Crohn's and vaginal ulcer

[nanunanu]

I was initially diagnosed postendoscopy with multiple erosive duodenal ulcers about a month ago due to upper abdominal pain occasionally presenting as chest pain.    I was taking Nexium, which looked to be working very well.  Since the doctor noted that I was also incidentally chronically constipated even as a child, and diagnosed me with Irritable Bowel and he prescribed Zelnorm 6mg BID.  About a week of taking Zelnorm, I started to have lower abdominal pain, became more constipated, had bilateral hip joint pain, and could barely sit or walk comfortably by the 3rd day. I then developed low grade fever, and tachycardia.  Colonoscopy was immediately done, and I was diagnosed with Crohn's Ileitis.  I have not had diarrhea at all.  I was started on Mesalamine 1000mg TID and Metronidazole 250 mg BID. About 3 days after these meds, I started to have vaginal pain near the urethral opening, occasional pruritus, no foul odor, no discharge, I took it upon myself to inspect my introitus, and found a single 1 mm ulcer in the vaginal mucosa near the introitus not where the pain is at. The ulcer itself is painless, with a slightly depressed white center, with no increased redness or inflammation surrounding it. Is this all related? Why the constipation in the diagnosis of Crohn's? Is it OK to refuse treatment with Budesonide, because I work with close contact with infectious patients? Should I seek treatment for the vaginal ulcer with the GI or Gyne  since I know it might be related to Crohns.  I am Asian. No family history whatsoever. I don't drink alcohol, but I smoke. My past medical history includes Dengue Fever with platelet transfusion and 3 childbirths. Chronic constipation is my only significant past medical history.  I used to be on depot injections for birth control, but stopped and my last dose was Nov 2004. With all this happening in a month's time, I am afraid of what is yet to come, and I am not on steroids yet. I use to think of horses all the time, but this looks like a zebra to me, that is why I have been neglecting sporadic low grade fever, about 3X in 6 months. I just always think its the flu. Help me get things straight rather than go doctor shopping or thinking zebras. Thanks!

[Kevin Pho, MD]

Although possible, I am not aware of a vaginal ulcer being associated with Crohn's disease.  I would consider a GYN referral first to look at this.

As for the constipation - it is more uncommon for this to be related to Crohn's, but any change in bowel habits can certainly be possible.  It is also possible to have irritable bowel superimposed on Crohn's disease.

I cannot make any recommendation as to whether you should take the Bedesonide or not.  I would discuss this specific concern with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[kimbacat]

Hi,

Crohn's disease does not always equate to diarrhea, it can be constipation dominant.  How it affects each person is highly individualized.  you can go to www.ccfa.org for info.

did they biopsy those duodenal ulcers?  that might also be crohn's.  my understanding of taking meds such as budesonide (which should only be take short term) and the other maintenance med such as azathioprine, 6mp, methotrexate, etc is that in Crohn's disease, you are trying to reduce an OVER active immune system.  so taking the meds does not necessarily mean that you will be 'immune commpromised'.  I know nurses and Docs with Crohn's disease on these immune "modulators"  that work in hospital settings seeing, treating and caring for patients.  talk to your doc and your employer about it.  It's not going to do you or them any good if you are too sick to work because you aren't taking the appropriate treatment.

If the ulcer is CD related, treating the CD is the best way to treat the ulcer since most extra-intestinal manifestations of Crohn's respond well to treating the underlying disease itself.  If you are concerned, I would recommend seeing a gyno that specializes in vulvular/vaginal problems and not a regular gyno, or at least a regular gyno that has experience with Crohn's complications.  I seriously doubt you'd find a regular gyno that has any clue about CD related gyno probs, so I'd go the specialist route.  I have vaginal/vulvular problems related to CD and I find going to a gyno that specializes in these problems is sooooo much better, at least he can readily identify what it is NOT!  And my doc is much less gung-ho on the 'well, the only way we're going to find out is if we biopsy it and I can't treat you if I don't know what it is'.  He knows and I know that if we biopsy, it's just going to confirm what we think, and not add any info, so why torture me?

take care

[MrsPooh1]

Are there women out there who constantly feel just plain ill with rectal vaginal fistulas.  Mine has been open for years and I go between pain, cramping and just general ill feeling due to the fistula activity.  Anyone else experience this?

[nanunanu]

The biopsy confirms Crohns Dse and tying up the initial endoscopy findings, they conclude that it was Crohns as both histopathology indicated Chronic inflammation.  The MD explained that I had not had any diarrhea, because my colon was spared and "clean and normal", and it is usually colonic type of Crohns which causes the diarrhea because the colon is the one that absorbs and secretes the water, in my case, the inflammation had caused obstructive symptoms, leading to the constipation.  The medications have now allowed me have a bowel movement more often now, and I believe the inflammatory process causing the obstruction is dissipating. As for the vaginal ulcer, I will update after my Gyne appointment.

[Chrissietravel]

A related discussion, Rectal Vaginal Fistulas was started.