Crohn’s Disease Symptoms

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Crohn’s disease and its complications cause a wide range of symptoms. Typical symptoms include diarrhea, abdominal pain, weight loss, and fever.1 Crohn’s disease can affect any part of the digestive tract. Therefore, you may have symptoms that affect the mouth and anus. Inflammation outside the digestive tract can cause symptoms that affect the skin, eyes, joints, and liver. Crohn’s disease can interfere with normal growth and development in children. It is linked to menstrual irregularities in women.

Diarrhea

Diarrhea is frequent, loose stool. Diarrhea may get worse during disease flares.2 It is more likely to be watery if you have inflammation in the small intestine. If the inflammation is in your large intestine, diarrhea may be bloody.2,3 Diarrhea is a risk factor for urgency or incontinence. Incontinence, or the inability to control bowel movements, is a devastating symptom. It affects many people with Crohn’s disease.

In a year-long survey, 63% of respondents with Crohn’s disease reported having diarrhea at some point.4 It was the most common symptom during a flare, occurring in 84% of respondents.

Abdominal cramps and pain

Nearly half (47%) of people with Crohn’s disease report having abdominal pain.4 The pain may be constant or off-and-on.5 It often occurs after meals. Some people limit how much they eat in order to minimize the pain.6 The pain may worsen during a flare. However, many patients have pain during remission, too.7

Weight loss

For multiple reasons, weight loss is a common symptom of Crohn’s disease. It is likely to occur during flares, when it can be difficult to eat. Malabsorption and bleeding can also decrease nutritional status. You may be able to identify and avoid foods that worsen your symptoms. However, too many food restrictions can also limit intake and make it difficult to eat a balance diet.

Fever

Fever may be related to the inflammatory process. It can also be a side effect of commonly used medications or a symptom of a complication.1,8

Fatigue

Most people with active Crohn’s disease—and many people in remission—report feeling fatigue. Fatigue interferes with your ability to do physical or mental work. It can affect your quality of life and relationships.9 Many factors contribute to fatigue. These factors include difficulty sleeping, anemia, medications, depression, and the inflammatory process itself.

Constipation

Constipation can be a symptom of complications or a side effect of medications. Specifically, a stricture or anal fissure can lead to constipation. Opioid pain relievers and iron supplements can also cause constipation.

Perianal disease

Perianal disease includes abscess, fistula, fissure, skin tags, stricture, or hemorrhoids that affect the rectum or anus. Perianal disease is often the first sign of Crohn’s disease. It is most common in people with inflammation in the colon and rectum.10 Elderly individuals and children are at the highest risk.11

Oral symptoms

Crohn’s disease can cause sores, cracks, swelling, and redness in the mouth.12 Sometimes, the lining of the mouth undergoes the same changes as the lining of the digestive tract. Other times, malnutrition and medications cause oral symptoms. Not all sores are painful. However, painful sores can interfere with eating and drinking.

Inflammation of the joints, skin, eyes, and liver

Between 6% and 47% of people with Crohn’s disease have symptoms outside the digestive tract.13 The joints are the most commonly affected parts outside of the digestive tract. Some people develop painful red growths under the skin during flares. A small percentage of people experience eye inflammation. Eye inflammation can be mild or severe, depending on which layer of the eye is affected. Primary sclerosing cholangitis is an inflammatory condition in the liver that often overlaps with inflammatory bowel disease. This condition causes scarring in the bile ducts. Other Crohn’s-related liver conditions are autoimmune hepatitis and gallstones.

Menstrual irregularities

Many women report that Crohn’s disease caused changes in their menstrual cycle. Others report that they have cyclical changes in bowel symptoms. Girls diagnosed with Crohn’s disease at a young age may go through puberty later.

Delayed growth

Poor growth and poor weight gain are common Crohn’s disease symptoms for young people.14 Reasons for this include not feeling hungry, difficulty absorbing food, aversion to eating because of symptoms and pain, and some medications. Growth delays are seen at Crohn’s disease diagnosis for about 10% of children.14 Growth continues to be a problem for 7% to 27% of children, even once treatment begins. Fortunately, treatment with newer medications seems to help children with Crohn’s disease reach average heights as adults.14

view references
  1. Lichtenstein GR, Hanauer SB, Sandborn WJ; Practice Parameters Committee of American College of Gastroenterology. Management of Crohn's disease in adults. Am J Gastroenterol. 2009;104:465-483.
  2. Wenzl HH. Diarrhea in chronic inflammatory bowel diseases. Gastroenterol Clin North Am. 2012;41:651-675.
  3. Juckett G, Trivedi R. Evaluation of chronic diarrhea. Am Fam Physician. 2011;84:1119-1126.
  4. Singh S, Blanchard A, Walker JR, et al. Common symptoms and stressors among individuals with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2011;9:769-775.
  5. Knutson D, Greenberg G, Cronau H. Management of Crohn's disease--a practical approach. Am Fam Physician. 2003;68:707-714.
  6. Crohn’s Disease: Introduction. Accessed 6/4/15 at: http://www.hopkinsmedicine.org/gastroenterology_hepatology/_pdfs/small_large_intestine/crohns_disease.pdf
  7. Bielefeldt K, Davis B, Binion DG. Pain and inflammatory bowel disease. Inflamm Bowel Dis. 2009;15:778-788.
  8. Wilkins T, Jarvis K, Patel J. Diagnosis and management of Crohn's disease. Am Fam Physician. 2011;84:1365-1375.
  9. van Langenberg DR, Gibson PR. Factors associated with physical and cognitive fatigue in patients with Crohn's disease: A cross-sectional and longitudinal study. Inflamm Bowel Dis. 2014;20:115-125.
  10. Safar B, Sands D. Perianal Crohn’s disease. Clin Colon Rectal Surg. 2007;20:282-293.
  11. Ruel J, Ruane D, Mehandru S, et al. IBD across the age spectrum: Is it the same disease? Nat Rev Gastroenterol Hepatol. 2014;11:88-98.
  12. Lankarani KB, Sivandzadeh GR, Hassanpour S. Oral manifestation in inflammatory bowel disease: A review. World J Gastroenterol. 2013;19:8571-8579.
  13. Ott C, Schölmerich J. Extraintestinal manifestations and complications in IBD. Nat Rev Gastroenterol Hepatol. 2013;10:585-595.
  14. DeBoer MD, Denson LA. Delays in puberty, growth, and accrual of bone mineral density in pediatric Crohn's disease: Despite temporal changes in disease severity, the need for monitoring remains. J Pediatr. 2013;163:17-22.
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