Crohn’s Disease Symptoms & Complications

Lots of people have stomach cramps with diarrhea or constipation. It’s uncomfortable, but you usually get over it and forget about it.

But when you have these symptoms often and they’re severe, there’s a chance you could have Crohn’s disease. You’ll need to see your doctor to find out for sure.

As many as 700,000 Americans have the disease. Although there’s no cure, there are treatments to manage it.

Symptoms

You may have:

  • Belly pain and cramps
  • Blood in your poop
  • Diarrhea
  • Drainage from a painful sore near your anus
  • Fatigue
  • Fever
  • Lack of appetite
  • Mouth sores
  • Urgent bowel movements
  • Weight loss

You might not have all these. The disease affects people in different ways. The symptoms can be mild, or they can leave you very weak. At its worst, Crohn’s can cause severe complications.

Complications

Crohn’s causes two types of complications:

  • Local, which involve the intestinal tract
  • Systemic, which affect your entire body. You might hear them called extraintestinal complications.

Local complications of Crohn’s include:

  • Abscess: This pocket of pus results from bacterial infection. It can form on your intestinal wall. Or you might get one near your anus that looks like a boil. You’d notice swelling, tenderness, pain, and fever. The symptoms go away once the sore is drained. Antibiotics can clear up the infection.
  • Bile salt diarrhea: Crohn’s disease most often affects the ileum, the lower end of your small intestine. This part usually absorbs bile acids, which your body creates to help it absorb fat. If your body can’t process the fat, you could get this type of diarrhea. Your doctor will give you medicine to remove the salts.
  • Fissure: Painful tears in the lining of the anus. They can cause bleeding during bowel movements. Topical treatments and sitz baths are common treatments.
  • Fistula: Sores or ulcers can turn into openings that connect two parts of your intestine. They can also tunnel into nearby tissues like the bladder, vagina, and skin. Antibiotics can treat small fistulas. You may need surgery if yours are large or if there are many of them.
  • Malabsorption and malnutrition: The disease affects your small intestine, the part of your body that absorbs nutrients from food. After you’ve had it for a long time, your body may no longer be able make the most of what you do eat. Treatment centers on replacing the missing nutrients.
  • Small intestinal bacterial overgrowth (SIBO): Your gut is full of bacteria that help you break down food. When this happens higher up in your digestive tract than normal, you can get gas, bloating, belly pain, and diarrhea. Antibiotics can help.
  • Strictures: These narrowed, thickened areas of your intestinal result from the inflammation that comes with Crohn’s. They can be mild or severe, depending on how much of your intestine is blocked. Symptoms include cramping, abdominal pain, and bloating. Medication can help, but if it doesn’t, or if the blockage comes back often, you might need surgery.

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Some of the most common systemic complications include:

Arthritis

Joint inflammation -- which leads to pain, swelling, and a lack of flexibility -- is the most common complication. There are three types of arthritis that sometimes come with Crohn’s.

  • Peripheral: This type affects large joints in your arms and legs, like your elbows, knees, wrists, and ankles. The problems might start in one joint, then move to another (doctors will call this migratory). It’s most common if you have Crohn’s disease of the colon. The inflammation will come and go along with your Crohn’s, but it doesn’t usually cause lasting damage.
  • Axial: This type affects your spine or lower back (the doctor will call it your sacroiliac joint). You might hear the doctor call it spondylitis or spondyloarthropathy. You might even have it before you’re diagnosed with Crohn’s. You might notice trouble breathing if it keeps your ribs from expanding. It can cause permanent damage if the bones of your spine fuse together.
  • Ankylosing spondylitis: This more serious type of spinal arthritis is rare among people with Crohn’s, but it can happen. In addition to causing arthritis in your back, it can also lead to inflammation in your eyes, lungs, and heart valves. Some people get it before a Crohn’s diagnosis. Doctors don’t know exactly what causes it, but they have found common genetic markers among people who have it.

Treatment for arthritis with Crohn’s involves:

  • Easing the arthritis symptoms like pain, swelling, and inflammation with:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen an aspirin. But people with Crohn’s can’t always take them because they irritate the lining of your intestines.
    • Steroids
    • Rest, heat, and range of motion exercises
  • Treating the Crohn’s, usually with
    • Steroids
    • Sulfasalazine
    • Immune system drugs like methotrexate and biologics

Bone Loss

Medications like steroids can lead to bone loss, a condition known as osteoporosis. They can:

  • Stop your body from absorbing calcium, which your body needs to build bone
  • Make your body get rid of calcium when you pee
  • Boost production of cells that break down bone
  • Lower the number of cells that help form bones
  • Lower your body’s output of estrogen. Estrogen also helps build bone.

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The proteins that cause inflammation change the pace at which old bone is removed and new is formed.

Vitamin D deficiency. If your body can’t absorb vitamin D because of Crohn’s damage to the small bowel or a small bowel resection, you’re less likely to be able to absorb calcium and make bone.

To prevent problems or stop them from getting worse, you can:

  • Ease up on steroids, or talk to your doctor about trying one with fewer side effects.
  • Take medications called bisphosphonates than can strengthen your bones:
    • Alendronate (Fosamax)
    • Risedronate (Actonel)

Skin Problems

Skin problems are the second most common systemic complication. Those most often linked to Crohn’s disease include:

  • Erythema nodosum: These small, tender, red nodules usually show up on your shins, ankles, and sometimes your arms. They’ll get better as Crohn’s inflammation is controlled. Steroids can help.
  • Pyoderma gangrenosum: These pus-filled sores often follow an injury or other skin trauma. They often appear on your legs but can show up anywhere. You might get them on your belly next to a stoma or surgery scars from colectomy. Over time the sores join and form deep, chronic ulcers. Steroids, certain biologic drugs, and medications you put on your skin can help.
  • Skin tags: These small flaps of skin are common in people with Crohn’s, especially around the anus or hemorrhoids. Poop can attach to them and irritate your skin. Hygiene can help manage them. Surgery isn’t a good idea because it can damage your anal sphincter or canal.
  • Mouth ulcers: You might hear them called canker sores. They form between your gum and lower lip or along the sides and bottom of your tongue. They get worse when the disease flares and ease when the inflammation is under control. Mouthwashes and a balanced diet can help.

Eye Problems

Over time, the inflammation in Crohn’s, or sometimes the other complications that come with it, can affect your eyes. Common conditions include:

  • Episcleritis: Inflammation of the area just beneath the conjunctiva (the clear tissue that covers the inside of your eyelids and the white of your eyes) is the most common complication of Crohn’s.  It can affect one eye or both. You’ll notice pain, itching, burning, and intense redness, but it won’t hurt your vision. Topical treatments can ease the symptoms. It will get better as your disease inflammation goes down.
  • Scleritis: This condition causes a constant pain that gets worse when you move your eyes. It can keep you awake. You may also have a headache; watery, red eyes; and light sensitivity. It can show up before you’re diagnosed with Crohn’s, but it doesn’t get better or worse along with the disease.
  • Uveitis: This is a painful inflammation of the uvea, the middle layer of your eye. It can cause blurry vision, light sensitivity, and redness. It doesn’t get better or worse with Crohn’s inflammation.  The doctor may prescribe eye drops with steroids to ease the inflammation. It can come before Crohn’s or result from the arthritis that often results from long-term Crohn’s. If you don’t get it treated, it could lead to glaucoma and blindness.

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Kidney Problems

These organs can be affected by Crohn’s because they play a role in processing waste and are located near your intestines. Potential issues include:

  • Kidney stones: They’re a common problem with Crohn’s because your body has a hard time absorbing fat. It binds to calcium and leaves a salt called oxalate that gets absorbed into your kidneys and can turn into stones. The risk goes up if you have a small bowel resection, which makes you more likely to get dehydrated. Treatment involves drinking more water and following a diet with lots of juices and vegetables.
  • Uric acid stones: These kidney stones form because your diarrhea makes your urine more acidic. If you can’t pass them, a doctor may have to remove them surgically.
  • Hydronephrosis: This happens when the ileum (where you small intestine meets the large) swells from Crohn’s and puts pressure on your ureter, the tube that carries urine from your kidney to your bladder. When urine can’t drain like it should, your kidney swells and scar tissue can form. You might notice a dull pain near your kidney and blood in your urine. Surgery to remove inflamed tissue and the part of the bowel that’s causing the problem can resolve it.
  • Fistulas: In addition to forming within your intestines, fistulas can also develop between the intestine and other organs, like the bladder or ureter. It’s more likely to affect men and can lead to urinary tract infections. Medications can help, but you might need surgery.

Liver Problems

Your liver processes everything you eat and drink. It can get inflamed as a result of Crohn’s treatment or the disease itself. You’re only likely to notice low energy and fatigue unless you develop a more serious problem. Among the most common issues:

  • Fatty liver disease: When your body doesn’t process fats as well, they can build up in your liver. Weight loss and exercise are usually the first options for treatment.
  • Gallstones: They form when little pieces of cholesterol or bilirubin (a substance that helps break down proteins in your blood) turn into stones inside your gallbladder.  Medication and surgery are treatment options.
  • Hepatitis: Chronic, long-term liver inflammation can result from Crohn’s disease itself. The same medication you take for your Crohn’s can treat it.
  • Pancreatitis: Inflammation of the pancreas can result from both gallstones and medications. It can cause pain, nausea, vomiting, and fever. Stopping the medication or removing the gallstone can fix the problem.
  • Primary sclerosing cholangitis: This is a disease of the bile ducts, tubes that carry bile from your liver to your small intestine. It causes scarring in the ducts that makes them narrow. It can lead to liver damage and failure. Dilation and stents can help open blocked ducts. Bacteria can control infection, and everything from antibiotics to antihistamines and opioids can help with the itching.

Physical Development Problems

Crohn’s can start at any age. When kids get Crohn’s, parents are likely to notice:

  • Growth failure: Kids with Cohn’s are likely to be shorter and weigh less than those without.  They may stop getting taller before symptoms start.
  • Delayed puberty: Kids with Cohn’s are likely to start puberty later than their friends.

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Crohn’s vs. Ulcerative Colitis

Crohn’s disease is often confused with another condition called ulcerative colitis. The symptoms are similar, and both involve periods of active flare-ups, followed by times when you don’t have symptoms, which is called remission.

The only way to find out if you have Crohn’s or ulcerative colitis is to see your doctor for tests.

WebMD Medical Reference Reviewed by Minesh Khatri, MD on June 14, 2018

Sources

SOURCES:

Crohn’s & Colitis Foundation of America: “What is Crohn’s Disease?”

Lei, H. Biomedical Optics Express, July 1, 2016.

Mayo Clinic: “Crohn’s disease.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Crohn’s Disease.”

Medline Plus: “Crohn’s Disease.”

DeFilippis, E. Current Gastroenterology Reports, Feb. 23, 2016.

Bray, J. Canadian Journal of Gastroenterology and Hepatology, Feb. 22, 2016.

Mayo Clinic: “Cholestyramine (Oral Route),” “Crohn’s disease,” “Nonalcoholic fatty liver disease.”

Crohn’s & Colitis Foundation: “Arthritis,” “Biologic Therapies,” “Bone Loss in IBD,” “Extraintestinal Complications: Kidney Disorders,” “Eye Complications in IBD,” “Intestinal Complications,” “Liver Disease and IBD,” “Skin Complications of IBD,” “What is Crohn’s Disease?”

UpToDate: “Clinical manifestations of Crohn disease in children and adolescents,” “Dermatologic and ocular manifestations of inflammatory bowel disease,”

World Journal of Gastroenterology: “Crohn’s disease and growth deficiency in children and adolescents.”

Cochrane Database of Systematic Reviews: “Methotrexate for treatment of active treatment resistant Crohn’s disease.”

Mayo Clinic: “Nonalcoholic fatty liver disease,” “Primary sclerosing cholangitis.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Definition & Facts for Gallstones” “Symptoms & Causes of Gallstones.”

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