Symptoms of Crohn's Disease

Crohn's disease is chronic inflammatory bowel disease that primarily can affect any part of the gastrointestinal tract from the mouth to the anus. While it tends to cause gastrointestinal symptoms such as bloating, flatulence, cramping diarrhea, nausea, vomiting, and blood in stools, the disease can cause additional symptoms when it affects other systems in the body. Complications include bowel obstruction and intestinal rupture, and there may also be an increased risk of bowel cancer in those with Crohn's. When its effects go beyond the gastrointestinal tract, the disease can lead to serious complications ranging from vision impairment and arthritis, to skin ulcers, osteoporosis, liver failure, and more.

crohn's disease symptoms
Illustration by Verywell  

Gastrointestinal Symptoms

The gastrointestinal (GI) tract is the organ system primarily affected by Crohn's disease. Approximately 30 percent of cases involve 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 involve only the colon, while 45 percent involve both the small intestine and the colon.

Among the characteristic symptoms of Crohn's disease:

  • Abdominal pain is usually the first sign and is often concentrated to 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), by contrast, usually results in more frequent bouts of varying consistencies. 
  • While blood in stools in 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 poor appetite and an associated loss of weight. The poor absorption of food and nutrients may further accelerate the weight loss.

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 not only causes the narrowing of the intestinal passage, it increases overall inflammation and your risk of short- and long-term complications.

Among them:

  • 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 a 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.

Perhaps the most serious concern is the increased risk of colorectal cancer. The persistent intestinal inflammation can sometimes trigger genetic changes in cells that cause them to divide abnormally and develop cancer. In people with Crohn's disease, the area most commonly affected is the small bowel, but it can, in fact, affect any part of the small or large bowel.

The risk of cancer tends to increase the longer you have Crohn's disease. A 2014 review of studies concluded that the cumulative risk of colorectal cancer is 2.9 percent at 10 years, 5.6 percent at 20 years, and 8.3 percent at 30 years after Crohn's disease diagnosis. The latter is roughly a two-fold increase in risk compared to the general population.

Extraintestinal Symptoms

Those 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 the persistent inflammation that is centered on the GI tract.

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

Eyes

Inflammation of the middle layer of the eye (uveitis) 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, under the burden of 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. 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. They nodules are caused by inflammation of adipose (fat) cells in the deeper subcutaneous layer of 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 significant tissue death (necrosis).

Bones

Osteoporosis, a condition characterized by the loss of bone mass, is common in adults with long-term Crohn's disease. It can not only cause lower back pain, but it can significantly increase the risk of a fracture. Clubbing of the fingers is also occasionally seen.

Children with Crohn's disease are also prone to delayed development, generally related to delayed skeletal development. Over 50 percent of these children will be of subnormal height, while around 25 percent will have short stature (defined as two deviations below the mean height for the child's age and gender). Puberty is also frequently delayed.

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). Others 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. Severe complications 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. But, there is also 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 Doctor

The symptoms of Crohn's disease can be so diverse and variable that it may be difficult to know when to see a doctor. Ultimately, the one factor that separates Crohn's disease from your run-of-the-mill gastrointestinal problem is the persistence of symptoms.

It is important, therefore, to see a doctor if you have any or all of the following:

  • Ongoing bouts of diarrhea that don't respond to over-the-counter (OTC) remedies
  • Abdominal pain that is either persistent or recurring
  • Blood in the stool
  • Unexplained weight loss
  • Unexplained fever lasting for more than a couple of days
  • A family history of inflammatory bowel disease (IBD), including Crohn's disease or ulcerative colitis

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.

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