Crohn’s disease is generally more difficult to diagnose than the other major inflammatory bowel disease, ulcerative colitis (UC). This is because Crohn’s isn’t confined to any one area of the gastrointestinal (GI) tract and the symptoms can be more varied. UC is located in the colon, while Crohn’s may appear anywhere from the mouth to the anus.
Each different location of Crohn’s disease has its own set of symptoms. You can better assist your doctor in making a proper diagnosis if you know what symptoms to watch out for.
A few symptoms are common among most locations of Crohn’s disease. These symptoms include:
- abdominal pain with cramps
- weight loss
- lack of energy
Pain usually begins within an hour of eating and is most often concentrated around the navel, the lower right abdomen, or both.
Swelling is a symptom of Crohn’s disease that can be concerning. Mild swelling and bloating throughout the abdomen can be common in Crohn’s disease and may be affected by diet. However, if you have localized swelling that is painful, you should seek medical care. This can be a sign of an intestinal blockage or significant infection. Swelling that is accompanied by extreme tenderness, fever, or redness of the skin may be due to an abscess, or deep infection. Any of these more serious symptoms require urgent medical attention.
About one-third of people with Crohn’s will also be diagnosed with perianal disease. Perianal disease can cause fistulas, fissures, abscesses, or skin tags. Fistulas create abnormal connections between different parts of your intestine, your intestine and your skin, or your intestine and other organs. Some people may have swollen skin tags around the anus as well.
Symptoms of Crohn’s disease of the colon, known as Crohn’s colitis, manifest differently depending on where the disease is located in the colon.
If the disease is located on the right side of the colon, you will generally have cramps and diarrhea. If it’s located on the left side or involves most of the colon, you may have blood in the stool in addition to the other symptoms.
If the disease is located in the rectum, symptoms will be similar to UC. Symptoms may also include bloody diarrhea or the feeling of having a bowel movement in which little or nothing comes out.
People with Crohn’s disease of the small intestine, known as small bowel Crohn’s, will likely experience cramps, diarrhea, and weight loss.
Occasionally, a person with small bowel Crohn’s will develop constipation rather than diarrhea. This can be caused by inflammation and scarring in the small intestine. These areas can narrow into what is called a stricture. Strictures can lead to nausea, vomiting, and intestinal obstructions.
The ileum is the lower portion of the small intestine. It attaches the small intestine to the colon. If you have Crohn’s of both the ileum and colon, you may experience symptoms associated with either disease or symptoms of 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 first 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.
If symptoms do occur, they’re likely to happen in the upper abdomen either during or immediately following a meal. A smaller percentage of people will experience nausea, vomiting, or both.
Weight loss is another common symptom. This is because people with painful Crohn’s of the stomach may avoid eating or consume less food to prevent pain and other symptoms.
In some cases, because of scarring, this type of Crohn’s will cause a narrowing of the area between the stomach and the duodenum. If this happens, you will usually experience a decrease in appetite, a prolonged bloated feeling located in the upper abdomen, nausea, and vomiting.
Crohn’s of the appendix, esophagus, and mouth are rare types of the disease.
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, you 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.
Clinical research into Crohn’s is ongoing. These studies offer potential new directions for the study of Crohn’s and its complications. A wide variety of bacteria, viruses, and fungi are currently being studied to see if certain infectious organisms may have a role in the development of Crohn’s disease. Another quickly growing area of research is exploring how the immune system interacts with the intestinal system. These interactions can often become potential targets of new therapies.
In fact, medications that block inflammation pathways have become important new therapies in the treatment of Crohn’s. In 2016, the FDA approved the drug Stelara (ustekinumab) for the treatment of moderate to severe Crohn’s disease. This medication works by blocking the activity of certain proteins that produce inflammation. In 2014, the medication Entyvio (vedolizumab) was approved by the FDA also for the treatment of moderate to severe Crohn’s disease. It blocks the interaction between inflammatory cells and blood vessels, preventing the inflammatory cells from entering into the gastrointestinal tract.
For inflammatory bowel diseases like Crohn’s, physical exercise has been shown to have several benefits that may improve quality of life. Exercise can help reduce weight, which can often mean fewer flare-ups. It can help prevent osteoporosis and improve muscle mass. Researchers believe that during exercise muscles release anti-inflammation proteins that may improve the immune system. Physical exercise also has an important role in the emotional well being of people with any chronic illness.
From our medical expert
Crohn’s disease is a serious and often debilitating condition that affects millions of people around the world. But recent research may produce some new therapies to help people with Crohn’s.
One team has identified a hormone receptor in intestinal cells that is involved in inflammation and fibrosis when activated. They are working on ways to shut down that receptor.
Other research has found an abnormal response to normal intestinal yeast in people with Crohn’s disease. An abnormal response to normal intestinal bacteria is already known to occur in people with Crohn’s. The discovery of an abnormal response to intestinal yeast may lead to some new types of antimicrobial therapy for Crohn’s patients.
Finally, an enzyme has been identified that inhibits the formation of Paneth cells in the gut. Paneth cells produce antimicrobial proteins and are known to be deficient in people with Crohn’s disease. Scientists think a new method of treating Crohn’s disease may involve inhibiting this enzyme.