Chapter 9. Ulcerative Colitis and Crohn’s Disease

“About 25 percent to 40 percent of ulcerative colitis patients must eventually have their colons removed because of massive bleeding, severe illness, rupture of the colon, or risk of cancer.”
Ulcerative Colitis; National Institutes of Health [1]

Think outside the box

Ulcerative colitis and Crohn’s disease are characterized by inflammation and ulceration of the intestinal mucosa, or the inside upper layer of the intestinal walls (epithelium). In turn, inflammation blocks primary intestinal functions—the absorption of water, electrolytes, and nutrients from the chyme. Naturally, an accumulation of too many unabsorbed fluids in the lumen (the cavity of a tubular organ) causes diarrhea. In turn, the loss of essential fluids and nutrients leads to severe dehydration, malnutrition, loss of electrolytes, and associated complications.

Mainstream medical references classify ulcerative colitis (UC) and Crohn’s disease (CD) as Inflammatory Bowel Diseases (IBD). While ulcerative colitis is localized exclusively inside the large intestine, Crohn’s disease may extend into both the large and small intestines. According to The Merck Manual of Diagnosis and Therapy, the “groupings and subgroupings [of both conditions] are somewhat artificial. Some cases are difficult, if not impossible, to classify.”[2]

In other words, the most apparent symptoms (abdominal cramps, pain, diarrhea, bleeding, fever, dehydration, malnutrition, and weight loss) of ulcerative colitis and Crohn’s disease appear to be similar, and their respective treatments (diet, medication, rehab, etc.) are also similar. For these reasons, the overview of both conditions is combined into one chapter. For the record, there are significant morphological differences between the two conditions, but they aren’t relevant for a treatment and prevention overview. To streamline the narrative, the term “inflammatory bowel diseases” may be used in place of the repetitive “ulcerative colitis and Crohn’s disease,” unless noted otherwise.

Inflammatory bowel diseases rarely happen out of the blue—they may follow years of Irritable Bowel Syndrome, gastroenteritis, and the other functional disorders of the GI tract described throughout this book. Symptomatically, constipation may or may not be an apparent precursor, because it is often latent, i.e., hidden from view, and isn’t recognized. But that doesn’t mean that it isn’t there. In fact, this book’s central theme, the critical role of latent constipation in the pathogenesis of intestinal inflammation, is confirmed by the following remarkable fact:

An anal fissure is a laceration of the anal canal mucosa that won’t heal. An anal fistula is a duct from the anal canal into the perianal region that was formed from the initial ulceration of the anal mucosa. Let’s think outside the box about the connections between fissures, fistulas, constipation, inflammation, and Crohn’s disease:

Q. What causes an anal fissure or fistula?

The extreme straining that’s required to expel dry, hard (not necessarily large) stools. Anyone who’s ever experienced a fistula or fissure will tell you that they are extremely painful, especially during defecation, and that they bleed often.

Q. What does this pain do to a person, especially a child?

Pain causes the delaying or withholding of stools to avoid further pain and bleeding. Children may withhold stools for days, even weeks at a time.

Q. What happens when a person delays or withholds stools?

Formed stools inside the large intestine get impacted from the rectum all the way back to the cecum.

Q. What happens when the stools get impacted and accumulate throughout the entire length of the large intestine?

They extend all the way back into the small intestine (ileum) and cause intestinal obstruction, which is actually a prominent symptom of Crohn’s disease.

Q. And what happens when this occurs?

The presence of feces in the small intestine causes mucosal inflammation. Inflammation causes profuse diarra. Diarrhea is often followed by severe constipation.

After that, it’s simple: constipation is either not treated at all or it’s treated with fiber. In both cases stools accumulate and impact. Depending on the diet, it may take up to a month to accumulate enough impacted stools to obstruct the small intestine again. At this point diarrhea kicks in again. After this cycle repeats itself several time, a person develops chronic intestinal inflammation or bleeding ulcers, and that’s when Crohn’s disease or ulcerative colitis are finally diagnosed.

The other probable path to either condition is a matter of just plain bad luck. Accidental food poisoning, travelers’ diarrhea, viral infection, or a food allergy may bring along intestinal inflammation, vomiting, and diarrhea. The outcome—a ride to hell or a full recovery—depends on the treatment of the original cause.

• The prudent approach: a brief (24 to 48 hours) fast following the attack (you wouldn’t have an appetite anyway). Then, a low-density recovery diet for a week or two (no fiber, no known food allergens, and no hard-to-digest foods). After that, the mucosa heals, and you are as good as new.
• The imprudent approach: taking drugs to suppress vomiting and/or diarrhea (just recall those happy-go-lucky TV ads), so you can continue eating as if nothing happened. This is, unfortunately, the more typical “protocol,” which keeps the intestinal inflammation raging on, and on, and on. Then, at the first sign of diarrhea and blood, the treatment of ulcerative colitis or Crohn’s disease starts in earnest, and the ride to hell begins.

You may wonder why two diseases, both culminating with severe diarrhea, are included in this book. The answer is obvious—they may begin with diarrhea, but, actually culminate with equally severe constipation. In other words, as much as constipation may cause ulcerative colitis or Crohn’s disease, both of them cause constipation too. Directly, when the recovery is spontaneous, and indirectly as well, after a treatment with prescription drugs and/or fiber.

This book provides ample evidence that the generally accepted treatment of ulcerative colitis and Crohn’s disease-related constipation with dietary fiber is THE CAUSE of the next round of diarrhea, and behind the gradual progression (worsening) of both diseases, namely more mucosal inflammation, more ulcerations, more anorectal damage, more blood loss, and more drugs to treat the ensuing diarrhea. This is followed by more fiber to alleviate constipation, and (surprise, surprise) the diarrhea-constipation cycle repeats itself.

The previous chapter (Chapter 8, Irritable Bowel Syndrome) provided equally ample evidence that constipation, hidden or not, is one of the leading causes of ulcerative colitis and Crohn’s disease.

The origins of ulcerative colitis and Crohn’s disease: Debunking uncommon nonsense

You’ve probably heard this truism time and again: to cure a disease, you must first eliminate its causes. That’s common sense, right? The bad news is: ulcerative colitis is still “incurable,” because its causes are still “unknown:”