Short bowel syndrome: Time for a gut check?

How your body gets the nutrients it needs is a fascinating process—and one that is important to understand when you have Crohn’s disease.

After your stomach begins to break down the food you eat, the food moves into your small intestine, or small bowel. There, the bowel absorbs vitamins, minerals, fats, proteins, carbohydrates, and water. All of these nutrients are important in keeping you healthy. At roughly 23 feet long, a healthy small intestine provides plenty of space for absorption to take place. 

But if you have short bowel syndrome (SBS), that’s not the case.

What is short bowel syndrome?

SBS is a disorder that affects people who have had large portions of their small bowel removed, damaged, or missing as a result of an injury or disease. For people with Crohn’s disease, SBS occurs as a result of large portions of the small intestine being surgically removed.

SBS can have negative effects on the body’s ability to absorb important nutrients. So, knowing about SBS and recognizing when you might have it is vital. Many (around half) patients with SBS may require artificial nutrition and/or hydration.

Short bowel syndrome symptoms

The most common SBS symptom is chronic diarrhea, which can lead to malnutrition, dehydration, and weight loss. Other signs and symptoms may include:

• Abdominal pain and cramping  
• Bacterial overgrowth
• Bloating 
• Fatigue 
• Food sensitivities
• Heartburn 
• Intestinal gas 
• Oily and/or foul-smelling stool  
• Thirst

Signs of deficiencies caused by SBS may include:

• Anemia
• Easy bruising 
• Thinning or fragile bones (osteoporosis) and bone pain

You can often adapt to a shortened bowel if you’re missing only small segments of your small intestine. But the more of your small bowel the surgeon removes, the more likely you are to get SBS. The diagnosis of SBS is generally made when a patient’s bowel length is critically low and prevents the normal absorption of fluids and nutrients.

Many other complications of SBS are possible, too. These may include kidney stones, high lactic acid in your bloodstream, mental health issues (anxiety/depression), and increased production of stomach acid.

If you develop SBS signs and symptoms after a bowel resection, you should alert your doctor.

Short bowel syndrome treatment

Doctors use blood and stool tests and a physical exam to diagnose SBS. If you have the condition, the good news is that it may be temporary. Sometimes, your remaining small intestine will take over the work of the missing portion of your bowel. But it could take up to two years for this to happen. As a result, you typically need treatment in the interim. Intestinal rehabilitation centers are one option. These specialized medical facilities focus on assisting people with intestinal failure and related conditions through a team of specialists who work together to develop personalized care plans tailored to each patient’s needs.

Doctors personalize your medical care based on factors, including how much of your small intestine remains and its location. They also consider any symptoms you have. Generally, the goals of treatment are to:

• Ensure you get the nutrients and fluids you need
• Manage your symptoms 
• Prevent SBS complications

Managing short bowel syndrome involves a comprehensive and collaborative approach by a team of healthcare professionals. This team can typically include doctors, surgeons, dietitians, nurses, and social workers, all of whom have experience in treating patients with intestinal issues.

You can learn more about the IBD care team by viewing this video titled Meet Your IBD Care Team.

To get adequate nutrition for short bowel syndrome. The dietitian on your care team may recommend changing the foods in your diet and eating several small meals each day instead of three large meals. Additionally, you may be advised to use supplements to help meet your nutritional needs such as electrolyte supplements, nutritional supplements, oral hydration solutions, or vitamin and mineral supplements.

Your doctor may also recommend various medications to improve nutrient absorption and help manage your symptoms. But don’t take any medicine on your own. Always check with your doctor first.

If other treatments don’t work, getting your nutrition through a feeding tube or a vein can become necessary. Doctors may also consider surgery to help you better absorb nutrients or treat certain complications. You can learn more about nutrition and enteral nutrition here.

Questions to ask your doctor

If you think you might have SBS after resection surgery, you may wish to ask your doctor the following questions: 

• Are there steps I can take to help myself feel better?
• How do I know if I’m getting the nutrients I need? 
• How do you diagnose SBS? 
• What kind of follow-up care will I need? 
• What treatment do you recommend for SBS? 
• Will I have any long-term consequences from SBS?
• How do I know if the remaining portion of my bowel is still working properly?

Learn more

View our Short Bowel Syndrome and Crohn’s Disease publication to learn more about SBS and managing the condition. The Crohn’s & Colitis Foundation’s community and support page can guide you to additional resources.  

Learn more about how your gastrointestinal tract works by visiting the Foundation’s GI Tract Guide.

Sponsored by:

Ironwood Pharmaceuticals