Symptoms of Crohn's Disease

Crohn's disease is a chronic inflammatory bowel disease that primarily affects the gastrointestinal tract but can affect other organs in the body too. This condition causes gastrointestinal symptoms such as bloating, flatulence, cramping diarrhea, nausea, vomiting, and blood in stools.

Complications include bowel obstruction and intestinal rupture, and it's associated with an increased risk of bowel cancer. When its effects go beyond the gastrointestinal tract, the disease can cause vision impairment, arthritis, skin ulcers, osteoporosis, liver failure, and more.

Gastrointestinal Symptoms

Gastrointestinal (GI) tract symptoms are the primary effects of Crohn's disease. Approximately 30 percent of people with Crohn's disease have involvement in the small intestine, particularly the terminal ileum (the junction through which partially digested food moves from the small intestine to the large intestine). Another 20 percent only have involvement of the colon, while 45 percent have both.

Among the characteristic symptoms of Crohn's disease:

• Abdominal pain is usually the first sign and is often concentrated in the lower right side of the abdomen, where the terminal ileum is located. The pain may be accompanied by cramping, bloating, flatulence, and nausea.
• Diarrhea is also common and can vary based on the location of the inflammation. Inflammation of the ileum (ileitis) usually results in watery stools. Inflammation of the colon (colitis) usually results in frequent bouts of varying consistencies. 
• While blood in stools is less common with Crohn's disease than with ulcerative colitis (a related disorder also classified as an inflammatory bowel disease), it can sometimes be profuse if the intestinal inflammation is severe. 
• Nausea and stomach pain will typically lead to diminished appetite and weight loss. Impaired absorption of food and nutrients may lead to further weight loss, as well as other complications.

Inflammation in the GI tract is not limited to the intestines alone. Recurrent mouth sores (aphthous ulcers) are common in people with Crohn's disease, while anal itchiness, fistulas, fissures, or abscesses can lead to extreme discomfort and fecal incontinence. The stomach and esophagus are less commonly affected.

Gastrointestinal Complications

Under the persistent burden of inflammation, the walls of the intestines will undergo a consistent, overall thickening as layers of scar tissue begin to build up. This can cause narrowing of the intestinal passage, increase inflammation, and raise the risk of short- and long-term complications.

Among the complications:

• Bowel obstruction is the most common complication of Crohn’s disease and may be mild or severe, depending on the degree of obstruction. Symptoms include cramping, bloating, and vomiting.
• Intestinal abscesses (localized pockets of pus caused by bacteria) can cause abdominal pain, tenderness, and fever.
• Intestinal fistulas are abnormal openings through which gastric fluids can leak and cause infection in the skin and other organs.
• Bowel perforation (rupture) may occur as a result of an abscess or fistula, allowing the contents of the intestines to spill into the abdominal cavity and cause a serious infection (peritonitis).
• Toxic megacolon is a rare but serious complication of Crohn's disease in which the colon suddenly dilates and loses its ability to contract. Symptoms include severe bloating, pain, fever, rapid heart rate, and intestinal hemorrhage. If left untreated, the buildup of gas can lead to rupture, septic shock, and death.

The most serious concern is the increased risk of colorectal cancer. The persistent intestinal inflammation can sometimes trigger genetic changes in cells that lead to cancer. With Crohn's disease, cancer most commonly begins in the small bowel, but can affect any part of the small or large bowel.

Extraintestinal Symptoms

The extraintestinal symptoms of Crohn's disease (those occurring outside of the GI tract) are far-ranging and just as impactful as those affecting the intestines. They are caused by inflammation or nutritional deficits.

The most common extraintestinal symptoms involve the eyes, joints, skin, gallbladder, nervous system, blood, and blood vessels.

Eyes

Uveitis (inflammation of the middle layer of the eye) can cause blurred vision, light sensitivity, and eye pain. When it affects the white of the eye (sclera), it can lead to episcleritis.

Both are usually benign conditions that resolve on their own but the chronic inflammation can lead to permanent damage and vision loss.

Joints and Connective Tissue

Crohn's disease is associated with a group of diseases called seronegative spondyloarthropathy in which one or more joints are affected by arthritis or one or more muscle attachments are affected by enthesitis (inflammation at the attachments of the joints).

In people with Crohn's disease, there are three areas typically affected by arthritis:

• Larger, weight-bearing joints of the knees, hips, shoulders, elbow, and wrist
• Five or more smaller joints on the hands or feet, occurring symmetrically (meaning either in both hands or both feet)
• The spine, leading to ankylosing spondylitis

The symptoms of arthritis include painful, warm, swollen, and stiff joints accompanied by the loss of joint mobility.

Skin 

The most common skin condition associated with Crohn's disease is erythema nodosum, which appears as raised, tender, red nodules, mainly around the shins. These nodules are caused by inflammation of adipose (fat) cells in the deeper subcutaneous layer of the skin.

Another, more serious skin condition is called pyoderma gangrenosum. This painful condition is characterized by an ulcerative sore that usually begins on the leg as a tiny bump but can increase in size, causing necrosis (tissue death).

Bones

Osteoporosis, a condition characterized by the loss of bone mass, is common in adults with long-term Crohn's disease. It can be related to low absorption of calcium and vitamin D. This condition significantly increases the risk of bone fractures.

Clubbing of the fingers, which is unrelated to osteoporosis, is also occasionally seen.

Gallbladder

Crohn's disease decreases the intestines' ability to reabsorb bile that has been secreted by the gallbladder and liver for digestion. The imbalance in secretion and reabsorption can lead to the accumulation of bile salts in the gallbladder, resulting in an increased risk of gallstones.

Gallstones can be incredibly painful and cause cramping, indigestion, nausea, vomiting, and pain in either the back or upper-right abdomen.

Central Nervous System

It is estimated that one of every seven people with Crohn's disease experiences neurological symptoms. They may be mild to moderate and include a headache, depression, or a tingling or numb sensation in the hands and feet (neuropathy).

Other effects may be more serious and include:

• Anterior ischemic optic neuropathy, the sudden loss of central vision due to the decreased blood flow to the optic nerve
• Posterior reversible encephalopathy syndrome (PRES), a nerve disorder characterized by a headache, confusion, seizures and visual loss
• Chronic axonal polyneuropathy, which can manifest with loss of motor control and sensation

The neurological symptoms of Crohn's disease are poorly understood and are believed to be linked to severe, long-term untreated disease.

Blood and Circulatory System

People with Crohn's disease often have anemia due to the poor absorption of nutrients in the intestines. Additionally, Crohn's disease is associated with another type called autoimmune hemolytic anemia, in which the immune system attacks and destroys its own red blood cells. Symptoms may include fatigue, pale skin, shortness of breath, lightheadedness, dizziness, and a fast heartbeat.

Crohn's disease also leads to the abnormal clumping of platelets and the formation of blood clots. This can cause deep vein thrombosis (DVT), the obstruction of blood flow to the leg, which can trigger symptoms of pain, swelling, warmth, and cramping.

If not treated appropriately, the blood clot can dislodge and move from the leg to the brain, heart, and lungs, where it can cause a stroke, heart attack, or pulmonary embolism.

When to See a Healthcare Provider

The symptoms of Crohn's disease can be so diverse and variable that it may be difficult to know when to see a practitioner.

Crohn's Disease Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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The good news is that, if treated appropriately, the outlook for people living with Crohn's disease is very positive. Despite its impact on your health, it is not a condition associated with a shortened lifespan. With early diagnosis and treatment, you can avoid many of the long-term complications of the disease.