Expert Q&A

A: Unfortunately, sexual dysfunction, which can include pain, is common patients with UC and CD. Please bring this up with your UC health care provider, so that they can provide you with a referral to a sexual health specialist. Sometimes given the difficulties with urgency and frequency that come with a UC flare, patients can develop pelvic floor dysfunction, in which the muscles of the pelvic floor have difficulty relaxing, which may contribute to pain. Pelvic floor physical therapy can be done, if this is found to be the cause of the pain. hide answer

A: Unbearable pain should never be a normal part of Crohn’s disease. The goal for our Crohn’s patients is to be well, and in a stable remission. If your partner is in pain, she should undergo testing with her health care provider to find out why the bloating and pain is occurring, and what can be done to treat the underlying problem. Your partner’s health care provider can provide suggestions for pain control if needed as well. In the meantime, Ibuprofen and other NSAID pain relievers should be avoided in IBD patients, because frequent use can worsen GI tract inflammation. Acetaminophen, in doses as directed on the label, is an over the counter pain reliever that can be used safely for IBD patients. 5. I was just diagnosed with mild Crohn’s in my small intestines. I do not have the usual sympto hide answer

A: Crohn’s disease in the small intestine often does not cause diarrhea, since it is the job of the colon to absorb water and create formed bowel movements. If your Crohn’s is limited to the small intestine, it makes sense that your colon is still doing its normal job of making regular, formed bowel movements. Sometimes the symptoms of small bowel Crohn’s, like bloating, or abdominal pain, can be harder to notice if they happen slowly over time. Some types of eye inflammation can be linked to bowel inflammation, and Humira is also indicated for the treatment of one type of eye inflammation called uveitis. Yes, the medications are usually safe and well tolerated. In Crohn’s disease, for reasons that we do not completely understand, your immune system is doing something it should not---it is attacking your small intestine. Humira and Imuran are meant to turn down this overactive immune response. Most patients tolerate these medications well, and your health care team will be carefully monitoring you to make sure this is the case. Risks of cancer are very low as well. There are several things you can to do help keep yourself safe and help prevent infections and cancer, which include keeping up to date on vaccinations and cancer screening. The Crohn’s and Colitis Foundation has made a checklist for the best ways to maintain your health, which can be found here: https://www.crohnscolitisfoundation.org/sites/default/files/2019-09/Health%20Maintenance%20Checklist%202019-3.pdf When your doctor makes a decision regarding the best treatment for you, the decision includes not only how active your disease is right now (thankfully mild for you), but also the risks of the disease becoming worse or developing complications in the future. Therefore, even though the disease may be mild now, it likely is important to treat it now, so that you can enter remission, and it never becomes anything more than mild. hide answer

A: Very few cases of HSV2 associated with anti-TNF biologics have been reported in medical journals. Most cases seem to have been associated with patients on multiple immunosuppressants, such as prednisone and/or 6MP or Imuran along with a medication like Humira or Remicade. Risks and benefits of your medications are important to discuss with your health care provider to come up with the best plan that may work for you. Keep in mind that stopping biologic treatment may lead to a flare of your UC or arthritis, which could lead to steroid use. Steroids are much higher risk than biologics when it comes to infectious risk. Entyvio (vedolizumab) is thought to be an intestine specific medication, and thus far, has not been associated with risk of other infections. However, Entyvio may not control arthritis and may require that a second medication be started to control the arthritis. hide answer

A: Allergic reactions can occur during the Remicade infusions. Because your daughter has required steroids during the last several infusions, she may want to try pre-treatment with a dose of an anti-histamine, such as Benadryl, and a dose of steroids before the infusion in order to prevent a reaction. Slowing the infusion rate sometimes can also be helpful. Methotrexate is often useful for both Crohn’s and arthritis. Your daughter may want to discuss whether the current dose of methotrexate can be adjusted to better control her joint pains. Alternatively, her doctor may want to do some testing to make sure that her intestines are healed, because ongoing intestinal inflammation can also be a cause of ongoing joint pains. Alternatively, her doctor may want to do some testing to make sure that her intestines are healed, because ongoing intestinal inflammation can also be a cause of ongoing joint pains. hide answer