Decades ago, if you had Crohn’s disease that was difficult to control or if you couldn’t tolerate steroids, your doctor may have suggested an approach called bowel rest.
Today, thanks to better and safer treatments for Crohn’s, bowel rest is far less common — but it may be used as a last recourse, says James Marion, MD, 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.
Bowel rest involves giving your digestive system a break from eating any food by mouth, according to the Crohn’s & Colitis Foundation (CCFA). The idea is similar to staying off your foot to give a sprained ankle time to heal, Dr. Marion explains.
With bowel rest, your body still receives nourishment — just “through means that don’t require active digesting and processing of nutrients,” explains Sunanda V. Kane, MD, a gastroenterologist at the Mayo Clinic in Rochester, Minnesota.
This typically involves taking in liquid nutrition through a tube that runs from your nose to your stomach or small bowel, an approach called enteral nutrition. Or you might have nutrients delivered into your bloodstream through a large vein in your chest or arm via a process called parenteral nutrition. The mixture that’s used contains protein, carbohydrates, fats, vitamins, and minerals, Dr. Kane explains.
“Enteral feeding is typically done at home, where parenteral often starts off in the hospital until the right formula is configured, and is then continued at home,” she says.
When Bowel Rest May Be Effective
“If you’re not a good candidate for surgery or if your Crohn’s has caused a small bowel obstruction, which means a blockage prevents your small bowel from functioning well enough to provide the nutrition you need, you may be a candidate for bowel rest,” Marion says. Your doctor might also suggest it if, when eating, an obstruction in your small bowel causes you to vomit, or if the obstruction may perforate your bowel, he adds.
One advantage of bowel rest is that it doesn’t involve medications, Kane says. This may be why it was more common in the past, when steroids — with their numerous side effects — were the main treatment for Crohn’s disease, Marion explains. Long-term use of steroids can have negative consequences, including bone thinning, weight gain, and increased blood pressure.
But bowel rest has some drawbacks, too. If you’re being fed through an IV line, there is a risk for infection at the injection site as well as risk for clotting. In addition, long-term tube feeding can cause damage to your liver. It can also be unpleasant to have a feeding tube in your nose for an extended amount of time, Marion adds.
How to Cope With Bowel Rest
You shouldn’t be hungry or dehydrated on tube feeding, Kane says. “Sometimes what’s perceived as hunger is really just the desire to eat in the company of others. Hydration shouldn’t be a problem either, because there is adequate fluid in the preparations you will be given.”
Here are some tips for getting through bowel rest and recovery:
Ask about the big picture. If you’re prescribed bowel rest, it’s important that your doctor is very clear on what’s required and what the next steps will be, Marion says. Be sure to ask questions: How long will you be on bowel rest? What happens if it doesn’t work? “It’s not something that should be open-ended,” he says. And Kane agrees, adding that understanding why you’re doing it and for how long can help you get through it.
Chew gum. “I always encourage my patients to have gum to chew on or hard candies to suck on, which can give you something to savor,” Marion says. “It’s a little thing, but it can help.”
Slowly reintroduce solid food. When you’re done with bowel rest and ready to reintroduce food, it’s important to do so gradually. “Don’t go to a steakhouse for your first meal,” Marion says.
Start with clear liquids and then progress to full liquids, such as gelato or ice cream, if you can tolerate milk products. Add soft, mushy foods such as porridge, scrambled eggs, and overcooked pasta. If you can tolerate these, you can add chopped meats like chicken — and ultimately cooked vegetables, too. “You can add more foods once you find you can tolerate the progression,” Marion says.