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 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 location of Crohn’s disease has its own set of symptoms. You can help your doctor make a proper diagnosis if you know what symptoms to watch for.
Some signs and symptoms are common, regardless of the primary location of the disease. These include:
- abdominal pain with cramps
- weight loss
- lack of energy
Pain usually begins within an hour after eating and is most often concentrated around the navel, the lower right abdomen, or both. Mild abdominal swelling or bloating is also common in Crohn’s disease and may be related to food choices.
However, if you have localized swelling that is painful, or accompanied by fever or redness of the skin, you should get immediate medical care. This can be a sign of an intestinal blockage, an abscess, or a significant infection.
Fistulas create abnormal connections between different parts of your intestine, between your intestine and your skin, or your intestine and other organs. Perianal disease can cause fistulas, fissures, abscesses, or swollen skin tags around the anus.
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:
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
- 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:
- weight loss
Disease may be located in the upper part of the small intestine, called the jejunum, or the lower part, called the ileum.
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 most common form of Crohn’s disease, ileocolitis affects both the colon and the ileum, which is the lower portion of the small intestine. The ileum 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 small bowel Crohn’s or Crohn’s colitis, or symptoms of both. This is because Crohn’s of the ileum may flare up when the disease in the colon 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 and duodenum, called gastroduodenal Crohn’s disease, will experience no symptoms at all.
If symptoms occur, they’re likely to happen in the upper abdomen either during or immediately following a meal. A small 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 will 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 bloated feeling located in the upper abdomen
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.
Complications of Crohn’s disease sometimes involve the inflammation and scarring that can occur.
Serious complications of Crohn’s may include:
- obstruction of the esophagus, small intestine, or colon
- abscesses (pockets of pus within tissue)
- fistulas, often between two parts of the intestine
- anal fissures
- intestinal bleeding
- perforation of the small intestine or colon
- major distention or dilatation of the colon (this is rare)
Other areas of the body may also be affected by Crohn’s, such as:
- skin conditions such as erythema nodosum or pyoderma gangrenosum
- eye conditions such as uveitis or episcleritis
- joint inflammation
- inflammation or infection of the bile ducts or liver
- nutritional deficiencies and malnutrition
If you notice changes in your bowels that don’t seem to be resolving, speak with a doctor. If you notice common symptoms of Crohn’s disease, it’s important to get an accurate diagnosis.
These symptoms may include:
- pain or cramping in your abdomen
- bloody stool
- persistent diarrhea
- unexplained weight loss
- a fever that lasts longer than a couple days
Crohn’s disease is generally categorized into five types, each with its own set of signs and symptoms. Many of these types have overlapping symptoms. That’s why it’s important to keep track of what you experience and share it with your doctor.
A good strategy is to keep a food and symptom journal to bring with you to appointments, or try a tracking app.
It can also be helpful to talk to others who understand what you’re going through. IBD Healthline is a free app that connects you with others living with IBD through one-on-one messaging and live group chats, while also providing access to expert-approved information on managing IBD. Download the app for iPhone or Android.