In some bowel diseases, it is impossible to avoid removing diseased parts of the small intestine. When large portions of the small intestine must be removed, short bowel syndrome may develop.
What is short bowel syndrome?
The medical term short bowel syndrome (KDS) is used to describe a number of conditions that can result in significant loss of bowel length after surgical procedures and inadequate digestion and processing of nutrients. When only 60 to 100 centimeters of small intestine remain, nutrient processing cannot be adequately secured, resulting in deficiency symptoms. Normally, the small intestine is five to six meters long, so it is understandable that a loss of length leads to health restrictions. Short bowel syndrome is most common in patients with severe Crohn’s disease, but also occurs as a result of surgery due to cancer, radiation, and vascular occlusion.
Causes
The most common cause of short bowel syndrome is severe Crohn’s disease with recurrent inflammation of the small bowel. However, acute vascular occlusions in the small intestine (mesenteric infarcts), colon cancer and radiation to the abdomen due to cancer, intestinal injuries, fistulas, and intestinal obstructions may also result in the need to remove large portions of the intestine. In childhood, short bowel syndrome most often occurs when there are complications from premature births, congenital malformations or tangles. Inguinal, umbilical, and incisional hernias may also be possible causes.
Symptoms, complaints, and signs
The symptoms of short bowel syndrome depend on the cause, the remaining length of small bowel, and the area of bowel that had to be operated out. The shortened intestine and associated nutrient deficiency can cause discomfort in various organs. There is massive, sticky diarrhea with strong odor, especially with high carbohydrate content. As a result of the disturbed digestion, flatulence and abdominal cramps occur, often with severe weight loss. The deficiency of vitamins and nutrients that occurs as a result of the shortening can manifest itself in different ways, depending on the substance that is missing. In the case of a vitamin deficiency, the skin is dry, an increased tendency to bleed, night blindness can be observed. Similarly, a lack of vitamin B12 and folic acid deficiency can lead to anemia, accompanied by a pale skin color, fatigue and reduced performance. The vitamin deficiency can also affect nerves in the spinal cord and cause misfeeling in the hands and feet, for example, walking problems. When blood salts such as magnesium and calcium are deficient, muscles cramp and bones ache. A protein deficiency can cause severe weight loss, and ankles and lower legs can swell due to water retention.
Diagnosis and course of the disease
The diagnosis of short bowel syndrome depends on the severity of the disease and which parts of the intestine had to be removed. After surgery, it is important to regularly check blood counts to determine whether the body is receiving adequate vitamins and nutrients, regular weight checks, and stool examinations to prevent complications in time. X-ray examinations or a computed tomography (CT) scan may also be useful to monitor the intestines if necessary. To a certain extent, the intestine is able to adapt to the new conditions and compensate for the function of missing sections (medical adaptation). The adaptation period after surgery can last up to a year and is often associated with severe diarrhea at first, especially in the first few weeks after surgery. Usually, the bowel recovers after a certain period of time and affected individuals feel an improvement in their symptoms after this adaptation phase. If medications do not help, artificial feeding may be used temporarily or an artificial bowel outlet may be placed. If the remaining bowel length is less than one centimeter, artificial feeding may be required permanently. In more severe cases, if further weight loss occurs despite artificial nutrition, often the only solution is intestinal transplantation.
Complications
Short bowel syndrome can cause various complications. For example, diarrhea and fatty stools may result from the overproduction of stomach acid.The accompanying lactose intolerance often aggravates the gastrointestinal complaints and contributes to the acidification of the organism. The decrease in bile acid concentration can cause gallstones and kidney stones. This can cause various complications such as biliary and renal colic, jaundice, urinary retention and inflammation of the ureters. In severe cases, the bile duct may become inflamed, causing fever and chills. In addition, short bowel syndrome increases the risk of oxalate stones, also associated with severe complications and severe pain. In the long term, the systemic complex in short bowel syndrome leads to a decrease in quality of life and the development of psychological problems. Problems may also arise in the treatment of short bowel syndrome. Nutrition via infusion can lead to infections and vein irritation, cause edema, and cause long-term damage to both the cardiovascular system and the digestive tract. In addition, dietary changes can cause pronounced fatty stools and subsequently hemorrhoids. The preparations used to regulate stomach acid can cause sleep disturbances, reddening of the skin and other side effects. Colestyramine prescribed for kidney and gallstones can cause nausea, heartburn, loss of appetite and the like.
When should you go to the doctor?
Short bowel syndrome is when parts of the small intestine had to be removed due to a disease. Because of the shortened small intestine, affected individuals often suffer from sticky diarrhea. Immediately after the shortening of the intestine, such complaints are completely normal. In this case, there is no need to see a doctor. However, improvement can be brought about with appropriate medication. After a few weeks, the intestine should have adjusted to the new conditions, so that the diarrhea should subside. If this is not the case, a doctor should definitely be consulted. However, if the small intestine has been shortened to a length of less than 2 cm, then artificial feeding may be necessary. In such a case, permanent medical observation is necessary. An appropriate physician should also be consulted if pain in the intestinal area persists for a long time. Only in this way can serious complications be detected, treated and eliminated at an early stage. Anyone who forgoes subsequent treatment in the case of short bowel syndrome exposes himself to risk.
Treatment and therapy
Usually, the bowel is placed on artificial feeding for two weeks immediately after surgery to minimize the risk of massive weight loss. It is administered intravenously through an indwelling venous catheter during this time. During the first few weeks, severe diarrhea may occur in clusters, which must be treated with medication; in addition, fluid and nutrient intake must be monitored, and nutrients must be added if necessary. After the diarrhea subsides, a normal diet can be slowly established and the artificial diet gradually phased out. If a large part of the small intestine had to be removed, this phase may take correspondingly longer. If symptoms continue to occur even though the remaining part of the small intestine is long enough, a piece of the small intestine can be surgically cut out, rotated 180 degrees and reattached at the same place. The intestinal muscles then ensure that the food pulp is transported in waves back upside down toward the stomach. This allows the food to linger longer in the intestine and promotes the absorption of nutrients.
Outlook and prognosis
Life expectancy in short bowel syndrome is based on the type and severity of the underlying disease and its course. Depending on which parts of the bowel need to be removed and the length of the residual bowel, parenteral nutrition may be required. If the length of the residual bowel is less than one meter, the patient usually requires constant care. Age, general condition, and any concomitant diseases also affect the prognosis. In addition, complications may occur that worsen the prognosis. Meanwhile, with a healthy lifestyle and adherence to medical guidelines, patients can live a life with a relatively high quality of life. In the case of mild short bowel syndrome, there are often only a few limitations. Those affected then only need to consult their doctor regularly so that symptoms can be monitored and any complications detected at an early stage. The prognosis in this case is very good.A complete cure for short bowel syndrome is not yet possible. After the patient has been treated surgically, infections can develop that may be life-threatening. Even if the remaining length of the bowel is extremely short, there may be an acute danger to the patient’s life. Constant medical monitoring is also necessary in these cases.
Prevention
In general, no prevention is possible for short bowel syndrome, but affected individuals can ensure that the residual bowel is protected and the condition does not worsen by following behavioral measures. To achieve this, it is important to follow the dietary recommendations of physicians, go for regular checkups, take medications according to their prescription, and see a doctor immediately if complications arise.
Follow-up care
Measures of aftercare usually prove to be very difficult in short bowel syndrome and in many cases are not possible at all. Therefore, affected individuals should see a doctor very early in this disease to avoid further complications. If short bowel syndrome is not treated, it inevitably leads to significant limitations in the quality of life of the affected person. In most cases, after the surgical intervention that led to the short bowel syndrome, no special measure of aftercare is necessary. Diarrhea usually resolves itself after a few weeks, so there is no need to see a doctor. This should only be done if the diarrhea has not disappeared on its own after a few weeks. In severe cases, however, patients with short bowel syndrome are dependent on artificial feeding, so that the help and care of the affected person by his or her own family has a positive effect on the further course of the disease. As a rule, this also requires regular check-ups with a doctor in order to detect and treat other damage to the intestine at an early stage.
What you can do yourself
What measures short bowel syndrome patients can take to reduce discomfort and support the healing process after surgery depends on the causative disease. As a general rule, rest and bed rest apply after surgery. The previous diet may be continued, although initially only small portions of an easily tolerated diet should be consumed. Meals should consist of fish and low-fat meat, egg, milk and milk products, potatoes, root vegetables and low-acid fruit and are best divided into six to eight small portions. Fat intake can be increased slowly, always accompanied by medical check-ups. In addition, sufficient fluid intake is important, especially if diarrhea has occurred. For example, isotonic drinks, juice spritzers, sweetened tea or water have proved effective. In addition to these dietary measures, steps must be taken to alleviate the individual symptoms. In the case of dry skin, care products from the drugstore help, as well as natural ointments and lotions made from chamomile, lemon balm and other medicinal plants. Diarrhea, bloating and anemia should resolve on their own after a few days to a few weeks, as long as the diet prescribed by the doctor is followed.
