What Inflammatory Bowel Disease Pain Feels Like

Pain that's associated with inflammatory bowel disease (IBD) is experienced differently by each person living with it. The location and kind of abdominal pain also will vary with two main types of IBD, Crohn's disease (CD) and ulcerative colitis (UC), and their subtypes.

Some people with IBD don't always have any pain at all during IBD flare-ups. Still others may have pain from an unrelated condition, such as appendicitis, gallstones, or gastroesophageal reflux disease (GERD).

This article presents the kinds of pain that are common symptoms of IBD. It also explains the quadrants, or sections, of your abdomen, and how the location of pain can help with a diagnosis.

Identifying IBD, Based on Pain Location

Jessica Olah / Verywell

Symptoms of IBD pain

There are a number of IBD symptoms that are common to people who have CD or UC, which causes ulcer sores in the digestive tract. They can include:

The pain itself is a key symptom. It's important for you to know the organs of the body that are in your abdomen, to better identify what may be the cause of your pain.

Healthcare providers divide the abdomen into four sections when talking about symptoms. These sections are called the right upper quadrant (RUQ), the right lower quadrant (RLQ), the left upper quadrant (LUQ), and the left lower quadrant (LLQ).

Your navel marks the center where these four quadrants meet.

Recap

People with IBD have some common symptoms but experience pain differently, based on whether they are diagnosed with Crohn's disease, ulcerative colitis, or an unrelated problem. Knowing how to describe this pain will help you and your healthcare provider to better understand its source and possible causes.

Right or Middle Abdomen Pain

This pain may feel like cramps in the middle of the abdomen or the RLQ. It is most common with the types of CD known as ileocolitis and ileitis. Together, these subtypes account for 75% of all CD that is diagnosed.

With ileocolitis, which is the cause in 50% of CD cases, the inflammation is found in the ileum, the last section of the small intestine. It also affects part of the colon, or large intestine.

Ileitis, which is diagnosed in 25% of cases, affects only the ileum. People with ileitis sometimes find that their pain or discomfort will arrive within a few hours of eating a meal.

Recap

Pain in the RLQ or middle abdomen may suggest the most common types of Crohn's disease. Ileocolitis and ileitis affect the colon and lower small intestine and account for 75% of all CD cases.

Upper Middle Abdomen Pain

One type of IBD is known as gastroduodenal CD. It often causes pain located in the middle and upper sections of the abdomen.

This disease type is far more rare, occurring in up to 4% of all diagnoses. It's even more rare for you to have only the duodenum, a part of the digestive tract in the small intestine, affected. This happens in just 0.07% of all CD cases.

Besides pain, other symptoms may include:

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

Variable Abdominal Pain

The pain of what's called jejunoileitis can vary quite a bit. In some cases, it may be mild, but in others, people experience severe pain.

This type of CD affects the jejunum, the middle section of the small intestine. It is a fairly rare subtype. People with this CD variant may also experience crampy pain after eating.

Rectal Pain

There can be many reasons for pain that affects your rectum. This is the final part of your digestive tract, at the end of the large intestine just before the anus opening.

The causes of pain may be relatively simple, such as a case of hemorrhoids caused by swollen veins in the rectum. They also can be quite serious, as in the case of rectal cancer.

With IBD, rectal pain is a common symptom of UC. One type, called ulcerative proctitis, is the initial diagnosis in between 25% and 55% of all cases. It's possible for this type of UC to progress and affect other parts of the colon.

Apart from the pain, other symptoms may include:

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

Recap

If your pain is in the upper middle or is more variable across the abdomen, it may mean a more rare type of CD affecting the small intestines. Rectal pain is a common sign of ulcerative colitis.

Left-Sided Pain

Pain on the left side of the abdomen is one of the more classic symptoms of UC. There are two common types that can cause this pain.

One type is called proctosigmoiditis. In this case, the ulcers are found in the rectum and the sigmoid colon, at the end of the large intestine. One 2022 review of 165 people with a UC diagnosis found that 22.4% of them had this type.

The other is called distal or left-sided colitis, with the same study identifying this type in 27.7% of the UC cases. With this diagnosis, it's the rectum, sigmoid colon, and the descending colon that become inflamed. Left-sided colitis pain can be severe at times.

Recap

In one study, half of all people with ulcerative colitis had one of two common types, either proctosigmoiditis or left-sided colitis. It's common with UC to have pain on the left side of your abdomen, which can be severe in some cases.

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 ulcer sores throughout the entire large intestine.

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.

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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.
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