Lots of people have stomach cramps with diarrhea or constipation. It’s uncomfortable, but you usually get over it and forget about it.
But when you have these symptoms often and they’re severe, there’s a chance you could have Crohn’s disease. You’ll need to see your doctor to find out for sure.
As many as 700,000 Americans have the disease. Although there’s no cure, treatments can manage it.
Symptoms
Symptoms of Crohn’s vary widely depending on the person and on the part of the gastrointestinal tract, or GI tract, that the disease attacks.
In the lower GI tract, or colon, common symptoms include:
- Belly pain and cramps
- Blood in your stool
- Diarrhea
- Drainage from a painful sore near your anus
- Urgent bowel movements
- Feeling like you haven’t totally emptied your bowels
- Loss of appetite and weight loss (Talk to your doctor about this.)
- Constipation, which may lead to blocked bowel
You might also have some of these symptoms if your Crohn’s is in the upper GI tract, or small intestine, though they may be fewer and milder.
But it’s also common to have no symptoms (silent Crohn’s) when the disease affects the small intestine. If your initial symptoms are silent, the next common signs of Crohn’s could include more serious effects like:
- Intestinal blockage
- Infection or abscess
- Pain or fever that won’t go away
- Hole or connecting tunnel in your intestine (fistula)
The disease can also have symptoms that affect your overall health, including:
- Fatigue
- Fever (less common with Crohn’s, so consider calling your doctor)
- Mouth sores
- Night sweats
- Unusual menstrual cycle
You might not have all these. The disease affects people in different ways. The symptoms can be mild, or they can leave you very weak. At its worst, Crohn’s can cause severe complications.
Complications
Crohn’s complications are less common than initial symptoms. They may be:
- Local, involving your intestinal tract
- Systemic, affecting your entire body. You might hear them called extraintestinal complications.
Local complications of Crohn’s include:
- Abscess. This pocket of pus results from bacterial infection. It can form on your intestinal wall. Or you might get one near your anus that looks like a boil. You’d notice swelling, tenderness, pain, and fever. The symptoms go away once the sore is drained. Antibiotics can clear up the infection.
- Fissure. Painful tears in the lining of the anus. They can cause bleeding during bowel movements. Topical treatments and sitz baths are common treatments.
- Fistula. Sores or ulcers can turn into openings that connect two parts of your intestine. They can also tunnel into nearby tissues like the bladder, vagina, and skin. Antibiotics can treat small fistulas. You may need surgery if yours are large or if there are many of them.
- Malabsorption and malnutrition. The disease affects your small intestine, the part of your body that absorbs nutrients from food. After you’ve had it for a long time, your body may no longer be able to make the most of what you eat. Treatment focuses on replacing the missing nutrients.
- Small intestinal bacterial overgrowth (SIBO). Your gut is full of bacteria that help you break down food. When this happens higher up in your digestive tract than usual, you can get gas, bloating, belly pain, and diarrhea. Antibiotics can help.
- Strictures. These narrowed, thickened areas of your intestine result from the inflammation that comes with Crohn’s. They can be mild or severe, depending on how much of your intestine is blocked. Symptoms include cramping, belly pain, and bloating. Medication can help. But if it doesn’t work or if the blockage comes back often, you might need surgery.
With the exception of fissures, which are fairly common with Crohn’s, most of the above complications don’t happen too often.
Some of the most common systemic complications are:
Joint inflammation
Crohn’s causes joint inflammation in a quarter of people who have the disease. Joint inflammation causes pain, swelling, and stiffness. Crohn’s can lead to three main types:
- Peripheral. This type affects large joints in your arms and legs, like your elbows, knees, wrists, and ankles. The problems might start in one joint and then move to another (doctors will call this migratory). It’s most common if you have Crohn’s disease of the colon. The inflammation will come and go along with your Crohn’s, but it doesn’t usually cause lasting damage.
- Axial. This type affects your spine or lower back (the doctor will call it your sacroiliac joint). It’s also known as spondylitis or spondyloarthropathy. You might even have it before you’re diagnosed with Crohn’s. You could notice trouble breathing if it keeps your ribs from expanding. It can cause permanent damage if the bones of your spine fuse together.
- Ankylosing spondylitis. This more serious type of spinal arthritis is rare among people with Crohn’s, but it can happen. In addition to causing arthritis in your back, it can lead to inflammation in your eyes, lungs, and heart valves. Some people get it before a Crohn’s diagnosis. Doctors don’t know exactly what causes it, but they’ve found common genetic markers among people who have it.
Treatment for arthritis with Crohn’s involves:
- Easing the arthritis symptoms like pain, swelling, and inflammation with:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen. But people with Crohn’s can’t always take them because they irritate the lining of your intestines.
- Steroids
- Rest, heat, and range-of-motion exercises
- Treating the Crohn’s, usually with
- Steroids
- Sulfasalazine
- Immune system drugs like methotrexate and biologics
Skin problems
Skin problems linked to Crohn’s are less common than joint inflammation. When they do occur, they most often include:
- Erythema nodosum. These small, tender, red nodules usually show up on your shins, ankles, and sometimes your arms. They’ll get better as Crohn’s inflammation is controlled. Steroids can help.
- Pyoderma gangrenosum. These pus-filled sores often follow an injury or other skin trauma. They usually appear on your legs but can show up anywhere. You might get them on your belly next to a stoma or surgery scars from colectomy. Over time, the sores join and form deep, long-lasting ulcers. Steroids, certain biologic drugs, and medications you put on your skin can help.
- Skin tags. These small flaps of skin are common in people with Crohn’s, especially around the anus or hemorrhoids. Poop can attach to them and irritate your skin. Hygiene can help manage them. Surgery isn’t a good idea because it can damage your anal sphincter or canal.
- Mouth ulcers. You might hear them called canker sores. They happen between your gum and lower lip or along the sides and bottom of your tongue. They get worse when the disease flares and ease when the inflammation is under control. Mouthwashes and a balanced diet can help.
Bone loss
This is a common complication of Crohn’s. In some cases, it could be due to the disease itself, but the powerful corticosteroid medications that doctors use to treat the disease also have an effect. They can:
- Stop your body from absorbing calcium, which it needs to build bone
- Make your body get rid of calcium when you pee
- Boost production of cells that break down bone
- Lower the number of cells that help form bones
- Lower your body’s output of estrogen. Estrogen also helps build bone.
The proteins that cause inflammation change the pace at which old bone is removed and new is formed.
Vitamin D deficiency
This is a common part of the bone loss problem. If your body can’t absorb vitamin D because of Crohn’s damage to the small bowel or a small bowel resection, you’re less likely to be able to absorb calcium and make bone.
To prevent problems or stop them from getting worse, you can:
- Ease up on steroids, or talk to your doctor about trying one with fewer side effects.
- Take medications called bisphosphonates than can strengthen your bones, such as:
- Alendronate (Fosamax)
- Risedronate (Actonel)
Eye problems
Though it’s not very common, the inflammation in Crohn’s or the complications that come with it can affect your eyes. Possible conditions include:
- Episcleritis. Inflammation of the area just beneath the conjunctiva (the clear tissue that covers the inside of your eyelids and the whites of your eyes) is the most common complication of Crohn’s. It can affect one eye or both. You’ll notice pain, itching, burning, and intense redness, but it won’t hurt your vision. Topical treatments can ease the symptoms. It will get better as your disease inflammation goes down.
- Scleritis. This condition causes a constant pain that gets worse when you move your eyes. It can keep you awake. You may also have a headache; watery, red eyes; and light sensitivity. It can show up before you’re diagnosed with Crohn’s, but it doesn’t get better or worse along with the disease.
- Uveitis. This is a painful inflammation of the uvea, the middle layer of your eye. It can cause blurry vision, light sensitivity, and redness. Your doctor may prescribe eye drops with steroids to ease the inflammation. It can come before Crohn’s or result from the arthritis that often results from long-term Crohn’s. If you don’t get it treated, it could lead to glaucoma and blindness.
Kidney problems
Also possible, but uncommon, is that Crohn’s starts to affect your kidneys, which work closely with your intestines. Potential issues include:
- Kidney stones. There are two kinds: calcium oxalate and uric acid stones. Oxalate stones are a common problem with Crohn’s because your body has a hard time absorbing fat. Instead, the fat binds to calcium and leaves a salt called oxalate that gets absorbed into your kidneys and can turn into stones. The risk goes up if you have a small bowel resection, which makes you more likely to get dehydrated. Treatment involves drinking more water and following a diet with lots of juices and vegetables.
- Uric acid stones. These kidney stones form because your diarrhea makes your urine more acidic. If you can’t pass them, a doctor may have to remove them surgically.
- Hydronephrosis. This happens when the ileum (where your small intestine meets the large) swells from Crohn’s and puts pressure on your ureter, the tube that carries urine from your kidney to your bladder. When urine can’t drain like it should, your kidney swells, and scar tissue can form. You might notice a dull pain near your kidney and blood in your urine. Surgery to remove inflamed tissue and the part of the bowel that’s causing the problem can resolve it.
- Fistulas. In addition to forming within your intestines, fistulas can develop between the intestine and other organs, like the bladder or ureter. It’s more likely to affect men and can lead to urinary tract infections. Medications can help, but you might need surgery.
It’s uncommon, but it does happen in some people with Crohn’s. Your liver processes everything you eat and drink. It can get inflamed as a result of Crohn’s treatment or the disease itself. You’re only likely to notice low energy and fatigue unless you develop a more serious problem. Among the most common issues:
- Fatty liver disease. When your body doesn’t process fats as well, they can build up in your liver. Weight loss and exercise are usually the first options for treatment.
- Gallstones. They form when little pieces of cholesterol or bilirubin (which helps break down proteins in your blood) turn into stones inside your gallbladder. Medication and surgery are treatment options.
- Hepatitis. Long-term liver inflammation can result from Crohn’s disease itself. The same medication you take for your Crohn’s can treat it.
- Pancreatitis. Inflammation of the pancreas can result from both gallstones and medications. It can cause pain, nausea, vomiting, and fever. Stopping the medication or removing the gallstone can fix the problem.
- Primary sclerosing cholangitis. This is a disease of the bile ducts, tubes that carry bile from your liver to your small intestine. It causes scarring in the ducts that makes them narrow. It can lead to liver damage and failure. Dilation and stents can help open blocked ducts. Your doctor might prescribe antibiotics or other meds called bile acid sequestrants. Antihistamines and opioids can help with the itching.
Physical development problems
This is a fairly common problem with Crohn’s, especially in kids. The disease can start at any age. When kids get Crohn’s, parents are likely to notice:
- Growth failure. Kids with Crohn’s are likely to be shorter and weigh less than those without. They may stop getting taller before symptoms start.
- Delayed puberty. Kids with Crohn’s are likely to start puberty later than their friends.
What Causes Diarrhea When You Have Crohn's Disease?
Lots of factors can cause Crohn’s diarrhea, and many are linked. One problem leads to another and then another. The main trigger is inflammation. Here’s how it can harm your gut:
Fluid and electrolyte imbalances. As much as 42 cups of fluid enter your intestine every day. Normally, fluids flow freely back and forth through the gut wall, along with nutrients and electrolytes – important minerals like sodium and chloride. Electrolytes help move fluid in and out of your cells. When inflammation affects their function, too much water stays in your gut, and the result is diarrhea.
Damage to the gut lining. Inflammation can damage epithelial cells in the gut lining. This thin layer of tightly packed cells acts as a barrier to keep out toxins and germs while it lets in fluids and electrolytes. When it’s damaged, the proteins that glue the cells together can leak. This allows proteins and bacteria to escape into your body where they cause even more inflammation and worse diarrhea.
Altered microbiome (dysbiosis). The microbiome is the common name for the trillions of mostly friendly bacteria, viruses, and fungi that live on and in your body. Though they’re in every nook and cranny – including between your toes – most are in your gut. These microbes perform functions that are essential for life and health. They help digest your food, make vitamins, and boost your immune system. When antibiotics, a poor diet, smoking, or stress upset the delicate balance of the microbiome, lots can go wrong. Unfriendly bacteria can overwhelm friendly ones. You may also have fewer different types of bacteria (bacterial diversity). This is important because lower diversity is linked to diarrhea that doesn’t go away after your gut has healed. Also, because the microbiome can’t control your immune system the way it normally would, you may have lots more inflammation – and more diarrhea.
Bile acids. Bile is a substance made in your liver that helps digest fats. Your body usually releases the right amount of bile based on the food you eat. If your body produces too much bile or can’t use it correctly, you may develop what’s known as bile acid diarrhea (BAD). It can trigger an urgent need to poop. You might have trouble controlling your urine, too. BAD is common in people with Crohn’s.
Crohn’s vs. Ulcerative Colitis
Crohn’s disease is often confused with another condition called ulcerative colitis. The symptoms are similar, and both involve periods of active flare-ups followed by times when you don’t have symptoms, which is called remission.
The only way to find out if you have Crohn’s or ulcerative colitis is to see your doctor for tests.