Crohn's disease is generally more difficult to diagnose than the other major inflammatory bowel disease, ulcerative colitis. This is because Crohn's isn't confined to any one area of the gastrointestinal (GI) tract. Ulcerative colitis is located in the colon, while Crohn's may appear anywhere from the mouth to the anus.
There are several different types of Crohn's disease, each with its own set of symptoms. You can better help your doctor make a proper diagnosis if you know what symptoms to watch out for.
A few symptoms are common among all types of Crohn's disease. These symptoms include abdominal pain with cramps, diarrhea, weight loss, and a lack of energy. Pain usually begins within an hour of eating and is most often around the navel, the lower right abdomen, or both. Activities like jogging will often make the pain worse.
Another symptom that differentiates Crohn's from ulcerative colitis is swelling. This swelling is found in about 25 percent of people with Crohn's and is usually located in the lower right part of the abdomen. The swelling is typically about the size and firmness of a small grapefruit. The tenderness of the swelling, which is easily felt, ranges from mild to extreme. Mild tenderness points to an inflamed intestine and enlarged lymph glands. Extreme tenderness may be due to an abscess, in which case the skin may appear red and/or stretched. Moderate tenderness could signal a combination of the above causes.
Another symptom of Crohn's disease that affects 25 percent of people is perianal disease. It’s usually in the form of an abnormal connection between two organs that aren't typically joined (a fistula), which may also include one or more abscesses. Some people have swollen skin tags around the anus as well.
Symptoms of Crohn's disease of the colon (Crohn's colitis) manifest differently depending on where the disease is located in the colon.
If the disease is on the right side of the colon, a person will generally have cramps and diarrhea. If it’s located on the left side or involves most of the colon, a person may experience blood in the stool in addition to the other symptoms.
If the disease is located on the rectum, symptoms will be similar to ulcerative colitis. They may include bloody diarrhea or the feeling of having a bowel movement in which little or nothing comes out.
Between 70 and 80 percent of people with Crohn's disease of the small intestine (small bowel Crohn's) will experience cramps, diarrhea, and weight loss.
Occasionally, a person with small bowel Crohn's will have constipation rather than diarrhea. Pain is so extreme with this type of Crohn's that some people will avoid eating. This accounts for most of the weight loss.
The ileum is a portion of the small intestine. Someone with both Crohn's of the ileum and Crohn's colitis may experience symptoms associated with either of the diseases above, or both. This is because Crohn's of the ileum may flare up when the colonic disease is in remission, or vice versa.
The duodenum is the part of the small intestine closest to the stomach. Many people who have Crohn's of the stomach or duodenum will experience no symptoms at all. Over 90 percent of those who have symptoms, however, will have pain in the upper abdomen either during or immediately following a meal. A smaller percentage will experience nausea, vomiting, or both.
Around half of the people who have symptoms of Crohn's of the stomach or duodenum will experience weight loss because they are avoiding food. In some cases, because of scarring, this type of Crohn's will cause a narrowing of the outlet of the stomach into the duodenum. If this happens, you will usually experience a decrease in appetite, a prolonged bloated feeling located in the upper abdomen, and nausea.
These types of Crohn's are extremely rare so it’s not possible to identify their "typical" symptoms. Crohn's disease of the appendix may mimic appendicitis and can be present without any other unique symptoms. Crohn's of the esophagus may cause pain behind the breastbone while swallowing.
If the esophagus has become narrowed due to scarring, a person may have trouble swallowing or food may become stuck on the way down. Contact your doctor immediately if you have these symptoms.
Signs and symptoms of Crohn's of the mouth normally consist of large, painful sores in the mouth. If you have this symptom, contact your doctor.