When Bowel Rest May Be Effective
Bowel rest can be used before or after certain surgeries.
Sometimes a person with Crohn’s who is getting surgery may be malnourished because of a flare, which can lead to a bowel obstruction and is not ideal for an operation. In this case, bowel rest would be used to avoid any adverse outcomes to the surgery while keeping the patient nourished, says Philpott.
Enteral nutrition and bowel rest are both recommended courses of treatment for Crohn’s for children, especially when doctors want to induce remission in kids and teenagers with mild to moderate Crohn’s and eliminate the risks some medications pose to younger people.
“Children have different nutritional requirements than adults,” says David Ziring, MD, a pediatric gastroenterologist at Cedars-Sinai in Los Angeles. “So we employ it as a tool more extensively than our adult counterparts.”
In a meta-analysis published in 2019 in the World Journal of Pediatrics, researchers looked at 18 studies of children with Crohn’s and found that kids who received enteral nutrition were able to achieve clinical remission at about the same rates as those who took steroids. But kids who received enteral nutrition had a higher chance of experiencing endoscopic and complete mucosal healing and weight gain than those who received steroids.
How to Cope With Bowel Rest
Dr. Ziring notes that bowel rest is not an effective therapy in most cases.
“There are certainly lots of GI doctors who are not aware of this and continue to put patients on bowel rest,” he says. “That's not to say that parenteral nutrition isn't a valuable tool for patients with Crohn's disease in getting them ready for surgery or after surgery, or if they can't tolerate anything in their GI tract, but it's not used therapeutically to induce remission in patients with Crohn's disease.”
If you are put on bowel rest or some sort of liquid diet, you shouldn’t feel any discomfort that would cause you to be intolerant to the process, Philpott says, and you should alert your provider immediately if you do. You may experience some bloating, but especially in a surgical situation, clear feedback every step along the way is necessary for success.
If you are on bowel rest, there are two things you should consider during rest and recovery.
The first is to make sure that you and your doctor are clear about what’s required and what the next steps will be, advises James Marion, MD, the director of education and outreach at the Susan and Leonard Feinstein Inflammatory Bowel Disease (IBD) Clinical Center at Mount Sinai Hospital in New York City. Be sure to ask questions such as: How long will I be on bowel rest? What happens if it doesn’t work? "It’s not something that should be open-ended,” he says.
The second is to slowly reintroduce solid food. “Don’t go to a steak house for your first meal,” Dr. Marion says.
Start with clear liquids and then progress to full liquids. Add soft, mushy foods such as porridge, scrambled eggs, and overcooked pasta. If you can tolerate these, add chopped meats like chicken — and ultimately cooked vegetables, too. “You can add more foods once you find you can tolerate the progression,” explains Marion.
Diet as an Alternative to Bowel Rest
Because bowel rest is an older treatment option, doctors now opt for diet and nutritional therapy when possible.
“Eating food rather than resting the bowel often helps to maintain or improve a patient's nutrition-related quality of life,” says David Gardinier, RD, an IBD registered dietitian at the Cleveland Clinic.
One type of diet is the Crohn’s disease exclusion diet, which combines whole foods and partial enteral nutrition (liquid formula). The diet is often used in children and adults with mild to moderate Crohn’s disease. The Crohn’s disease exclusion diet may be an alternative to liquid nutrition because it has similar benefits to a liquid diet while still allowing patients to eat from a list of specific foods, notes Gardinier.
The diet has two six-week elimination phases followed by a maintenance phase.
“The first six-week phase involves the patient getting half their nutrition from liquid supplements and the other half from a set list of foods; the second six-week phase allows the patient to decrease the liquid supplement to a quarter of their nutrition and expands on the food list that makes up the other 75 percent,” says Gardinier. “The maintenance phase ends up similar to a Mediterranean diet, with a variety of fruits, vegetables, whole grains, and lean proteins.”
Additional reporting by Beth W. Orenstein.
