazeh agrees: “Lack of bowel movements related to bowel obstruction needs to be evaluated by the doctor, and most times, patients need admission to the hospital for fluids, treatment, and potential surgery,” he says.
Takeaways
Constipation in Crohn’s disease is much like constipation for people who don’t have Crohn’s. With a few exceptions, the causes, symptoms, and treatments don't differ. The biggest concern is if your constipation means you have a bowel obstruction, which can have constipation-like symptoms as well as belly pain, nausea, and vomiting. If you have such symptoms, call your doctor.
