What to Know About Crohn’s Disease Pain

If you have Crohn’s disease, a form of inflammatory bowel disease (IBD), you probably know that abdominal discomfort is a hallmark symptom. But you might still have questions about what Crohn’s pain feels like for others with the disease, how bad it can get, and what will make it go away. Here’s what you can expect, and when to talk to your doctor about pain that’s related to your Crohn’s.

Crohn’s disease can cause pain or discomfort that worsens over time, especially if the condition isn’t well-managed. Around 83% of patients with Crohn’s report experiencing pain, primarily in their abdominal area, reports a study published in the Journal of Crohn’s & Colitis.

Exactly how those abdominal cramps feel varies from one person to the next. “Pain can be individualized to the patient, depending on where their disease is located, how severe it is, and if they have complications,” such as a fistula or abscess, says Nirupama Bonthala, M.D., the director of women’s health in inflammatory bowel disease at UCLA Health in Los Angeles.

Crohn’s pain is primarily driven by inflammation, which happens when the immune system mistakenly attacks tissue in a person’s gastrointestinal (GI) tract. “The inflammation can activate nerve endings in the GI tract and cause abdominal cramping,” explains Sushrut Jangi, M.D., a gastroenterologist with Tufts Medical Center in Boston, MA.

Inflammation tends to be worst during a flare or if someone’s Crohn’s isn’t well-controlled. “For many people, a flare won’t necessarily be more diarrhea or rectal bleeding, but more pain,” Dr. Bonthala says.

Persistent inflammation can also lead to complications like strictures (scarring that causes areas of the GI tract to become thicker or more narrow) or fistulas (abnormal connections or tunnels that can form from the GI tract to other tissue or organs). Strictures can cause severe pain if they become blocked and form a dangerous obstruction where digested food can’t get through, Dr. Bonthala says. Fistulas can also be painful, especially if they become infected.

The inflammation from Crohn’s can also cause complications in other parts of the body that can be painful. “Patients can get inflammation in the joints, skin, or eyes, and that’s all associated with pain in those areas,” Dr. Jangi says.

Crohn’s pain isn’t one-size-fits-all, and depends on where your disease is located, how severe it is, and if you have complications like strictures or fistulas, says Dr. Bonthala.

But it’s worth noting exactly when and where you feel pain, how often, and how severely. “The way a person’s pain expresses often tells us about the underlying cause,” Dr. Jangi says. For instance, abdominal pain caused by general inflammation tends to be dull and crampy and might come and go. “If it’s in the stomach, the pain could feel like heartburn or indigestion,” says Dr. Bonthala.

On the other hand, pain caused by a stricture that’s developed a blockage is typically triggered by eating. It tends to intensify as the blockage gets worse and is usually accompanied by not being able to have a bowel movement or pass gas. Fistula-related pain is typically concentrated around the anus and can feel like a stabbing sensation when you go to the bathroom, Dr. Jangi explains.

Crohn’s can cause pain throughout the body, though it’s most likely to be concentrated around where your GI tract is inflamed. “A very common area where patients will have inflammation is at the end of the small intestine, on the lower right side, so a lot of people will have pain there,” Dr. Bonthala says. “If someone has Crohn’s but hasn’t been diagnosed yet, they might think the pain is from appendicitis.”

Your GI tract runs from your mouth all the way to your anus, so you might feel pain anywhere along that route, depending on where you’re experiencing inflammation. Crohn’s inflammation in the mouth can show up as sores that form between the gums and lower lip or under the tongue, according to UpToDate.com (an evidence-based clinical reference). And if you have perianal Crohn’s disease, which is prone to causing fistulas, you might experience sharp pains around your anus.

Crohn’s-related issues beyond your GI tract can also cause pain elsewhere, per the Crohn’s & Colitis Foundation. Many people experience:

• Eye pain or dry eye

• Painful skin lesions or rashes

• Stiff or swollen joints

Pain caused by Crohn’s often shows up or gets worse during a flare, since flares are caused by new or worsening inflammation. “Being on the right treatment should stop or control the inflammation, and controlling the inflammation should decrease most people’s pain,” Dr. Bonthala says.

That’s the ideal scenario, anyway. For some people, pain can persist even when they’re on the right meds. Up to 40% of patients with IBD also have irritable bowel syndrome (IBS), per a Gastroenterology & Hepatology report. And IBS can cause abdominal pain and cramping despite a person’s IBD being well-controlled, says Dr. Bonthala.

Crohn’s can, over many years, also cause your GI tract to become more sensitized to pain in general. Doctors call this phenomenon central sensitization. “There can be many pathways to pain even if someone doesn’t have inflammation,” Dr. Bonthala explains. “Your gut becomes sensitized to pain because of the trauma it’s gone through in the past.” A mild bout of gas that wouldn’t be a big issue for an otherwise healthy person, for instance, might leave you very uncomfortable.

The number one way to keep your Crohn’s pain in check: Keep the disease itself under control. That means taking your prescribed medications, say Dr. Jangi and Dr. Bonthala. These typically include immunomodulators or biologics. “Inflammation is associated with increased signaling of pain molecules. So once you turn the inflammation off, much of the pain should go away,” Dr. Jangi explains. As an added bonus, these drugs can typically stave off long-term joint damage and pain, too, notes the Crohn’s & Colitis Foundation.

But it can take a few weeks to a few months for a systemic therapy to fully kick in. If you’re newly diagnosed or are having a flare, your doctor may recommend taking corticosteroids for a few weeks to quickly bring down your inflammation while your long-term treatment ramps up. (Taking them long-term can increase the risk for problems like osteoporosis.) “Corticosteroids are pretty effective at shutting down active inflammation. Patients can feel relief almost within hours,” says Dr. Jangi.

Lifestyle changes may also provide pain relief. Some strategies to try:

• Acupuncture: Engaging in three sessions per week for 12 weeks can decrease Crohn’s-related inflammation, found a clinical trial published in eClinicalMedicine.

• Mindfulness practices: Things like yoga, tai chi, and mindfulness meditation help “reduce our perception of pain,” which can make the discomfort easier to tolerate, Dr. Jangi says.

• Physical activity: People with Crohn’s who are active have less inflammation, and in turn, less pain, according to a Crohn’s & Colitis 360 review.

Finally, avoid taking non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, or naproxen if you have Crohn’s, since the meds can harm your gut lining and make your symptoms worse.

Pain can be a sign that your Crohn’s isn’t well-controlled or that you’re heading into a flare. “You know your body. If you have a minor episode of pain, don’t brush it off. Let your doctor know,” Dr. Bonthala says. Seeking help sooner will help you get the problem under control faster and avoid potential complications.