As Ben Franklin said, “An ounce of prevention is worth a pound of cure,” and if you have Crohn’s Disease or colitis, you know there are fewer mantras truer than this.
The symptoms of IBD and some of the medical treatments that go along with it can all put you at risk for various ailments and other diseases.
Crohn’s and colitis can affect many different body systems, sometimes all at once, and sometimes systematically. For example, some of the symptoms and treatments can put you at risk for infections, skin cancer, and weak bones. Fortunately, by taking a few preventative measures, you can help protect your body from these health risks.
Why Vaccinations are Important
Just as a seat belt can protect you from serious injury if you get into a car accident, vaccinations can protect you from serious infections that can be even more dangerous when you have IBD. Vaccinations basically teach your body’s immune system how to detect and destroy certain bugs or toxins and can make you resistant (immune) to certain infections. Your doctor is your best ally in determining which vaccinations you need based on your age and other risk factors. Depending on your risk factors (such as travel locations or treatment medications), your doctor may suggest you get the following vaccinations:
- Influenza (note that the nasal spray flu vaccine should be avoided if you are on steroids, other immunosuppressive drugs, or biologic therapy)
- Pneumococcal vaccine (e.g., Pneumonia, Meningitis, Otitis Media)
- Hepatitis B
- HPV (Cervarix for females aged 19-26 and Gardasil for both genders aged 19-26)
- Varicella (Chicken pox)
- Meningococcal vaccine
About 25% of people who have Crohn’s and colitis have severe skin problems related to the disease itself, as well as treatment therapies.
This includes the following:
- Acrodermatitis enteropathica (red patches around the mouth and on the hands, feet, and scalp; caused by zinc deficiency)
- Apthous stomatitis (small painful ulcers or canker sores in the mouth and on the lips)
- Crohn’s disease of the skin (ulcers or plaques around an ostomy site and in the genitals of females)
- Erythema nodosum (skin lesions, usually on the lower leg)
- Pyoderma gangrenosum (ulcers filled with pus, usually on the lower legs)
- Sweet’s syndrome (fever, pinkeye, joint pain and/or small, red bumps on arms, neck, face, or back)
If you have Crohn’s or colitis, then you know that the immunosuppressive drugs that you might take can weaken your immune system. Having a weakened immune system can in turn make you more susceptible to the sun’s damaging ultraviolet (UV) rays and put you at risk for skin cancer.
The two main categories of skin cancer are:
- Melanoma (skin cancer that arises from pigment-making cells
- Non-melanoma (cancers that arise from the outermost layer of the skin, such as basal cell and squamous cell)
You can help protect yourself against skin cancer by wearing long sleeved shirts and pants, sunscreen, hats, and sunglasses. Make sure to have any concerns checked out by your doctor.
Perianal Skin Care
Going to the restroom and wiping frequently can definitely cause skin problems around the anal area. Perineal dermatitis is a skin injury that can range from slight redness to itching and even ulcer formation and bleeding from the ulcerated skin. These skin problems can extend all around the buttocks, groin, and even your upper thighs and lower abdomen.
During normal conditions, the outermost layer of skin would maintain a protective physical barrier to the external environment, which would then protect the inner layers and also prevent water from your body from evaporating into the air. However, when you are constantly exposing your skin to liquid stools and wiping frequently, you lose a lot of moisture, which causes damage to the skin and allows irritants (such as stool acids) and microorganisms to penetrate the skin.
The following practices may help keep your perianal skin clean and healthy:
- Manage moisture by cleansing and patting your skin dry after each bowel movement
- Wear cotton underwear instead of nylon and avoid plastic-backed products
- Use a good cleanser and moisturizer that helps maintain the natural barrier on your skin
- Always consult a doctor if a rash remains consistent or is extremely painful to rule out any bacterial and yeast infections
Risks to Bone Health
Bones depend on calcium and vitamin D in order to be strong and healthy. When you have Crohn’s or colitis, your body may lack the essential amounts of calcium and vitamin D that your bones need and may lead to serious bones problems, such as not being able to replace lost bone mass or generate new bones fast enough. This can make your bones weak and result in easily fractured bones.
Osteopenia occurs when your bone mineral density (or BMD) is lower than normal peak BMD, but not quite low enough to be classified as osteoporosis. Your BMD is very important as it is a measurement of the minerals in your bones which shows you how strong or weak they are. Left untreated, osteopenia can easily lead to osteoporosis
Osteoporosis literally means “porous bone.” All bones are naturally a little porous and look very much like honeycombs under a microscope. In osteoporosis, the pores are much larger than they are in healthy bones and become larger still over time. Bones in this condition are said to be less dense (i.e., having low density) and are weakened and more easily broken than healthy bones.
In addition to the added risk factor of taking steroids during IBD treatments, other risk factors include the following:
- Caucasian descent
- Family history of osteoporosis
- Body mass index of 19 or lower
- Drinking alcohol
- Deficiency in calcium and vitamin D
- Low testosterone levels (in males)
Additional Bone Risk Factors of Crohn’s and Colitis
There are several factors related to Crohn’s and colitis that lead to between 30 and 60 percent of these patients having lower bone density than healthy levels. These factors that help put IBD patients at risk for bone problems include the following:
- Steroid therapy can cause bone loss and more than half of the patients who use steroid therapy for long terms develop osteoporosis
- During the process of inflammation, chemicals called cytokines are released into the body and can disrupt the process of bone formation, which leads to bone loss
- Vitamin D deficiency is very common during inflammation of the small intestine or if you have undergone resection of the small intestine and certain medications can also result in deficiencies
Colon cancer is the fourth most diagnosed cancer in the world. Those already suffering from Crohn’s disease of the colon and ulcerative colitis seem to be at higher risk for colon cancer than healthy people. The key to treating colon cancer is to spot it early on. However, there are a few steps that you can take to help reduce your chance of getting colon cancer, such as eating a healthy diet, consuming as much folate and fiber as tolerable, exercise, and get regular screenings from your doctor.
Recent studies have shown that women with Crohn’s or colitis have a slightly higher chance of having an abnormal Pap smear than healthy women. The risk is even greater if you are on immunosuppressive medications, you smoke, you have multiple sex partners, or you have a family history of cervical cancer. Getting the HPV vaccine may help prevent an abnormal pap smear from becoming cervical cancer.