Stricture or Narrowing of the Bowel in IBD

Written by Gastroenterology CNP, Sinead Nolan

What is a Stricture or Narrowing of the Bowel:

In patients with inflammatory Bowel Disease (IBD) ongoing inflammation and then repeated healing in the bowel may cause scar tissue (Fibrotic) to form . This can create a narrowing in the bowel known as a stricture. Inflammation alone without scarring can also cause a narrowing in the bowel. A stricture or narrowing of the bowel is a complication more common in Crohns Disease but can also appear with Ulcerative Colitis. A stricture or narrowing can make it difficult for food to pass through and if it’s very narrow can cause a blockage.

Symptoms include:

In severe cases a bowel obstruction may occur. This is where no food is able to pass through the bowel. It is really important to seek medical attention if concerned the bowel is obstructed/blocked.

Diagnosis of a Stricture or Narrowing

Diagnosing a stricture can be done by Ultrasound, CT or MR enterography imaging which will show the severity of the narrowing in the bowel. Attending for an Endoscopy may also be recommenced by your gastroenterologist to confirm a narrowing. Strictures are most commonly found at the end of the small bowel (ileum) but can also found in other parts of the digestive system such as the large bowel (colon),  rectum or anus. 

Management of a Stricture or Narrowing

Following a Low Fibre or Low Residue diet can help minimise the symptoms of a stricture, by helping reduce the amount of undigested food passing through the narrowed bowel. The Irish Nutrition and Dietetic Institute have a very good fact sheet which gives great nutritional advice on what to do when experiencing a flare. The fact sheet gives guidance on foods to choose and limit if following a low fibre diet due to strictures and also gives a suggested meal plan. It is important to follow the advice of the dietitian linked to your care or if you do not have access to a dietician your IBD nurse or Gastroenterologist.

Medications may relieve the symptoms of a stricture or narrowing by reducing the inflammation causing the narrowing. However if the stricture is severe and does not respond to medical treatment, surgery may be required. Surgery also may be needed if there is repeated blockages and there is a risk of a perforation, this is where the bowel tears due to the blockage and is considered a medical emergency.

Once a stricture or narrowing is diagnosed it is important to be monitored regularly by your IBD Team to reduce the risk of complications and manage the stricture or narrowing effectively.

Fact Sheet for IBD Flare:

https://www.indi.ie/images/FactSheet_3_IBD_flare_PAGES.pdf

References: