What is Crohn’s Disease?
Crohn’s Disease belongs to a larger group of GI tract disorders called IBD, or Irritable Bowel Disease. Unlike ulcerative colitis, which mainly affects the colon, Crohn’s Disease impacts many different organs from the mouth down to the anus. Associated with an overzealous immune response, the body identifies its tissue as a threat and begins attacking. This leads to inflammation and hypersensitivity in the GI tract, causes ulcer development, feelings of cramping and abdominal pain, and abnormal bowel movements.
One of the more severe and infrequent symptoms of Crohn’s Disease is bleeding, whether from the mouth, the excretory tract opening, or internal bleeding from the intestines or colon. In some cases, the bleeding resolves itself with increased management of symptoms; in others, medical intervention is required with medicine, dietary changes, or even surgery.
Causes of Bleeding in Crohn’s Disease
Due to the general nature of Crohn’s Disease, identifying a sure cause of the bleeding independent of medical evaluation raises some challenges. In addition, bleeding in Crohn’s Disease does not occur as frequently as bleeding in ulcerative colitis: less research exists on the role of bleeding in this specific condition. One explanation posits oversensitivity of the gut lining leads to bleeding from the gums in one’s mouth, the intestines, the colon, or one’s rectum. Regular constipation or diarrhea irritates already sensitive tissue around the bowels and induces the potential development of hemorrhoids (which can also lead to the appearance of blood in one’s stool).
As a rule, if the blood appears bright red, it likely comes from the rectum or anus since less time elapses for it to emerge from the body. If the blood looks dark red or brown, it likely comes from an internal source.
Gum Bleeding
Perhaps the most common and least understood type of bleeding in Crohn’s, bleeding from the gums appears most frequently in those newly diagnosed. Generally, this resolves itself with an implemented treatment plan to alleviate general symptoms, but studies found that 50% of new Crohn’s patients experienced oral bleeding as a result of their IBD. One prominent theory links sensitivity to inflammation from other body parts, such as in the gut lining, contributing to inflammation and bleeding in the mouth. Alternatively, gut microbiome dysfunction has also been linked to dysfunction of the oral microbiome, leading to bleeding in both areas.
Rectal Bleeding
Rectal bleeding appears bright red and happens through oversensitivity of the tissue surrounding the rectum or anus. Frequent diarrhea irritates the skin in and around the rectum as it passes, causing blood to appear in stool. Appearance of blood from the rectum may also result from the development of hemorrhoids, or swollen veins bursting from the skin. This bleeding occurs due to straining associated with Crohn’s-caused constipation.
Anal Bleeding
In addition to the reasons for rectal bleeding, anal bleeding arises with the development of anal fissures, a rupture in the anal canal typically caused by straining. Unlike hemorrhoids, which typically heal on their own, anal fissures sometimes require medical intervention.
Intestinal Bleeding
Hypersensitivity in the intestinal lining leads to ulcer development, or sores, along the GI tract. This results in bleeding, which appears in the stool as dark red, brown, or even black. Ulcers are both a symptom of Crohn’s and a cause of other Crohn’s side effects, such as cramping, abdominal pain, or abnormal bowel movements.
How to Manage Crohn’s Disease Bleeding
As always, it is best to consult a licensed medical practitioner if blood appears in stool. It may heal on its own, as in the case of hemorrhoids, or be resolved with at-home treatments, such as dietary changes to softer foods to prevent gum bleeding.
Seek Medical Attention
In the cases where the bleeding does not resolve or decrease in volume after a few days, or it increases, see a doctor as soon as possible for medical evaluation and treatment. Likewise, if a fever develops, one begins vomiting blood, feeling faint, or developing severe bleeding, seek emergency attention as soon as possible.
Anti-Inflammatories
Many doctors recommend anti-inflammatory medications or changes to already existing medical treatments to decrease the body’s response to inflammation and stop the sensitivity causing the bleeding. Some biologics manage and prevent bleeding, but research suggests this is less ideal, for medical cases wherein the only other alternative is surgery to remove the affected organ.
Diet
In addition to medical treatment, changes to diet can prevent bleeding. Through the consumption of beneficial foods, such as those contained in a low FODMAP diet, Crohn’s symptoms can be reduced and managed. Likewise, through proper exercise and sleep, Crohn’s symptoms may come under control naturally and increase the chances of remission.
Summer Pitocchelli-Schwartzman
