Crohn's disease is one of the group of conditions called inflammatory bowel disease (IBD) in which parts of the digestive system become inflamed. Patients with Crohn's may be affected anywhere in the digestive system, from the mouth to the rectum. The exact cause of Crohn's is unknown; current medical opinion is that the body's immune system attacks the digestive tract and causes the diseases's range of symptoms. Unfortunately, symptoms may be present a long time before a diagnosis is made.
Abdominal Pain
Abdominal pain, a common symptom of IBD, may be a dull aching sensation or sharper, more cramp-like pain. The lower right part of the abdomen is the most common location for pain, because this is where the terminal ileum (the end of the small intestine) is; the terminal ileum is the most common area to become inflamed. Patients may find that the pain increases just before a bowel movement, and that having a bowel movement decreases the pain temporarily.
Fear of Eating
Patients with Crohn's disease may notice an association between eating food and abdominal pain. Because it is not clear which foods trigger the pain, they may develop a fear of eating.
Loss of Appetite
As Crohn's develops, patients begin to feel a general sense of illness, almost as though they are fighting a cold. One of the general, nonspecific symptoms that may occur because of the inflammatory process is a loss of appetite. This is also closely related to the fear of eating.
Weight Loss
This common symptom of Crohn's disease is the result of a combination of factors: the fear of eating brought on by the perceived association between food and pain; the lack of appetite brought on by the overall inflammatory process and feeling unwell; and the diarrhea that is also a hallmark of Crohn's. Together, these processes result in undesired weight loss that is quite significant--as much as 20 percent of the person's body weight.
Fever
Patients with Crohn's disease often have a chronic, low-grade fever. This symptom may be noticed for months before a diagnosis is made.
Diarrhea
Frequent episodes of loose, watery stool may occur either because more fluid is being produced by the inflamed intestine or because less fluid is absorbed because of the inflammation.
Bloody Stool
While obvious blood in the stool is not the most common symptom of Crohn's, it may occur if the large intestine is inflamed. In this case, the inflammatory process leads to ulcerations in the wall of the intestine, which may result in blood in the stool.
Fatigue and Weakness
The combination of eating less, being in pain, having more bowel movement, and losing weight may make the patient with Crohn's feel weak and tired. Crohn's is associated with an inability to digest certain nutrients correctly (malabsorption), so fatigue may occur as a result of that as well.
Fistulas
Because Crohn's disease affects the entire wall of the intestine, a complication called fistula formation may occur. This is when two parts of the body that are not normally in contact--for instance, the intestine and the bladder--become in contact. As the intestinal wall inflammation worsens, it may lead to formation of a hole in the intestine; if this hole occurs adjacent to another organ--for instance, the bladder--it is said that a fistula between the bowel and the organ has formed. Symptoms related to this abnormal contact include frequent bladder infections and a feeling of passing air while urinating. Other fistulas may form as well, such as between the bowel and skin, or the bowel and the vagina.
Symptoms around the Anus
These occur in about one-third of patients with Crohn's disease, and include pain around the anus (perianal pain), anal fissures (small cuts in the anus that are painful and may bleed), and anal skin tags (flaps of skin that may drain or be painful).
Symptoms in the Mouth
Patients whose symptoms occur primarily in the mouth may complain of severe sores called aphthous ulcers. Alternatively, they may simply have pain in the mouth and gums. Rarely, patients may have difficulty swallowing or pain while swallowing; this occurs when the Crohn's inflammation has affected the esophagus.
Extraintestinal Manifestations
This term covers symptoms that occur outside the digestive tract. Common symptoms include a rash called erythema nodosum, which consists of painful bumps on the legs, back and abdomen; arthritis, which is inflammation of the knees, ankles and other joints; and arthralgia, which is joint pain without necessarily having joint inflammation.
References
- "Tintinalli's Emergency Medicine: A Comprehensive Study Guide"; Judith E. Tintinalli, MD, MS, et. al.; 2004
- "Gastrointestinal Physiology"; Kim Barrett; 2006
- "Up To Date"; Denise Basow; 2009
- "Current Medical Diagnosis and Treatment"; Stephen J. McPhee, Maxine A. Papadakis; 2010
