- Symptoms of Crohn’s Disease and How It’s Diagnosed
- What Are the Signs of Crohn’s Disease?
- What Are the Five Types of Crohn’s Disease?
- How Do You Know if You Have Crohn’s Disease?
- What Causes Crohn’s Disease?
- Crohn’s Disease in Children
- Signs and symptoms of Crohn’s disease in women
Symptoms of Crohn’s Disease and How It’s Diagnosed
Signs of Crohn’s disease vary depending on the location and severity of the inflammation involved.
Talk to your doctor if you start to develop signs and symptoms of Crohn’s disease.
Crohn’s disease is an inflammatory condition that can affect any part of the digestive tract.
Most people with Crohn’s disease experience some inflammation in both the small intestine and the colon (large intestine), which moves stool to the rectum. (1)
The exact nature of Crohn’s disease symptoms are different in each person. Even in the same person, symptoms are likely to vary over time. (2)
Factors that can affect Crohn’s disease symptoms include what areas of the digestive tract are involved, whether your Crohn’s is responding well to your treatment, and how long you’ve had the disease. (2)
What Are the Signs of Crohn’s Disease?
Symptoms of Crohn’s disease can vary widely from person to person, depending on the areas of the digestive tract that are affected and the severity of the inflammation. (2,3)
Symptoms affecting the digestive tract may include:
- Persistent diarrhea
- Rectal bleeding
- Abdominal cramping and pain
- Nausea or loss of appetite
- Urgent need to defecate
General symptoms of Crohn’s disease often include:
- Weight loss
Crohn’s disease can also cause symptoms in other parts of the body:
- Joint pain or soreness
- Red, painful, or itchy eyes
- Red, tender, or bumpy skin
- Disruption of menstrual cycle in women
What Are the Five Types of Crohn’s Disease?
There are five types of Crohn’s disease, each with their own set of symptoms.
Ileocolitis If you have ileocolitis — the most common form of Crohn’s disease, which affects the end of the small intestine and the colon — you’re likely to experience diarrhea and pain in your lower right or middle of your abdomen.
You may also experience significant weight loss with this form of Crohn’s, according to the Crohn’s & Colitis Foundation. (1)
Ileitis Symptoms of ileitis — which affects just the end of the small intestine — tend to be similar to those of ileocolitis.
Gastroduodenal Crohn’s disease If you have gastroduodenal Crohn’s disease — which affects the stomach and beginning of the small intestine — you’re likely to experience a reduced appetite, weight loss, and nausea or vomiting.
Jejunoileitis If you have jejunoileitis — which affects the upper half of the small intestine — you’re likely to experience abdominal pain, cramping, and diarrhea following meals.
Crohn’s colitis If you have Crohn’s colitis — which affects only the colon — you’re likely to experience diarrhea, rectal bleeding, and sores around your anus.
You’re also more likely to experience skin lesions and joint pains if you have Crohn’s colitis, according to the Crohn’s & Colitis Foundation. (1)
How Do You Know if You Have Crohn’s Disease?
Your doctor will most likely use your medical history, a physical exam, and a series of tests to diagnose Crohn’s disease and rule out other conditions that may cause similar symptoms. (4)
Conditions with symptoms that can be similar to those of Crohn’s disease include:
- Irritable bowel syndrome (IBS)
- Lactose intolerance
- Ulcerative colitis (an inflammatory condition similar to Crohn’s disease)
During a physical exam, your doctor will probably check for bloating, swelling, and painful or tender spots in your abdomen and listen to the area with a stethoscope. (5)
Your doctor may also perform or order the following tests for Crohn’s disease.
Blood tests Your doctor may check for anemia (inadequate red blood cells) or look at your white blood cell count, which may indicate inflammation or infection somewhere in your body if it’s elevated.
Certain blood tests may also help rule out other conditions.
Stool tests Your doctor may find it useful to see if any blood is present in your stool, or to check for other irregularities that could indicate a digestive disease other than Crohn’s.
To perform this test, your doctor will give you a container to catch and store your stool sample. You’ll then return it to your doctor or send it by mail to a lab.
Colonoscopy Your doctor will insert a thin, flexible tube containing a camera (called a colonoscope) into your rectum and pass it into the colon to look for abnormalities.
You’ll receive sedation, anesthesia, or pain medicine for this procedure.
During the procedure, your doctor may take a series of biopsies (small tissue samples) from inside your colon to view under a microscope.
Before having a colonoscopy, you’ll need to follow procedures to empty your bowel, which typically means drinking a laxative solution and not eating for a specified period of time.
Upper GI endoscopy After you drink a liquid anesthetic to numb your throat, your doctor will insert a flexible tube containing a camera (called an endoscope) down your throat and esophagus and into your stomach and the upper part of your small intestine.
In a similar procedure called an enteroscopy, your doctor will use a special tube to look further into your small intestine. This tube may contain a balloon or spiral (like a corkscrew) to help it move in the area.
Wireless capsule endoscopy You’ll swallow a capsule (about the size of a large vitamin) containing a tiny video camera that allows your doctor to see abnormalities throughout your digestive tract.
Imaging tests Your doctor may perform an X-ray or CT scan to look for abnormalities that might be missed in an upper GI endoscopy or colonoscopy, or if there are reasons not to perform these procedures.
In a procedure called an upper GI series, you’ll drink a chalky liquid called barium before having a series of X-ray images taken. This liquid helps increase the contrast in X-ray images of your digestive tract, allowing greater detail to be seen. (5)
What Causes Crohn’s Disease?
Scientists do not yet know what causes Crohn’s disease, but they have some theories.
One possible cause of Crohn’s is an autoimmune reaction, in which the immune system attacks the body’s healthy cells. Doctors think bacteria in the digestive tract could mistakenly trigger an immune system response, which could cause inflammation and lead to Crohn’s symptoms.
Genetics may also play a role. Research has shown that individuals with a parent or sibling with Crohn’s disease are more likely to be diagnosed themselves, according to the National Institutes of Health. (3)
Crohn’s Disease in Children
Crohn’s disease can develop at any age, but it’s typically diagnosed between age 10 and 40. (6)
Research studies have estimated that about 20 percent of Crohn’s disease cases are diagnosed in children younger than 18, according to the Seattle Children’s Hospital. (6)
In rare cases, Crohn’s disease can be caused by immune deficiencies in children younger than 5, including babies. (6)
Children typically experience symptoms similar to those of adults.
The most common Crohn’s disease symptoms in children are:
- Abdominal pain
- Weight loss
Children with Crohn’s disease may experience some additional complications that don’t affect adults, including:
- Delayed puberty
- Slow growth rate (about one-third of children with Crohn’s disease will have a shorter-than-expected adult height) (7)
Signs and symptoms of Crohn’s disease in women
Around 50 percent of women with Crohn’s disease are under the age of 35 at the time of diagnosis.
Symptoms of Crohn’s disease that affect females include:
1. Irregular periods
Share on PinterestCrohn’s disease may cause irregular periods or infertility in women.
A flare-up of Crohn’s disease can influence hormone levels, nutrition, and stress, which all play a role in the menstrual cycle.
The inflammation caused by Crohn’s can block the normal function of hormones. Other common symptoms, such as diarrhea and loss of appetite, can impact whether the body gets enough nutrients.
A flare-up of Crohn’s can cause stress because the symptoms can be uncomfortable and affect a person’s ability to carry out everyday tasks.
Women with IBD may experience heightened symptoms in the weeks before and during their period.
2. Iron deficiency
Females with IBD are at higher risk of developing an iron deficiency than those who do not have the condition. This may be due to bleeding from the intestine or a lack of iron absorption.
A heavy menstrual cycle can also affect iron levels in the body, so a woman with both IBD and heavy periods should speak to a doctor about the possibility of an iron deficiency.
3. Fertility issues
Research shows that women who are experiencing a Crohn’s remission have similar fertility rates as the general population. However, if the disease is active or if a person has recently had surgery for the condition, they may have more difficulty conceiving.
Anyone with Crohn’s disease who is thinking about conceiving may wish to speak to a doctor, as some treatment options may also affect fertility.
According to the Crohn’s & Colitis Foundation, women with IBD do well during pregnancy if the disease was in remission at the time they became pregnant. If a woman conceives during an IBD flare-up, the disease may stay active or get worse during pregnancy.
Most medications for Crohn’s disease are safe to use while pregnant and breastfeeding, but there are exceptions, so it is best to speak with a doctor.
Dyspareunia is the medical term for pain during sex.
If someone is experiencing pain during sex, it may indicate that the disease is active in the part of the digestive tract surrounding the anus or vagina. It could also indicate a fistula. A fistula is a small abnormal passage that develops between two internal organs, often the bowel and intestine.
Contributor: Kadakkal Radhakrishnan, MD
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If your child has been diagnosed with Crohn’s disease, you most likely — and understandably– have many questions and concerns. To navigate through this disease, it’s important that you know exactly what this autoimmune disorder is.
Crohn’s disease, also known as regional enteritis, is an inflammatory bowel disease that potentially can affect the entire gastrointestinal tract from the mouth to the anal opening. Fortunately, this is a pretty uncommon condition. The chance of finding a patient with Crohn’s disease is about one in 5,000, and of this number, about 20 percent are children.
The most commonly affected sites include the end of the small intestines, called the ileum, and the beginning of the large intestine, called the cecum. Ileo-cecal Crohn’s disease affects 50 percent to 60 percent of patients, while isolated ileal disease is seen in 30 percent of patients, and colonic disease, which affects the large intestine, is seen in 20 percent of patients.
Crohn’s disease occurs in patients who may have an underlying genetic susceptibility – most commonly due to subtle variations in specific genes. We have a better idea of these genetic variations now; however, having a genetic tendency does not confer an absolute risk to develop Crohn’s disease. Rather, it actually increases the risk.
RELATED: Crohn’s and Ulcerative Colitis — By the Numbers
Symptoms to look out for
If your child complains of prolonged episodes of intermittent abdominal pain, along with diarrhea, this could be a sign of the autoimmune disorder. Many children suffer from weight loss due to poor nutritional intake, inflammation or malabsorption of nutrients.
Abnormal skin tags in the bottom area and anal fissures are also symptoms of the disease; however, the most common cause of an anal fissure is constipation. Occasionally, patients develop abscesses around the anal opening.
These abscesses are due to fistulas – abnormal communication from the bowel to the outside. Although rare, patients can also develop strictures, or narrowing of bowel, which leads to bowel obstruction or abscesses inside their belly.
RELATED: Mom’s Advice Is Still the Best for Treating Diarrhea
How Crohn’s disease is diagnosed
If your child has any symptom suggestive of Crohn’s disease, you should seek the help of your pediatrician. Diagnosis of Crohn’s disease takes into account the “big picture” – which includes the symptoms, examination, laboratory tests, imaging techniques and endoscopy.
On laboratory testing, patients may show anemia, low blood proteins and elevated markers of inflammation. An endoscopy, where a camera with a fiber optic light source is passed into the stomach through the mouth, called upper endoscopy, or through the bottom into the entire length of the colon, called a colonoscopy, often is required to obtain a biopsy from the inside to confirm the diagnosis.
Some patients may require a scan of their abdomen, whether it be a special CT scan called CT enterography or a special MRI scan called MR enterography. These imaging modalities offer a better delineation of parts of the small bowel that may not be reached by conventional endoscopy.
A capsule endoscopy, where the patient swallows a capsule size camera, is another way of looking at the small bowel. Although this test is rarely used — because it doesn’t replace the conventional endoscopy — it does help find evidence of small bowel involvement that would point toward the disease.
RELATED: Endoscope Offers Smart Fixes for Your Serious Digestive Problems
When it comes to treating Crohn’s disease in children, it’s necessary to induce remission, maintain remission and manage complications.
Often, steroids are used to induce remission; however, there is no role for steroids in the long-term management of Crohn’s disease. Trial of elemental diet may help induce remission of Crohn’s disease in the place of steroids.
Patients sometimes require immune modulators, which are medications that modulate or calm the immune system and help control gastrointestinal inflammation. These medicines include azathioprine, 6-mercaptopurine and methotrexate.
For a severe case of Crohn’s and in selected patients with fistulas, biological agents like Infliximab, Adalimumab, Certolizumab and, rarely, Vedolizumab may be used. Biological agents are engineered medications that are antibodies against specific mediators involved in the inflammatory process in Crohn’s disease.
Both immunomodulators and biological agents have side effects, but these side effects are rare. Studies suggest that the benefits of these medications outweigh the risks associated with them, but I strongly recommend patients discuss the side effects of these medications with their gastroenterologists.
Lifestyle changes are also part of Crohn’s disease management. This includes taking in adequate calories and refraining from smoking. Patients may also develop certain dietary intolerances while battling Crohn’s, including lactose intolerance, but this often improves with healing.
Complications of Crohn’s disease, such as obstruction, fistula and abscesses, may require surgery. Crohn’s disease is associated with a higher risk of surgery – almost an 80 percent lifetime risk of surgery – but with newer treatment approaches, this risk may be lower.
As mentioned, Crohn’s disease is also associated with higher risk of colon cancer. Patients who suffer from the disorder require screening colonoscopies starting eight years after the diagnosis.
Crohn’s disease treatment guide
This post is based on one of a series of articles produced by U.S. News & World Report in association with the medical experts at Cleveland Clinic.