He has taken every medication I can imagine, including Humira injections into his stomach. At present, he is taking hyoscyamine and Apriso plus pain medication when it gets too severe. He has a colonoscopy every year. When he has one of these “attacks,” the pain is so severe that he gets in a fetal position and can barely walk. He has been to the hospital at least 15 times in the past two years. He recently went twice in one week and before that, in just a three-month span, he went seven times.

He is unable to work because he is sick or too weak to function at least five days a week. He has never used drugs, alcohol or tobacco. Surgery has been suggested, but we are trying to avoid that if possible. He has seen at least six different doctors, and we are now hoping that you can help us. Please.

DEAR READER: Crohn’s disease is a type of inflammatory bowel disease (IBD). It can be debilitating and may lead to life-threatening complications, so it should be taken seriously by the sufferer and the treating physician(s). While there is no cure, there is good news. Today’s treatments can greatly reduce symptoms and may even lead to long-term remission.

The most common symptoms include diarrhea, abdominal pain and cramping, reduced appetite, weight loss, ulcers and blood in the stool. Others, especially those with severe Crohn’s, may also experience inflammation of the liver or bile ducts, arthritis, fever, fatigue, skin disorders and eye inflammation. Children may experience delayed growth or sexual development.

Complications include bowel obstruction, malnutrition, anal fissures, ulcers, fistulas (an abnormal connection between different parts of the intestine) and more. There is also an increased risk of colon cancer; however, the vast majority (more than 90 percent) of sufferers never develop it.

There are several types of treatment available. The first type is anti-inflammatory drugs, such as the Apriso (mesalamine) that your grandson is on, as well as azulfidine and corticosteroids. Immune-system suppressors are also used. Your grandson was placed on at least one of these, Humira (adalimumab). There are several others in this category. Antibiotics, which may be helpful in treating some of the complications, such as ulcers, abscesses and fistulas, may also be beneficial for those without complications, as many researchers believe that antibiotics will reduce levels of harmful bacteria within the intestine, as well as suppress its immune system.

Commonly used medications include pain relievers, antidiarrheals, iron supplements, laxatives, vitamin B12 injections, calcium and vitamin D, and/or special diets, such as nutrients introduced directly into the veins, which can bypass the stomach and intestine, thus reversing malnutrition.

Finally, surgery. If diet, lifestyle changes, medication and other treatment fail to relieve symptoms, surgery to remove a damaged portion, close fistulas or remove scar tissue may be recommended. Unfortunately, at best, surgery can provide years of remission, but it will be temporary. Nearly three-quarters of patients who undergo surgery will experience recurrence, with approximately half of them requiring a second procedure or more. Even if signs and symptoms improve, medication is often prescribed following surgery in an attempt to reduce the risk of recurrence.

I suggest your grandson try some of the following lifestyle and home remedies and at least meet with a surgeon to discuss his situation. He is clearly suffering, and if medications have not worked for him thus far, surgery may be his best option.

There is no evidence that diet can cause IBD, but certain foods and drinks may aggravate symptoms. He should limit his dairy intake; eat smaller meals; drink plenty of fluids; eat foods lower in fat, especially if the Crohn’s is affecting his small intestine; consider taking multivitamins to supplement lost nutrients; avoid foods that worsen symptoms; experiment with fiber to find the foods that cause the least upset but help reduce diarrhea; and finally, consider consulting a dietician familiar with the disorder to get further suggestions. He should also try to keep his stress levels down by exercising within his limits, practicing relaxation and breathing techniques and, perhaps, even learning biofeedback. He may also wish to see a Crohn’s specialist at a nearby teaching hospital.

To provide related information, I am sending you a copy of my Health Report “Irritable Bowel Syndrome.” Other readers who would like a copy should send a self-addressed stamped envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Her only complaint is the nonstop abdominal pain. She’s currently taking 300 milligrams of gabapentin three times a day and 20 milligrams of omeprazole twice a day. She says the only difference she notices is that when the pain is really bad, the gabapentin gets her back to base quickly, but she doesn’t get any better.

I would appreciate your thoughts on her condition. You always have thoughtful and helpful advice. Thank you.

DEAR READER: It appears you have taken a great deal of time and expended a great deal of effort in seeking relief for your daughter. I’m not sure that I can add too much more, but I’ll try.

Possibilities include irritable bowel syndrome, abdominal migraines, lactose intolerance and the use of aspirin or ibuprofen taken for the pain. I’m reluctant to mention stress, peer pressure, poor diet or lack of support because your note is so supportive, and your daughter appears well-rounded; however, if she has dark or bloody stools, a change in bowel habits or constipation she hasn’t mentioned, we might have a basis from which to begin. You might ask her physician whether he or she believes a CT scan or MRI might shed some light onto the problem. You also might consider a second opinion with another specialist. This is no reflection on her physician, but sometimes different views help. Keep me posted.

After the surgery, I was able to urinate a few times a day but retained two pounds of fluid for two days. On the third day after the surgery, I was finally able to eliminate all of the retained fluid and I urinated every 20 minutes all day long. Since then, I have noticed that my urine stream is weak. It has been five months since the surgery, and lately, when my bladder is full in the morning, I am not able to empty it fast enough, and it causes pelvic pressure and pain and sometimes cramping until it slowly empties. I do not have a fever, blood in my urine or a burning sensation. I do not have a history of kidney stones and have only had one UTI, which was 11 years ago. The only medication that I currently take is atenolol in the morning. The night prior to the surgery, I was given misoprostol to ripen my cervix. The procedure required a catheter, which was removed before I regained consciousness.

Could this change in my ability to empty my bladder quickly be a result of general anesthesia or the catheter? What tests and treatment should I seek? Will this go away, or is it something I have to live with? I now urinate frequently to intentionally prevent my bladder from getting too full, but I’m not sure what else I could or should be doing. Many thanks for sharing knowledge and expertise.

DEAR READER: A catheter is a thin, flexible tube that is inserted into the body to either introduce or withdraw fluids. The word catheter is most often used to describe a tube that is used to empty the bladder. This can be achieved by insertion directly into the urethra, which leads to the bladder, or in some instances, a special opening is created within the abdomen for the catheter to be placed.

Dilation and curettage (D&C) is a surgical procedure in which a physician dilates the cervix and then scrapes the uterine lining. This is done for a number of reasons, including following abortion or miscarriage, heavy menstrual cycles or as a diagnostic tool for determining the presence of certain gynecologic disorders.

Now, to your specific concerns.

First, because of the proximity of the vagina to the urethra and bladder, your question is whether either or both were inadvertently damaged. This is fairly unlikely; however, it is a possibility that should be looked into.
Next, a catheter can cause scarring of the urethra if inserted improperly and repeatedly over time. Since you mentioned its use only once, during your surgery, this is probably not your problem, but I can’t rule it out entirely.

Request a referral to a urologist for further examination and testing. He or she can then determine whether your problem is directly related to the D&C or some other condition, such as a urinary-tract infection. While it’s uncommon, some people don’t experience any symptoms or have only mild ones that go unnoticed.

To provide related information, I am sending you a copy of my Health Report “Urinary Tract Infections.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167 Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

After my diagnosis, I went online to learn as much as I could about this condition. After reviewing several websites, such as the Mayo Clinic and “WebMD”, I began to notice a trend in their recommendations about diet. The majority of them ended with similar statements. “Your doctor may recommend no nuts, seeds or corn, but there has been no evidence to suggest that these foods actually contribute to this condition.”

Have I stumbled upon one of these “our practices have not caught up with the science” findings or is there still legitimate rational for this restriction? Are we still preaching something that we no longer need to preach?

DEAR READER: Many gastroenterologists have changed their opinions about a diet for diverticulitis (infected diverticula). Your quote seems to sum up the latest recommendation. I am not aware of any recent studies about seeds (and the like) causing diverticulitis.

There is one way to help prevent diverticulitis and diverticula (intestinal out-pouches caused by weak spots and pressure): a high fiber diet. Diverticulitis is rarely present in areas of the world that regularly consume this type of diet. In fact, it was almost unheard of until the invention of steel-grind mills which remove most of the fiber from rice and wheat to make flour.

Diverticula do not usually cause problems and are most often found by accident during routine screening tests for colon cancer and other intestinal disorders. Diverticulitis, however, is generally diagnosed during an acute attack. Common symptoms include left lower abdominal pain, fever, nausea, constipation or diarrhea and abdominal tenderness. Less common symptoms are vomiting, rectal bleeding, frequent or painful/difficult urination, bloating and abdominal tenderness while wearing a belt or bending.

Treatment options vary. For mild to moderate attacks, home care is often recommended and includes a low-fiber or liquid diet, rest for the duration of the attack and oral antibiotics. Once the attack has subsided, fruits, vegetables and whole grains can be (slowly) introduced back into the diet. Severe cases or individuals who have recurrent infections or are at high risk of complications such as peritonitis (abdominal inflammation due to intestinal rupture), bleeding, intestinal blockage, abscess or fistula (abnormal passage between intestine and abdominal cavity, bladder or vagina), that should be treated in hospital with IV antibiotics and special diets. Some individuals with complications or frequent attacks may benefit from surgery to remove the diseased section of the colon and repair damage, such as fistulas.

It is important to see a doctor as soon as possible if you think you are having an attack of diverticulitis. It can mimic other disorders such as appendicitis. The sooner treatment is begun, the shorter the attack will be.

To give you related information, I am sending you a copy of my Health Report “Diverticular Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Can you give me any insight into this phenomenon?

DEAR READER: Your experience appears to be common among individuals who have had gallbladder removal surgery. In fact is it so common it has been titled postcholecystectomy syndrome. It occurs in 5-40% of all patients following gallbladder removal.

Symptoms may include persistent upper right abdomen pain, gas, bloating, nausea, upset stomach, vomiting and diarrhea. Diarrhea from this disorder can be eased by taking the medication cholestyramine.

Pain that persists should be followed up with your gastroenterologist to ensure that another condition, such as Irritable Bowel Syndrome, pancreatitis, peptic ulcers, or sludge in the bile duct are not to blame.

To give you related information, I am sending you a copy of my Health Report “Gallbladder Disease”. Other readers who would like a copy should send a self-addressed 4 ¼” X 9 ½” letter-sized stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.