What Inflammatory Bowel Disease Pain Feels Like

Ulcerative colitis and Crohn's disease pain locations are usually different

Ulcerative colitis and Crohn's disease pain locations are different, even though both of these conditions are classified as inflammatory bowel diseases (IBD). Also, the nature and location of pain vary from one person to the next.

This article explores Crohn's and ulcerative colitis pain locations and types, what pain in different parts of the abdomen may mean, and how Crohn's and ulcerative colitis pain locations can help with a diagnosis.

Identifying IBD, Based on Pain Location

Jessica Olah / Verywell

Symptoms of IBD

As forms of IBD, ulcerative colitis (UC) and Crohn's disease (CD) have some symptoms in common. They can include:

  • Ulcers (open sores) in the digestive tract
  • Diarrhea
  • Blood in the stool
  • Unintended weight loss
  • Loss of appetite
  • Abdominal pain

Areas of the Abdomen

The pain location itself is a key symptom. Knowing where your abdominal organs are can help you identify what may be causing your pain.

When talking about symptoms and pain locations, healthcare providers divide the abdomen into four quadrants:

  • Right upper quadrant (RUQ)
  • Right lower quadrant (RLQ)
  • Left upper quadrant (LUQ)
  • Left lower quadrant (LLQ)

The four quadrants meet at your navel. Pain may also be in the middle of your abdomen rather than neatly fitting into a single quadrant.

Ulcerative colitis and Crohn's disease pain locations don't include all of the quadrants.

Crohn's Disease Pain Locations

Crohn's disease pain locations vary by subtype of the disease. Possible locations include:

  • Right lower quadrant
  • Middle lower abdomen
  • Upper middle abdomen
  • Middle abdomen

RLQ or Middle Lower Abdominal Pain

The right lower quadrant or middle of your lower abdomen are common Crohn's disease pain locations. It's often described as a cramping pain.

Pain in this location is most common with subtypes of CD called ileocolitis and ileitis. Together, these subtypes account for 75% of all diagnosed cases of CD.

  • Ileocolitis involves inflammation in two places: the ileum (last section of the small intestine) and part of the colon (large intestine).
  • Ileitis, which is about half as common as ileocolitis, affects only the ileum.

This pain often comes on within a few hours of eating a meal.

Upper Middle Abdominal Pain

A type of IBD called gastroduodenal CD often causes pain in the middle and upper sections of the abdomen. These Crohn's disease pain locations correlate with problems in the:

  • Esophagus
  • Stomach
  • Duodenum (first part of the small intestine)

This disease type is rare, accounting for only about 4% of all diagnoses. It's even more rare for it to only impact the duodenum. This happens in just 0.07% of all CD cases.

Other symptoms of gastroduodenal CD may include:

  • Fullness, or an inability to eat very much at once
  • Nausea
  • Vomiting
  • Weight loss

Middle Abdominal Pain

The pain of another rare CD subtype, jejunoileitis, can vary from mild to severe. It affects the jejunum (middle section of the small intestine), causing pain in the middle of your abdomen.

People with this CD variant may have crampy pain after eating.

CROHN'S DISEASE
PAIN LOCATIONS 
Possible
Condition(s) 
Right Lower  Ileocolitis
Ileitis
Middle Lower  Ileocolitis
Ileitis
Upper Abdomen Gastroduodenal CD
Middle Abdomen Gastroduodenal CD
Jejunoileitis

Ulcerative Colitis Pain Locations

Ulcerative colitis pain locations are determined by the type of UC you have. Pain is typically in the:

  • Lower middle abdomen
  • Both left-side quadrants

Lower Middle Abdominal Pain

A common type of UC is ulcerative proctitis. It accounts for between 25% and 55% of all UC cases. It primarily affects the rectum—the last few inches of the large intestine, which connects to the anus.

Rectal pain comes from very low in the middle of the abdomen. But it's possible for this type of UC to move up into other parts of the large intestine or down into the anus and surrounding area.

Symptoms of ulcerative proctitis may include:

  • Loose or runny stools
  • Rectal bleeding
  • More frequent bowel movements
  • Straining, even after a bowel movement
  • Urgency
  • Incontinence
  • Constipation

Other Causes of Rectal Pain

Rectal pain has many possible causes, including less serious ones like hemorrhoids (swollen veins in the rectum) and extremely serious ones such as rectal cancer.

Left-Sided Pain

Pain on the left side of the abdomen, in both upper and lower quadrants, is one of the more classic ulcerative colitis pain locations. Two common types can cause this pain:

  • Proctosigmoiditis: Inflammation and pain are in the rectum and sigmoid colon, part of the large intestine that runs horizontally across the lower left quadrant. About 22% of people with UC have this type.
  • Distal or left-sided colitis: Inflammation and possibly severe pain are in the rectum, sigmoid colon, and the descending colon (part of the large intestine that runs down your left side from under the ribs down to the sigmoid colon).

Distal colitis accounts for almost 28% of UC diagnoses.

ULCERATIVE COLITIS PAIN LOCATIONS  Possible conditions 
 Lower middle  Ulcerative proctitis
Upper left  Proctosigmoiditis
Distal or left-sided colitis
Lower left Proctosigmoiditis
Distal or left-sided colitis

Severe Abdominal Pain

Severe pain in the abdomen can be a symptom of many different digestive disorders. With IBD pain, though, it often points to pancolitis. This type of UC causes ulcers throughout the entire large intestine. However, these sores can also be seen in other types of UC or CD.

Red Flag Symptoms

Watch out for any pain that is new, severe, or comes with other symptoms. These may include a lack of stool, bloating, nausea, constipation, or vomiting. Call your healthcare provider right away or 911 if your symptoms are severe. The cause may be a serious condition, such as toxic megacolon or a bowel obstruction.

Pain as a Tool for Diagnosis

Pain can come from different sources, and pain in the abdomen is particularly difficult to pinpoint. This means that it is not a symptom that is normally used to diagnose IBD or a specific form of IBD.

Rather, the type and location of pain may be used together with other signs and symptoms. The pain serves to help a healthcare provider begin a diagnosis of IBD or other conditions. Keep in mind that it's only a starting point.

Summary

Most people with IBD experience pain at some point, though pain is not always a part of an IBD flare-up. The types of pain are not always the same, depending on your IBD diagnosis and the exact location of the pain.

The pain from Crohn's disease is most often found in the RLQ or the middle of the abdomen. But in more rare cases, such as with gastroduodenal CD, it may be higher up in the abdomen or spread out and change location.

Rectal pain is a common sign of ulcerative colitis. Depending on the type of UC, so is pain in the left side of your abdomen.

Knowing the location of your pain can help you to understand the symptoms and discuss them more accurately with your healthcare provider.

A Word From Verywell

If you have IBD, you may take a lot of pain in stride and not complain about it. Pain, however, is always something you need to discuss with your healthcare provider or gastroenterology specialist.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Crohn’s & Colitis Foundation of America. The Facts About Inflammatory Bowel Diseases.

  2. Gajendran M, Loganathan P, Catinella AP, Hashash JG. A comprehensive review and update on Crohn’s diseaseDisease-a-Month. 2018;64(2):20-57. doi: 10.1016/j.disamonth.2017.07.001

  3. Song DJ, Whang IS, Choi HW, Jeong CY, Jung SH. Crohn’s disease confined to the duodenum: A case reportWJCC. 2016;4(6):146. doi: 10.12998/wjcc.v4.i6.146

  4. Crohn's & Colitis Foundation. Overview of Crohn's disease.

  5. Michalopoulos G, Karmiris K. When disease extent is not always a key parameter: Management of refractory ulcerative proctitisCurrent Research in Pharmacology and Drug Discovery. 2022;3:100071. doi: 10.1016/j.crphar.2021.100071

  6. Saleem A, Zeeshan M, Hazoor F, Mustafa G. Sigmoidoscopic extent of ulcerative colitis and associated factors in Pakistani populationPak J Med Sci. 2021;38(1). doi: 10.12669/pjms.38.1.4648

  7. Johns Hopkins Medicine. FAQs About Ulcerative Colitis.

By Amber J. Tresca
Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.