Crohn’s disease abdominal pain

9 Things to Know About Crohn’s Disease and Cramps


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If you have Crohn’s disease, you’re probably familiar with the pain of abdominal cramping. Not only is it one of the most common symptoms of the disease, but it can also present a unique set of challenges, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Learn these key facts about Crohn’s disease and abdominal pain to better cope with cramping.

What to Know About Crohn’s Disease and Cramps

Here are nine things you should know about Crohn’s disease and cramps:

1. Abdominal cramps can occur anytime. Cramping can start during a flare or when you’re in remission, says Jessica Philpott, MD, PhD, a gastroenterologist at Cleveland Clinic in Ohio. When Crohn’s disease is active, inflammation can change nerve and muscle function in the intestines, Dr. Philpott says. Even after inflammation is reduced, the functioning of the gastrointestinal tract remains altered.

2. Cramps can be caused by a variety of sources. Pinpointing the origin of cramps can help you treat the source, says Susan Coe, MD, a gastroenterologist with the Gwinnett Medical Center in Lawrenceville, Georgia. For example, if active Crohn’s disease is causing your cramps, treatment should be geared to reducing inflammation and treating any Crohn’s disease-related complications, such as a bowel blockage or fistulas, Dr. Coe says. Your doctor may recommend medications to help ease your symptoms during a flare and put the disease into remission afterward. If your cramping is from a stricture, which is the narrowing in a section of the colon, a low-residue, low-fiber diet can help, says Sandra M. Quezada, MD, an assistant professor of medicine in the division of gastroenterology and hepatology at the University of Maryland Medical Center in Baltimore. Foods low in fiber dissolve and pass through narrowed areas of the colon more easily, she says.

3. Sometimes cramping is in response to stress. When stress is the cause, taking steps to reduce stress can help reduce abdominal pain, Coe says. “A very real and intimate relationship exists between the mind and body,” she says. “Stress can make the digestive tract more aware of stimuli, particularly pain.” Try stress relievers such as yoga, tai chi, and meditation, suggests the Crohn’s & Colitis Foundation of America.

4. Your emotions can play a role. Having a chronic disease that causes frequent abdominal cramps can cause you to feel depressed, Philpott says. And depression doesn’t always present itself in traditional ways. Talk to your doctor if your pain leads to trouble sleeping or if you’re moodier than usual. He or she may recommend counseling or medication, such as an antidepressant. These drugs have been shown to improve abdominal pain in people with irritable bowel syndrome (IBS), which is common in people with Crohn’s disease, Dr. Quezada says.

5. Keep a journal to track your cramps. For some people with Crohn’s disease, cramps may kick in an hour or so after eating. That’s because eating triggers the process of peristalsis, which is the normal rhythmic contraction of the intestines, Coe says. “If Crohn’s disease is in remission, abdominal pain occurring after a meal may be the result of a hypersensitive response to this normal stimulus, which is a symptom of IBS,” she says. “However, if your Crohn’s disease is active, stomach pain that occurs after eating can be the result of significant inflammation or scar tissue.” Work with your doctor to figure out what’s causing your cramps.

6. Be aware of where you feel cramps. Crohn’s disease can affect any part of the digestive system, from the mouth to the rectum. The site of your pain will depend on which part of your gut is affected, Philpott says. With Crohn’s disease, the last part of the small intestine is most often affected. In that case, you’ll feel cramps most acutely in the lower right side of your abdomen, she says. “If you have Crohn’s disease in your small bowel, you’re also more likely to have pain soon after eating,” Philpott says. Eating frequent, smaller meals rather than larger ones is one way to help reduce the likelihood of cramping.

7. It’s not unusual to feel nauseous with cramping. Crohn’s disease can cause your small intestine to become distended, either from inflammation or gas. This often triggers the sensation of nausea, Coe says. “Some people develop nausea as their natural response to considerable pain, whether it’s gastrointestinal or otherwise,” she says.

8. Assigning a number to your stomach pain helps guide treatment. Coe asks people with cramping to describe their pain on a scale of one to 10, with 10 being the worst pain they’ve ever experienced and one being the least. Quantifying your pain in this way can help your doctor determine the cause of your pain and make treatment recommendations, she says.

9. Be aware of any changes in your abdominal pain. Changes, like cramps that worsen, could indicate a complication of Crohn’s disease that requires immediate treatment, Philpott says. Call your doctor right away if you notice that your symptoms are getting worse.

Upset Stomach or Crohn’s Disease?

The stomach is a fascinating organ that helps keeps our bodies nourished and healthy. This powerhouse organ breaks down food by secreting acid and enzymes. It contracts to digest food so the small intestines can absorb the nutrients. Your stomach also stands guard against harmful things like bacteria, parasites, or spoiled food. Problems with the stomach can arise for a variety of reasons and range from mild irritations to life-threatening conditions. One of the more serious gastrointestinal diseases is Crohn’s disease. Because Crohn’s disease symptoms can be confused with a regular upset stomach, it’s important to understand the differences between the two.

Understanding the Upset Stomach

We’ve all felt the uncomfortable symptoms of an upset stomach – abdominal pain, cramps, nausea, and diarrhea. Sometimes an upset stomach is caused by a parasite, bacteria, or virus. An upset stomach can also follow overindulgence in fatty foods, alcohol, or caffeine. For some, allergic reactions to certain foods can cause an upset stomach. In these instances, inflammation of the stomach lining and intestines occurs followed by a short period of stomach upset. In fact, a normal upset stomach often subsides within a few days and doesn’t require a doctor’s visit.

Crossing Over to Crohn’s Disease

Unlike an upset stomach, Crohn’s disease is a chronic inflammatory bowel condition. The inflammation can go beyond just the stomach and involve other parts of the gastrointestinal tract like the small intestines, mouth, esophagus, colon, and anus. With Crohn’s disease, the inflammation goes deep into the bowel tissue. This can lead to debilitating pain and even death if left untreated. Symptoms and severity vary from patient to patient but often include a combination of:

  • Diarrhea
  • Fever
  • Fatigue
  • Abdominal pain and cramping
  • Anemia
  • Blood in your stool
  • Mouth sores
  • Reduced appetite and weight loss
  • Pain or drainage near or around the anus
  • Joint pain

If these symptoms are persistent, seek medical attention. Most likely a combination of physical exam, blood tests, stool tests, and possibly a colonoscopy, endoscopy, or biopsy will be used to diagnose Crohn’s disease. It’s important not to delay seeing your doctor if you suspect you could have Crohn’s disease. Life-threatening complications can occur if left untreated.

Risk Factors for Crohn’s Disease

The exact cause of Crohn’s disease is unknown, but certain risk factors have been identified. These include:

  • Age: Crohn’s disease can affect anyone of any age, but is mostly diagnosed in younger patients around thirty years of age.
  • Family History: While not always associated with family history, approximately 1 in 5 people with Crohn’s disease also have a close relative with it as well.
  • Habits: Cigarette smokers have an increased risk for developing Crohn’s disease and experiencing more severe symptoms and complications.
  • Geography: Interestingly, people living in urban areas have a higher risk of developing Crohn’s disease. Environmental triggers and access to more processed foods are possible factors that exasperate Crohn’s disease.

Almost everyone will experience an occasional upset stomach as a symptom of poor diet, bacteria, or a virus. While the symptoms are uncomfortable they are usually not disruptive for more than a few days. However, for people with Crohn’s disease, the gastrointestinal tract can become so inflamed that it can cause severe symptoms. It’s important to seek medical care if you are experiencing symptoms that go beyond a normal upset stomach. If you have questions or concerns, contact your primary care provider or the Augusta Health Gastroenterology team.

Crohn’s disease symptoms vary from individual to individual but the most common symptoms include: gut pain, diarrhea, fever, weight loss, anemia, fissures, fatigue, and canker sores in the mouth. Gut pain typically includes cramping and sore to the touch. The cramping usually comes and goes and may become a constant ache as the condition gets worse.

Diarrhea can be as high as 10-20 times per day, including waking up in the night to go to the bathroom. Blood is occasionally in the stool. A high fever may mean that there is an infection, it is recommended to go to the physician. Weight loss can be caused by symptoms such as diarrhea. Anemia can result from malabsorption, due to inflammation of the gut lining, or blood in stools. In addition, since Crohn’s involves the immune system, there may be joint pain, eye problems, skin rash, or liver concerns.

Weight loss

Diarrhea, nausea, and loss of appetite can make it hard to get enough nutrients, leading to weight loss. To maintain a healthy weight, keep track of your weight, stay active, and focus on a healthy diet. Keeping track of your weight and share it with your physician and dietitian. Exercise and activity can be helpful by increasing appetite and building muscle. Aim for lower intensity and consider avoiding intense exercise when experiencing a flare up. Eat smaller, more frequent meals to assist with digestion. Focus on plenty of healthy fluids. Make them interesting by adding a bit of lemon or lime to add flavor. Focus on a wide variety of healthy foods in order to make sure you are getting enough nutrients. If loss of appetite or stomach pain is occuring, consider drinking smoothies or shakes.

Minimizing or eliminating the foods that lead to flare-ups will help prevent weight loss. Limit foods that are high in fiber (nuts, seeds, raw vegetables, beans). Avoid high fat foods (fried, full fat dairy, butter and oil) and dairy (milk, soft cheese, yogurt) that can lead to diarrhea.

Diarrhea and bleeding

Diarrhea is defined as loose, watery stool that happens at least 3 times per day. In Crohn’s the severity can range from mild to severe. It tends to get worse when there is a flare-up and better once inflammation goes down. Inflammation is the main cause, when your intestines are inflamed, they absorb less water, resulting in watery stool. Other causes include difficulty digesting, bacterial infection, fistulas, and post surgery malabsorption. Anti-diarrheal medications, such as codeine, diphenoxylate and loperamide may be recommended by your physician.

Typically, blood in the stool is less common than when compared to ulcerative colitis, but this varies between people. Bleeding can occur from anal fissures (tears in the tissue). With anal fissures, you will see bright red instead of dark red, which would indicate bleeding higher up in the intestines. Long-term anal fissures can be treated by methods including botox, calcium channel blockers, and nitrate ointment. If these treatments don’t work, your physician may recommend a surgery called lateral internal sphincterotomy.

Pain and low energy

Abdominal pain and cramps are some of the most common symptoms of Crohn’s disease. It is typically experienced around the belly button or lower right side of the abdomen, and usually occurs 1-2 hours after eating but can come and go anytime. Experiencing pain can have psychological impacts including anxiety. Keeping Crohn’s in remission for as long as possible, by taking prescribed medications, focusing on stress reduction, avoiding trigger foods, and avoiding smoking will help. If your doctor approves, acetaminophen can help with pain management. For increased comfort, soak in warm salt water baths, for fissure soreness and joint relief.

Fatigue is ongoing sense of tiredness, weakness, or exhaustion, that interferes with the ability to work or do daily activities. When diarrhea or abdominal pain symptoms happen at night, it can be difficult to get adequate sleep. Anemia is a common result of Crohn’s due to malabsorption. It is a condition in which the blood cells do not carry enough oxygen through the body, resulting in fatigue and low energy. About 25% of people with Crohn’s disease are depressed, which is commonly associated with fatigue. Improving the quality of sleep is the goal, including reducing caffeine and alcohol consumption before bed, getting activity, limit television, phone, and computer screens at least an hour before sleeping.


What is Crohn’s disease?

Share on PinterestBulky grains, like those contained in bread, can worsen Crohn’s disease.

Treatment may involve medication, surgery, and nutritional supplements.

The aim is to control inflammation, correct nutritional problems, and relieve symptoms.

There is no cure for Crohn’s disease, but some treatments can help by reducing the number of times a patient experiences recurrences.

Crohn’s disease treatment depends on:

  • where the inflammation is situated
  • the severity of the disease
  • complications
  • the patient’s response to previous treatment for recurring symptoms

Some people can have long periods, even years, without any symptoms. This is known as remission. However, there will usually be recurrences.

As periods of remission vary so much, it can be hard to know how effective treatment has been. It is impossible to predict how long a period of remission is going to be.

Medication for Crohn’s disease

  • Anti-inflammation drugs – the doctor will most likely start with mesalamine (Sulfasalazine), which helps control inflammation.
  • Cortisone or steroids – corticosteroids are drugs containing cortisone and steroids.
  • Antibiotics – fistulas, strictures, or prior surgery may cause bacterial overgrowth. Doctors will generally treat this by prescribing ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole.
  • Anti-diarrheal and fluid replacements – when the inflammation subsides, diarrhea usually becomes less of a problem. However, sometimes the patient may need something for diarrhea and abdominal pain.


Biologics are a new type of drug that scientists have developed from a living organism. They reduce the body’s immune response by targeting proteins that lead to inflammation.

Biologics appear to help people with Crohn’s disease.

Examples of biologics for Crohn’s include:

  • infliximab (Remicade)
  • adalimumab (Humira)
  • 6-mercaptopurine (Purinethol)
  • methotrexate
  • imuran (Azathioprine)
  • certolizumab pegol (Cimzia)

Biologic treatments can have side effects, include vomiting, nausea, and a weaker resistance to infection.

Some studies suggest that the use of biologics can reduce the chance that a person will need abdominal surgery within 10 years to 30 percent. Before the introduction of biologics, researchers put this figure at 40–55 percent.

Biologics also appear to reduce the risk of adverse effects that can arise when a person uses corticosteroids.

There are different types of biologic drugs, and individuals react differently to them. A doctor will recommend a suitable option, and they may suggest trying an alternative or a combination of drugs if the first one does not work.


The majority of Crohn’s disease patients may need surgery at some point. When medications no longer control symptoms, the only solution is to operate. Surgery can relieve symptoms that did not respond to medication, or to correct complications, such as abscess, perforation, bleeding, and blockage.

Removing part of the intestine can help, but it does not cure Crohn’s disease. Inflammation often returns to the area next to where the affected part of the gut was removed. Some Crohn’s disease patients may require more than one operation during their lives.

In some cases, a colectomy is needed, in which the whole colon is removed. The surgeon will make a small opening in front of the abdominal wall, and the tip of the ileum is brought to the skin’s surface to form an opening called a stoma. Feces exit the body through the stoma. A pouch collects the feces. Doctors say that a patient who has a stoma can carry on leading a normal and active life.

If the surgeon can remove the diseased section of the intestine and then connect the intestine again, no stoma is needed.

The patient and their doctor need to consider surgery very carefully. It is not appropriate for everyone. The patient has to bear in mind that after the operation, the disease will recur.

Most people with Crohn’s disease can live normal and active lives, hold jobs, raise families, and function successfully.

Crohn’s Disease

Crohn’s disease is a chronic (long-term) illness in which the intestine (bowel) becomes inflamed and ulcerated (marked with sores). Along with ulcerative colitis, Crohn’s disease is part of a group of diseases known as inflammatory bowel disease (IBD).

Crohn’s disease most commonly affects the lower part of the small intestine (ileum), although it can occur in any part of the large or small intestine, stomach, esophagus (“food pipe”), or even the mouth. It can occur at any age, but it is most common between the ages of 15 and 30.

Crohn’s disease can interfere with the normal function of the bowel in a number of ways. The bowel tissue may:

  • Swell, thicken, or form scar tissue, which can lead to blockage of the passageway inside the bowel.
  • Develop ulcers that can involve the deep layers of the bowel wall.
  • Lose its ability to absorb nutrients from digested foods (malabsorption).
  • Develop abnormal passageways (fistulas) from one part of the bowel to another part of the bowel, or from the bowel to nearby tissues such as the bladder or vagina, or even the skin.

What causes Crohn’s disease?

The cause of Crohn’s disease is unknown. It is believed that many factors cause an abnormal response of the immune system in the gastrointestinal tract.

Genetics (heredity) has been found to play a role in the disease process. First-degree relatives (mother, father, sister, or brother) of patients with IBD are about three to 20 times more likely to develop the disease than the general population. Having a sibling with Crohn’s disease can increase the risk of having the disease by 30 times compared with the general population. Children who have one parent with Crohn’s disease, and Jewish people of European descent, also have a greater risk for developing the disease.

What are the symptoms of Crohn’s disease?

People with Crohn’s disease go through periods of severe symptoms followed by periods of remission (no symptoms, or milder symptoms) that can last for weeks or years. Unfortunately, there is no way to tell when a remission will occur or when symptoms will return.

The symptoms of Crohn’s disease depend on where in the bowel the disease occurs and how severe it is. In general, symptoms can include:

  • Chronic diarrhea
  • Bleeding from the rectum
  • Weight loss
  • Fever
  • Pain and tenderness in the abdomen (often on the right side of the lower abdomen)
  • Feeling of a mass or fullness in the lower right abdomen
  • Delayed development and stunted growth (in children)

Other symptoms can develop, depending on the complications of the disease. For example, a person with a fistula (abnormal passageway) in the rectal area may have pain and discharge around the rectum. Other complications from Crohn’s disease include:

  • Arthritis
  • Kidney stones
  • Gallstones
  • Inflammation (swelling) of the eyes and mouth
  • Skin rashes or ulcers
  • Liver disease

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