Symptoms Of Crohn's Disease

Crohn's disease can affect any part of the gastrointestinal tract. As a result, the symptoms reported by patients with Crohn's disease can be much more varied than those reported by patients with ulcerative colitis.

 

As with ulcerative colitis, the symptoms experienced in Crohn's disease are highly dependent upon the location and severity of the inflammation within the gastrointestinal tract. However, the relative prominence of the symptoms may be different in Crohn's disease than in ulcerative colitis. Because there are locations that are much more commonly affected than others, there are presenting symptoms that also tend to be more common than others. As a general rule, abdominal pain, diarrhea, fatigue, and weight loss tend to be the most common presenting symptoms in Crohn's disease. In children, failure to grow normally or "failure to thrive" is a common presenting symptom.

 

 

Unlike ulcerative colitis, where the inflammation is limited to the innermost lining of the intestine, in Crohn's disease the inflammation and ulcers can penetrate through all the layers of the intestinal wall. Since there are nerves that can transmit pain signals in the deeper layers of the intestine, this means that pain may be a more consistent feature of Crohn's disease.

 

Strictures and Blockages: If Crohn's disease produces some narrowing of the intestine (most often in the small intestine), it can produce some degree of blockage, making it difficult for food and intestinal contents to get through the narrowed areas. This can be experienced as crampy abdominal pain that occurs within minutes to several hours after a meal, depending on the precise location of the narrowing. Bloating of the abdomen can occur along with this pain and, when it is particularly severe, nausea and vomiting may also occur. More complete blockages can occur and these will be associated with symptoms of abdominal pain, distension, nausea, and vomiting. During the episode, the person may not be able to pass any stool or gas.

 

Bowel Movements: As is the case in ulcerative colitis, patients with Crohn's disease may have crampy abdominal pain around the time of bowel movements. This may be due to irritability of the intestine and the associated spasm that can occur as a result of inflammation.

 

Diarrhea: Diarrhea is a common, but not universal, symptom of Crohn's disease. In fact, some patients with intestinal narrowing actually present with decreased bowel movements and constipation. The diarrhea that occurs in patients with Crohn's disease is usually not bloody, but when the lower part of the large intestine is inflamed, bleeding can occur more often.

 

Fatigue: Fatigue is a very common symptom in Crohn's disease and can be one of the most difficult symptoms to completely reverse with medical therapy. As in ulcerative colitis, it is probably due to the release of cytokines from the inflamed intestinal tissues.

 

Weight Loss: Weight loss may be due to the changes in metabolism caused by the cytokines, but it can also be caused by reduced nutrient intake as a result of pain that occurs after eating. In patients with small intestinal inflammation, there may be problems with absorption of nutrients, which can lead to weight loss.

 

Anal Problems: While patients with ulcerative colitis may describe irritation of the skin around the anus or may even develop hemorrhoids (swollen veins) because of the frequent bowel movements, patients with Crohn's disease are at risk of developing certain specific problems that are more serious. They can develop anal fissures or ulcers (painful breaks in the skin inside the anus), abscesses (painful collections of pus), and fistulas (small openings to the skin around the anus that can drain stool, pus, or blood).

 

 

Both ulcerative colitis and Crohn's disease can present with certain associated symptoms or conditions outside of the intestine. These are called extra-intestinal manifestations and are usually due to inflammation of other tissues outside of the bowel — joints, eyes, skin, and liver, for example. Joint manifestations (arthritis) are the most common. These extra-intestinal manifestations can occur at the time of first diagnosis of IBD, or they can occur later on in the course of the disease. In occasional cases, they can first occur months or even years before the bowel symptoms first become apparent. The same major extra-intestinal manifestations and symptoms (joint, eye, skin, and liver) can occur in both disorders.

 

 

 

Inflammatory bowel disease usually first develops in one of three different patterns of symptom onset: gradual, sudden, and relapsing or remitting.

 

 

Most often, Crohn's disease and ulcerative colitis develop very gradually so that it takes many weeks, months or, in some cases, years before patients recognize the symptoms and mention them to their doctor for diagnosis.

 

 

Unusually, though certainly not rarely, inflammatory bowel disease develops abruptly. Symptoms may come on suddenly, sometimes so quickly that the disease seems to develop virtually overnight, with the person going from a state of good health to a serious and severe illness without any obvious warning. This type of presentation is quite striking and can often make it very difficult for patients and their families. Important medical management decisions, including the choice of medications and the possibility of undergoing surgery, may be required.

 

 

Inflammatory bowel disease may also develop following a so-called relapsing or remitting course. Patients can present with mild episodes or flares that occur for days, weeks, or even months at a time. During these flares, symptoms get noticeably worse, but then seem to go away spontaneously (also called "going into remission") so that the person goes back to a state of normal health with no symptoms for many weeks, months, or even years before another episode or flare occurs.

 

Because these flares often subside on their own, patients will sometimes not go to the doctor for investigation or treatment, until an episode is more severe, lasts longer than usual, or is more concerning in some way.