Crohn’s disease is unpredictable, and there’s a learning curve as you start to figure out how to manage it. It may be hard to hear that Crohn’s can harm your GI tract to the point where you could need treatment at a hospital. But hospital care can be an effective way to get a flare under control. And if you need surgery, it can put you on a better course for the future.
How Common Is Hospitalization With Crohn’s?
The CDC regularly publishes reports about how many people with Crohn’s go into the hospital. These reports show that a lot has changed since biologic drugs to treat Crohn’s came onto the scene. The impact of those medicines and other early treatments is starting to show up in a lowered risk of hospitalization for people with Crohn’s.
Just what is your risk? An analysis of 23,000 people with Crohn’s found that the 1-, 3- and 5-year risk of a Crohn’s-related hospital stay was 29.3%, 38.5%, and 44.3% respectively. This means that close to 1 of every 2 people with Crohn’s is likely to be hospitalized within 5 years of their diagnosis.
Reasons for a Hospital Stay
For nearly half of all people with Crohn’s who go to the hospital, the cause is a severe flare. The types of care that a hospital offers can help with all your serious symptoms, including
extreme inflammation, pain, dehydration, and malnutrition. A hospital stay can get you to the point where you can manage Crohn’s on your own again and prevent complications.
Here are other reasons for hospitalization:
Severe Crohn’s complications. These are more common with untreated Crohn’s and need medical treatment. They include:
- Abscesses. These are infected pockets that can form anywhere along your GI tract, inside your abdomen or around your anus.
- Strictures. These come from scar tissue that narrows intestinal passages. They can cause a bowel blockage.
- Fistulas. These are narrow tunnels that can form in intestinal walls damaged by Crohn’s. They create unwanted passageways to other areas of the body.
Surgery or post-surgery complications. Surgery still accounts for about 40% of hospital stays. These aren’t always emergency procedures. You may choose when to have surgery (elective surgery) to remove a very diseased part of your colon before it can cause more trouble. This operation is called a bowel resection. Your doctor may do it with a laparoscope – a thin lighted tube with a camera. It uses fewer and smaller incisions. This means faster healing and a shorter hospital stay.
Side effects or complications from medication. For instance, drugs that work on your immune system can leave you with a greater risk for infections.
Extreme pain or overuse of opiate drugs to manage pain.
What to Expect at the Hospital
Your care team will personalize your treatment to your needs. But here’s what you might expect:
Evaluation and tests. Your team will review your medical history, current symptoms, other health conditions, any surgeries, and all your medications. Your doctor will do a physical exam to feel for tummy tenderness, bloating, and a possible mass. They’ll also look for signs of complications, like an abscess.
To get a complete picture, you may need imaging tests, like a CT scan, MRI, or colonoscopy. Blood test results will also provide information about your condition. These are likely to include a complete blood count, a metabolic panel, and tests for inflammation markers, nutritional deficiencies, and infections like C diff.
Treatment. To get your Crohn’s under control, you’ll likely start with medications such as corticosteroids, often by IV. You’ll also get antibiotics if you have an infection. The right nutrition is just as important as the right medication. You may get nutrients through an IV or a stomach tube if you can’t take in enough on your own.
If you don’t respond well enough to corticosteroids, there are other drugs that can help. In fact, biologic drug therapy has lowered the number of people who need bowel resection surgery. And if you do need that surgery, it’s good to know that it can be the best option when a section of your colon is very diseased. Complications like an abscess or a blockage will need specific treatment.
Going home. The length of your stay usually depends on why you’re in the hospital. For a flare, the average stay is 4.7 days. For surgery or a complication, it’s 4.4 days. If an infection brought you there, you may stay for a week.
Signs that you’re ready to leave the hospital include:
- Bowel movements that have become more regular
- Only slight rectal bleeding
- Being able to take and tolerate medications
- Being able to take in needed nutrition on your own
If you were on IV corticosteroids, you may get oral prednisone to take short term.
After a hospital stay, the goals are to stay in remission and lessen the chance of a return visit. Follow the care plan your team gives you. This may include new prescriptions. Know the early warning signs of another flare and what steps to take right away if one happens. Go to all follow-up appointments with your health care providers. If you still smoke or rely on opiates to manage pain, ask for counseling to stop both.
How to Stay Out of the Hospital From the Start
Whether in the ER or the OR, it’s not always possible to avoid the need for care. Crohn’s is complex and can progress despite your best efforts. But there are steps that can help you sidestep the hospital:
Get and stay on a care plan. Do this as soon as possible to limit damage from Crohn’s.
Get care from specialists. Look for an IBD medical center with health care teams that specialize in Crohn’s care. Outcomes are often better when care is specialized. You’ll also get a more personalized approach.
Be proactive about keeping track of your condition. Don’t wait until there’s a problem to contact your doctor with questions or concerns. Get prompt attention for a flare when you can still manage it at home.
Stick to your maintenance medication schedule even when you feel fine. This helps prevent both hospital stays and surgery.
Don’t smoke. Smokers who have Crohn’s tend to have higher rates of complications, like strictures. They also have a higher surgery risk than nonsmokers – 0.3% compared with 38.3%.
Practice self-care. Get regular exercise and focus on a diet of healthy and safe foods. Build your meals around high-calorie, high-protein foods to get the nutrients you need.
Develop resilience. That’s the ability to handle and bounce back from tough events, like a Crohn’s flare, without letting your anxiety levels skyrocket. It’s helpful for Crohn’s when you have to deal with physical and emotional stress on an ongoing basis. People with higher levels of resilience have lower disease activity, better quality of life, and fewer surgeries.
You can develop the skills to handle challenges on your own or through resilience training. With this type of training, you’ll work with your health care team to grow your self-confidence, optimism, and acceptance. You’ll also learn when and where to seek out extra support. Among patients who had this training at Mount Sinai Hospital in New York, ER visits fell by 90% and hospitalizations by 88%.