Children and Crohn's

Approximately 2 percent of patients with Crohn's disease present before 10 years of age, and 30 percent present between 10 and 19 years of age. Physicians may not suspect inflammatory bowel disease as a cause of gynecologic symptoms among patients younger than 19 years. In a study of 230 pediatric patients with Crohn's disease, 29 percent had significant pelvic pathology. Lesions include highly destructive perineal disease, complicated fistulas (rectourethroperineal, rectovaginal, rectolabial, multiple fistula draining sites) and simple perianal fistulas or abscesses. Children are less likely than adults to have fistulas, fecal incontinence or perineal disease. An inability to hold a retention enema (using 100 cm of water mixed with methylene blue for enhanced visibility) may indicate fecal incontinence if the suspected diagnosis remains unclear after the history and physical examination are complete.

Growth retardation, malnutrition, and primary or secondary amenorrhea can occur and may not be appropriately diagnosed. An accurate diagnostic assessment is difficult because children with Crohn's disease commonly present with perineal disease as the initial clinical manifestation. Unless this association is recognized, physicians might fail to perform a gynecologic examination in young patients.

All of the medications used for adults with IBD are also used for children, and the indications and contraindications are similar.

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