Medications that only manage symptoms are also called non-specific drugs. They work to reduce symptom severity, but have no effect on the inflammation that causes the symptoms.
Pain is common during a flare-up. Analgesics that contain acetaminophen, such as Tylenol®, sometimes in combination with codeine, may be used for short periods. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ASA (Aspirin®, Entrophen®, and others) or ibuprofen (Advil® and others) are probably best avoided.
These drugs reduce the muscle activity of the bowel wall, slow down the passage of stool through the bowel, and allow more fluid to be reabsorbed from the colon into the bloodstream. By doing so, they reduce the volume of liquid contained in the stools.
Loperamide (Imodium® and other brands) is the best known drug in this class. It may be used to reduce the severity of diarrhea for special events or situations, such as when travelling or when attending a special function. Use on a daily basis can, however, cause severe constipation and lead to serious problems.
Products that contain bismuth (e.g., Pepto Bismol®), attapulgite and/or pectin (e.g., Kaopectate®), or strawberry extract generally don't have much use in IBD.
The liver produces bile salts to help the intestine to digest fat. Over 90% of these bile salts are usually reabsorbed in the lower part of the small intestine (ileum). If the ileum is extensively diseased, or if part of it has been surgically removed, bile reabsorption is reduced and more passes into the colon. The excess that passes into the colon irritates the mucosa, causing even more fluid to collect in the colon. This results in watery diarrhea. Bile salt binders such as cholestyramine (Questran®) and colestipol (Colestid®) help prevent the bile salts from irritating the mucosa.
These medications may be helpful for Crohn's patients, especially for those who have had surgery to remove the lowest part of the small intestine.
Bulk-forming agents contain insoluble fibre from natural sources. They act to provide bulk and absorb fluids. For constipated patients, they help form stool that passes more comfortably. For patients with diarrhea, they help reduce the amount of liquid in the stools. Patients with IBD may need them if they develop an irritable bowel (IBS) once their colitis has settled down.
Over-the-counter products such Fibrepur®, Metamucil®, and Prodiem Plain® contain psyllium fibre. Fibyrax® contains a mixture of grain and fruit fibres. Foods that contain bran, such as bran cereals and breads, also have bulk-forming properties.
All patients with IBD need a well-balanced diet.
Most vitamins and minerals are absorbed in the upper part of the small bowel. Nutritional supplements may be needed, especially when you are actively growing or recovering from being sick. It is especially important to take calcium supplements if you have cut down your intake of milk products.
In some instances, supplementation with folic acid, iron, or vitamins (A, B12, D, K) may be needed to prevent symptoms of vitamin or mineral deficiency.
Alternative or complementary therapies such as acupuncture, meditation, relaxation techniques, and yoga may helpful for some patients.
Avoid other therapies that involve "complementary" or "alternative" products until you have discussed the possible risks and benefits with your doctor.