Symptoms of Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease (IBD) involves ongoing inflammation of all or part of your digestive tract. IBD is an umbrella term for three conditions—Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC)—with the most prevalent symptoms of blood and mucus in the stool, abdominal pain, unintentional weight loss, and diarrhea.

Many other symptoms may be present as well, and the pain may be in different locations depending on the disease. Your specific set of symptoms can help your doctor determine whether you have IBD and, if so, which type.

Frequent Symptoms

IBD is a painful condition and some of its symptoms can be worrisome. While there's a fair amount of overlap between the different types of IBD, each of the IBDs has its own potential set of symptoms.

Rectal Bleeding

Bleeding from the rectum, or seeing blood in the stool, is never a normal occurrence, and it is a symptom of IBD.

Blood in the stool is a common symptom of UC and IC. (It's less frequent in Crohn's disease.) There are times, however, when it can be of serious concern.

Mucus in the Stool

Passing mucus in the stool is not always a cause for alarm. Mucus is actually a normal part of stool, but it usually isn't visible to the naked eye. If there's enough mucus in the stool that you're aware of it, there could be several reasons why.

People with ulcerative colitis or Crohn's disease do sometimes pass visible amounts of mucus in their stool, either as a result of ulcers in the colon or possibly from the formation of a fissure.

People who have had surgery for ulcerative colitis and have a j-pouch (ileal pouch-anal anastomosis, or IPAA) may also pass mucus, which could be a sign of a condition called pouchitis. 

Abdominal Pain

Abdominal pain (what most generally call stomach pain) can be a tricky problem to diagnose because it can be a symptom of many different diseases.

People with ulcerative colitis tend to have cramp-like pain that is located in the lower-left portion of the abdomen, and people with Crohn's disease tend to have pain in the middle or lower-right abdomen (although pain could show up in other parts of the abdomen, too).

Not everyone with IBD has pain, and the pain may come and go, sometimes occurring after a meal or being relieved by having a bowel movement.

Persistent Diarrhea

Diarrhea has many causes, and most healthy adults have diarrhea a few times a year. Often, diarrhea resolves on its own, and the cause may go undiscovered. However, persistent diarrhea—lasting more than three days—can be the sign of a problem that might need treatment.

People with IBD often have episodes of what's called "explosive" diarrhea several times a day. This could be anywhere from three up to 10 or even 20 watery bowel movements daily.

Unintended Weight Loss

Losing weight without restricting calories or exercising could be a sign that something is going wrong in the body.

Diarrhea and lack of appetite can result in unintended weight loss simply from not taking in enough calories during the day.

Gaining weight while in remission from IBD might become a priority, but it should be done in a healthful way.

Rare Symptoms

In rare cases, some people with IBD may also present with:

• Fevers
• Fatigue
• Joint pain
• Skin rashes
• Increased menstrual symptoms
• Flare-ups of IBD symptoms before or during a menstrual period

Your medical team should be able to help you manage these symptoms.

Complications

IBD is hard on your intestines and various systems in your body. Over time, and especially if treatment is delayed or inadequate, some people develop serious complications.

Potential complications of IBD include:

• Bowel obstruction
• Bowel perforation
• Intestinal abscesses
• Intestinal fistulas
• Intestinal fissures
• Toxic megacolon
• Colorectal cancer

Some complications that may strike outside of the digestive system include:

• Delayed growth (in children)
• Eye disease
• Arthritis (especially seronegative spondyloarthropathy)
• Osteoporosis
• Increased risk of gallstones
• Neurological symptoms, which can be severe
• Anemia
• Blood and circulatory problems
• Mouth ulcers
• Difficulty getting pregnant

When to See a Doctor

If you're experiencing ongoing or severe digestive symptoms, you should see your primary care physician. Due to the difficulties involved in the diagnosis, you may be referred to a gastroenterologist.

• Significant abdominal pain could mean many things and should be checked out by a physician as soon as possible. Don't assume this is due to IBD if it's accompanied by vomiting, nausea, and fever. These are potential symptoms of a bowel obstruction, which requires immediate medical care.
• Any blood in the stool should always be checked out by a doctor right away. The blood loss of UC and IC can be significant. If it continues or is accompanied by diarrhea, pain, or vomiting, see a doctor immediately.
• If the mucus in stool is accompanied by abdominal pain, vomiting, or diarrhea, see a doctor right away to get it checked out.
• Suddenly losing weight unexpectedly is a reason to talk to a doctor, especially if there is also ongoing diarrhea, vomiting, or a lack of appetite.
• If diarrhea doesn't resolve on its own and is also accompanied by abdominal pain, blood in the stool, weight loss, fever, or other symptoms, see a physician as soon as possible.

If abdominal pain is severe or rectal bleeding is substantial, you may have a serious condition that needs emergency medical treatment.

Frequently Asked Questions

What are the general symptoms of inflammatory bowel disease?

Inflammatory bowel disease (IBD) is an umbrella term used to describe three distinct diseases affecting the digestive tract: Crohn's disease, ulcerative colitis, and indeterminate colitis. Symptoms commonly seen with all three of these diseases include:

• Abdominal pain
• Abdominal cramping
• Diarrhea
• Poor appetite
• Bloody stools
• Rectal bleeding
• Weight loss

How do symptoms of Crohn’s disease and ulcerative colitis differ?

Crohn’s disease (CD) can affect the entire gastrointestinal tract from the mouth to the anus, while ulcerative colitis (UC) is limited to the colon and rectum. As such, CD may cause mouth sores and stomach pain that UC doesn’t, while UC can cause rectal pain, intestinal ulcers, and bowel urgency that CD doesn’t.

How do symptoms of indeterminate colitis and ulcerative colitis differ?

Indeterminate colitis (IC) is the term used when the features of the disease cannot be clearly attributed to either Crohn’s disease (CD) or ulcerative colitis (UC). It may be that an intestinal ulcer is found, but it doesn’t involve mucosal tissues as UC typically would. Or there may be bowel urgency, intestinal ulcers, and rectal bleeding but little of the rectal inflammation that defines UC.

What are some of the complications of inflammatory bowel disease?

If left untreated, the persistent inflammation triggered by IBD can affect other organ systems, leading to intestinal and non-intestinal complications. Examples include:

• Intestines: bowel perforation, toxic megacolon
• Kidneys: kidney stones
• Liver: pericholangitis
• Joints: ankylosing spondylitis, sacroiliitis, axial arthritis
• Eyes: episcleritis, iritis
• Skin: erythema nodosum, pyoderma gangrenosum

Can inflammatory bowel disease lead to cancer?

Colorectal cancer is one of the biggest concerns related to ulcerative colitis. Ulcerative colitis increases cancer risk 10- to 30-fold compared to the general population. The risk starts to increase eight to 10 years after the initial diagnosis and continues to increase over time. After 30 years, the risk of colorectal cancer may be as high as 18%.

A Word From Verywell

IBD symptoms can be scary and a proper diagnosis can take some time. That may be frustrating, but each IBD requires different treatments, so it's important to work with your doctor to figure out exactly what's going on in your digestive system and get started with the right course for you. Doing so can help minimize the effect of the disease on your daily life.