Issue link: https://www.massageandbodyworkdigital.com/i/494122
38 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 1 5 Fistulae Another important and potentially dangerous complication is the result of those strictures. As testament to the remarkable capacity of the human body, the body will attempt to build a new passageway when material cannot pass through a tube. These new passageways are called fistulae. In the case of Crohn's disease, these fistulae can link one loop of intestine to another, or they can go from the intestine to the urinary bladder, or from the intestine to the uterus, or sometimes even from the intestine directly to the skin; this typically happens around the anus. Secondary infection and abscesses at these fistulae are significant risks because they allow material to gain access to parts of the body that don't have protection from fecal bacteria. Extra-Intestinal Manifestations Crohn's disease affects more than the digestive tract; it appears to trigger generalized inflammatory reactions in many areas. These complications are called extra-intestinal manifestations. Inflammation of the eyes is common, as is inflammation of the lungs or the pleurae. The gallbladder, liver, and pancreas are frequently affected by inflammation related to Crohn's disease. Inflamed and painful joints, kidney stones, hypercoagulability of the blood, and a blistering rash that appears on the shins are all signs of dysregulated inflammation associated with this disease. In addition, reduced access to nutrition makes people with Crohn's disease especially vulnerable to osteoporosis and anemia. Finally, people with Crohn's disease, especially those who were diagnosed young and who have multiple lesions, have a significantly increased risk of colorectal cancer. TREATMENT The treatment options for Crohn's disease are somewhat controversial. Many specialists argue whether a bottom-up (starting with low-impact treatment and ratcheting up as necessary) or a top-down (getting ahead of the disease process with biologic drugs and then scaling back as possible) approach is best. Ultimately, of course, this decision must be made on a case-by-case basis. For most patients, pharmacological therapy includes a range of options: 5-aminosalicylic acids, antibiotics and nutritional supplements, steroidal anti-inflammatories and immune system suppressants, or biologic therapies that alter T-cell activity. Other drugs might also be employed to manage symptoms and complications. Dietary adjustments for people with this condition mostly center around being sure that adequate nutrition is achieved, and most patients feel better when they avoid roughage: raw fruits and vegetables with peels, nuts in any form other than as nut butter, anything with small seeds (strawberries, tomatoes), corn, and popcorn. About two-thirds of all Crohn's disease patients have at least one surgery to remove diseased sections of the GI tract by the time they've been diagnosed for 15 years. Because this condition occurs in disconnected patches, however, a surgery is not considered to be curative; it can return somewhere else. MASSAGE FOR CROHN'S DISEASE Little research has been conducted about massage therapy as an intervention for patients with Crohn's disease. However, general trends suggest that people with chronic pain conditions are often enthusiastic users of CA M interventions, and massage is typically the most popular choice. It is interesting to point out that most inflammatory bowel disease patients do not use CA M interventions specifically for disease management, but rather for stress or other problems they feel contribute to their symptoms. This is supported by the experiences of several massage therapists who shared their stories for this article. Most MTs reported that their clients usually did not come during a flare, and when they did, only the gentlest, nonabdominal work was welcomed. At other times, depending on the client's needs, massage could be conducted without any special accommodations. Some clients were able to manage their disease proactively with a careful diet, exercise, and yoga; others used prednisone and repeated surgeries. A common theme is that clients feel massage therapy helps them with the stress associated with having Crohn's, and that managing the stress decreased the likelihood of having another flare. "I'd never had a massage before. I didn't tell the therapist where the pain was, but she knew. She put her hands right on it, and just held me. I'm not sure what she did, but it seemed to calm down the inflammation. She took my pain away. For half an hour, I had no pain. It was amazing. I'd never felt anything like it. Later, I realized that first appointment with a massage therapist started me down my path to this profession. In some way, I felt she passed being a massage therapist on to me." Meredith Kusmer Jerome