Crohn’s Disease Symptoms and How to Recognize a Flare
Everyone’s Crohn’s is different and symptoms are variable
Medically reviewed by Robert Burakoff, MD, MPH
Crohn's disease is a chronic inflammatory bowel disease (IBD). It can cause inflammation in any part of the gastrointestinal (GI) tract. It may also affect other body systems.
This condition causes symptoms such as abdominal pain, bloating, flatulence (gas), cramping, diarrhea, nausea, vomiting, and (sometimes) bloody stool. Symptoms and complications may differ between men and women.
This article will list the potential signs and symptoms of Crohn’s disease as well as describe the potential differences between men and women. (For the purposes of this article, “men” refers to adults assigned male at birth and “women” refers to adults assigned female at birth.)
Describing Crohn’s Disease Symptoms
The symptoms of Crohn’s disease may differ from person to person based on a number of factors. This includes where the inflammation is located in the digestive system, if there are complications, and how much inflammation is present. However, the most common symptoms that occur in the digestive system include:
Abdominal pain and cramping
Frequent or urgent bowel movements
Related conditions and signs and symptoms that may appear outside the digestive system can include:
Bone loss (osteoporosis)
Chills
Fevers
Crohn's Disease Mimics
The symptoms of Crohn's disease (and IBD in general) are similar to those of some other conditions. For that reason, it's important to get a confirmed diagnosis. The other conditions that might be ruled out can include:
Inflamed GI Tract
Crohn’s disease may cause inflammation in the digestive tract, including the mouth, esophagus, stomach, and intestines. The location and amount of inflammation differ from person to person. There are more and less common patterns of inflammation.
Pain Location
Abdominal pain tends to be common with Crohn’s disease, and more so than in other forms of IBD (such as ulcerative colitis).
Crohn’s disease has different forms. The location of abdominal pain may vary based on where the inflammation is located.
The abdomen is often described as being in four sections: the right upper, right lower, left upper, and left lower quadrant. Knowing where the pain is located is helpful in discussing it with healthcare providers.
Here are some of the most common forms of Crohn’s disease and where the abdominal pain might be located:
Ileocolitis: Inflammation in the ileum (last section of the small intestine) and the colon, which may cause pain in the lower right quadrant
Gastroduodenal: Inflammation in the esophagus, stomach, duodenum, which may cause pain in the upper or middle of the abdomen
Jejunoileitis: Inflammation in the jejunum (middle section of the small intestine), which may cause pain in the middle of the abdomen
Ileitis: Inflammation in the ileum, which may cause pain in the right or middle lower of the abdomen
Frequency
In studies, 60% of people with IBD report abdominal pain. The pain may be related to a flare-up: when the disease is active and causing inflammation.
However, 30% to 50% of people with IBD may have pain even when in remission (having few or no symptoms). This could be from having irritable bowel syndrome (IBS). But it’s unclear why pain may not improve when the other signs and symptoms of Crohn’s disease improve.
Flare vs. Remission
Active disease might be referred to as a "flare" and inactive disease as "remission." However, there's no real definition for these terms.
In one study, people with Crohn's disease described that during a flare-up, they have an increase in symptoms over a period of days or weeks. This includes fatigue, more daily bowel movements, and a feeling like medication is not helping control symptoms.
Crohn’s Symptom Differences in Females vs. Males
People of any age, sex, or gender can develop Crohn’s disease. However, there may be differences in how the disease affects people assigned male or female at birth.
People who menstruate may have more or worsening symptoms before or during their period. This may be because of a change in hormone levels. If the condition becomes severe, menstrual periods may stop until the Crohn’s is better controlled.
Changes in the menstrual cycle are also common, with 60% of people reporting infrequent periods, no period at all, bleeding between periods, or heavy periods.
Penetrative intercourse may also be painful for some people who have vaginas. In women with Crohn’s disease, 17% said that they had painful sex “sometimes,” “often,” or “every time.”
Crohn’s disease doesn’t appear to have a large effect on the symptoms or the age of onset for menopause (having a last period). However, this is not yet well understood.
Anemia (a low number of healthy red blood cells) is also more common in people with Crohn’s disease, especially for those who have a period.
Sexual function in men is also related to Crohn’s disease activity. Depression, which is more common in people with IBD, could be a factor in the development of erectile dysfunction, low libido (sexual desire), and decreased satisfaction. Erectile dysfunction may also be related to IBD, especially in the first two years after diagnosis.
People who have a prostate and also have IBD may also be more likely to develop prostate cancer. However, it’s not known if this increased risk means that there is also a need for more treatment or serious outcomes for prostate cancer.
Bone loss—osteopenia and osteoporosis—is more common in men who have IBD than in the general population. One study done in Germany showed that 56% of males with IBD had bone loss. In females with IBD, 30% had bone loss. This showed the importance of screening men with IBD for bone loss.
Crohn’s disease may cause vitamin and mineral deficiencies. A lack of zinc, in particular, could lead to infertility in males.
What’s Considered Mild vs. Severe Crohn’s Symptoms?
Crohn’s disease may be put into categories of mild, moderate, or severe disease. How these different levels are decided is not the same everywhere, but sometimes a clinical scale may be used.
The severity of the condition will help determine what treatments are used. The way that severity is partly decided is through the results of lab tests, colonoscopy or other endoscopy procedures, or imaging studies such as computed tomography (CT) scans or magnetic resonance imaging (MRI).
In addition, severity may also depend on the presence of complications, both inside or outside the digestive system.
One research tool that might be used, such as in a clinical trial, is a Crohn's disease activity index (CDAI), which can indicate the following using certain criteria:
Remission: Having no symptoms
Mild to moderate disease: Being able to eat, doesn't have a tender abdomen or complications, and hasn't lost more than 10% of their weight
Moderate to severe: Not getting better with treatments; usually used for mild or moderate disease and includes symptoms such as fever, abdominal pain or tenderness, occasional nausea or vomiting, or significant anemia, and losing a lot of weight
Severe: Not getting better with treatments such as biologics or steroids, and also includes symptoms such as high fever, vomiting, bowel obstruction, abdominal tenderness, muscle loss, or an abscess
Effect of Crohn’s Disease Symptoms on Quality of Life
Crohn's disease can have a negative effect on quality of life. The symptoms of Crohn's disease can affect daily activities, social life, relationships, and mental well-being. Stress, anxiety, and depression can also affect quality of life.
People with active disease vs. remission may also have a reduced quality of life. It's important to get Crohn's disease treated as well as possible to keep inflammation under control. That's not necessarily an easy or quick thing to do. Sometimes, it means working with several different types of healthcare providers.
Long-Term Complications of Unmanaged Crohn’s Symptoms
When Crohn's disease goes untreated, the inflammation can cause a variety of issues, both inside and outside the digestive system. These include:
Abscess: An abscess is a pocket of pus. In Crohn's disease, these are more commonly found in the abdomen or near the anus (the perianal area).
Bowel obstructions: The inflammation could cause swelling in the intestine or scarring. This could lead to the intestine becoming blocked.
Colon cancer: People who have disease in their colon may be at risk for developing colon cancer after a number of years with the disease.
Fistula: A fistula is a tunnel or a channel between two organs (such as the colon and the skin) that doesn't belong there and can form in severe Crohn's disease.
Malnutrition: People with Crohn's disease who aren't absorbing vitamins and minerals well or who are not eating a balanced diet may be at risk for malnutrition.
Strictures: Scar tissue can form in the intestine and lead to narrowed parts, which can cause pain or a risk of an obstruction.
Ulcers: Sores or holes in the digestive tract can form when Crohn's disease causes inflammation.
Summary
Crohn's disease is known for causing inflammation in the small and large intestines. It can also lead to other problems outside the digestive system. The symptoms of Crohn's disease are similar among people of all sexes, but there are some differences when it comes to sex-specific complications (such as menstruation or prostate cancer).
Crohn's disease can have an effect on quality of life, which is one of the many reasons it's important to start treatment and get inflammation controlled as early as possible.
Read the original article on Verywell Health.
