Crohn’s disease, a type of inflammatory bowel disease, has no cure. But there are many treatments, specific to type, and it is possible to keep the symptoms under control. A gastroenterologist offers some tips for understanding Crohn’s disease symptoms for those newly diagnosed.
What is Crohn’s Disease?
Crohn’s disease and ulcerative colitis are two types of IBD, diseases involving chronic inflammation of the gastrointestinal tract.
Crohn’s is caused by an overactive immune system. Cases are on the rise, but it’s unclear whether that’s because doctors are getting better at diagnosing it or if environment and diet play a role.
“There is a genetic component, but genetics alone don’t mean you’ll develop IBD,” Coates said in a Penn State Health news release. “It takes a certain type of genetic background mixed with an environmental exposure, such as an infection or a change in the microbiome — or the fungi, bacteria and viruses that reside in the gastrointestinal tract.”
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What are the symptoms of Crohn’s disease?
Crohn’s typically starts in younger people. Early symptoms can include abdominal pain, diarrhea, weight loss and fatigue. Sufferers may have nutritional deficiencies. They may feel anxious or depressed.
The ongoing inflammation can lead to a narrowing in the bowel, making it hard for food to pass through. People with Crohn’s also may have abscesses and fistulas, which are abnormal connections between the diseased areas and other parts of the body, Dr. Matthew Coates, who treats diseases of the digestive system at Penn State Health Milton S. Hershey Medical Center. explains.
Other symptoms can include skin rashes and problems with the eyes or joints.
“A lot of our strategy is focused on keeping the disease under control, and managing the disease activity and complications it’s known to cause,” Coates adds.
Crohn’s disease symptoms in females
Around half of women with Crohn’s disease are diagnosed before age 35.
While both men and women experience common symptoms like abdominal pain, diarrhea, and weight loss, women may also encounter specific issues:
- Menstrual irregularities (such as irregular or painful periods)
- Iron deficiency (potentially worsened by menstrual blood loss)
- Fertility challenges
- Painful sex
Symptoms of Crohn’s disease in men
While Crohn’s disease symptoms can be similar in men and women, some symptoms may be specific to men:
- Sexual dysfunction: Crohn’s disease and its treatments can sometimes lead to decreased sexual desire or erectile dysfunction.
- Increased risk of colorectal cancer: As with women, men with Crohn’s, particularly in the colon, have an increased risk of colorectal cancer.
- Increased risk of primary sclerosing cholangitis (PSC): a rare liver disease.
It’s important to note that Crohn’s disease can affect individuals differently, and not all men will experience these specific symptoms.
Symptoms of Crohn’s disease in children
Many children with Crohn’s disease have an abnormal immune system. However, it’s unclear if immune problems cause the disease or vice versa.
Crohn’s disease can occur at any age, but it most often affects people ages 15 to 35. It can also occur in young children.
The risk factors for Crohn’s disease in children and teens include:
- Family history of Crohn’s disease (close relative such as a parent, sibling)
- White race
- American Jewish ethnicity of European descent
- Living in developed countries, in cities, and in northern climates
- Smoking
Symptoms in children can vary and may include:
- Belly (abdominal) pain, often in the lower right area
- Loose stool (diarrhea), sometimes bloody
- Rectal bleeding
- Weight loss
- Fever
- Delayed growth
- Joint pain
- Anal fissure (cut or tear in the anus)
- Rashes
Some children may experience periods with no symptoms, called remission, which can last for years. The timing of remission and symptom return is unpredictable.
The symptoms of Crohn’s disease can resemble other health problems, so a healthcare provider’s diagnosis is essential.
READ: Is Your Child Growing Slowly? It Could be a Sign of Crohn’s Disease
Getting diagnosed
“It’s important to get a proper diagnosis and see an experienced inflammatory bowel disease (IBD) provider, preferably at a center that specializes in caring for these conditions,” said Dr. Coates, who treats diseases of the digestive system at Penn State Health Milton S. Hershey Medical Center.
Diagnosing Crohn’s disease is complex, as no single test can confirm it, and symptoms often mimic other conditions like bacterial infections. A thorough evaluation, including medical history and diagnostic testing, is necessary to rule out other causes. This process can take time, so prompt medical attention is recommended if Crohn’s disease is suspected.
Initial Testing and Evaluation
The diagnostic process begins with a physical exam and a review of your medical history, including questions about your overall health, diet, nutrition, family history, and daily routine.
To look for signs of Crohn’s disease and rule out other conditions, your doctor may order:
- Laboratory tests: Blood and stool tests are typically the first step.
- Imaging tests: X-rays of the upper and lower GI tract may be performed, sometimes using a contrast chemical for clearer images.
Consider bringing a family member or friend to your appointments for support and to help remember information.
Be sure to:
- Write down your symptoms to bring to your appointments.
- Ask your healthcare team about the most appropriate tests for you.
- Check with your insurance provider about coverage of costs.
Endoscopy and Imaging
Additional tests may be needed to visualize the GI tract and intestines. These are often outpatient procedures, and healthcare providers take precautions to minimize discomfort.
- Endoscopy: A small camera on a lighted tube is used to examine the colon.
- Colonoscopy: Examines the colon (the lowest part of the large intestine) by inserting a flexible, lighted tube through the anus.
- Upper endoscopy: Visualizes the GI tract from the mouth down, including the esophagus, stomach, and duodenum (the first part of the small intestine).
Colonoscopies require bowel preparation, and your healthcare team can provide instructions.
- Biopsy: A small tissue sample from the intestinal lining may be taken during an endoscopy or colonoscopy for further analysis. Biopsies help detect disease and are also used for colorectal cancer screening. The procedure is generally painless.
- Chromoendoscopy: During a colonoscopy, a blue dye may be used to highlight polyps or precancerous changes in the colon. This can lead to blue bowel movements afterward.
- Small Intestine Imaging: These tests examine parts of the intestine not easily seen with standard endoscopy or colonoscopy. They involve a swallowed oral contrast and may include:
- Fluoroscopic X-rays
- CT scans (computed tomography)
- MRI scans (magnetic resonance imaging)
- These tests may also be called enterography or enteroclysis.
- Pill Camera: A small, swallowed camera takes pictures of the small intestine and is later expelled in a bowel movement.
- Balloon endoscopy: May be used to view hard-to-reach areas of the intestine.
When undergoing these procedures, ask your healthcare providers what to expect and about any potential risks. Consider having someone accompany you for support. If you have concerns about costs or insurance coverage, resources are available to help.
READ: What is the Difference Between Crohn & Disease and IBS?
Crohn’s Disease Treatment Options
Treatments typically involve calming the immune system. They may include pills called immunomodulators or small molecules, and infusions or shots called biologics.
“A wide variety of treatments exist, which is why it’s so important to make sure your doctor carefully diagnoses and characterizes what type of Crohn’s disease you have, including the location, severity and types of complications,” Coates advises.
Small molecules target particular aspects of the immune system and are among the newest treatments. The U.S. Food and Drug Administration has approved these for ulcerative colitis. They are being studied for Crohn’s disease.
“This is a huge area of active investigation, and there are a large number of medications in the pipeline that are likely to be approved in the coming years,” Coates says.
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How to ease your Crohn’s disease symptoms
Diet may also help ease symptoms.
Evidence suggests that something called a low FODMAP diet can make IBD patients in remission less symptomatic, Coates says. FODMAP is an acronym for the fermentable sugars that are found in many types of fruit and artificial sweeteners. The small intestine absorbs them poorly.
READ: What Diet Is Most Likely to Help Ease Crohn’s Disease?
Studies haven’t proven that one diet is superior to another. Some do well eating whole or unprocessed foods.
Coates says that patients should feel encouraged by the opportunity to live normal, healthy lives after getting appropriate therapy.
“We have medicines that work in a variety of different ways, and more therapies available to us today than ever before,” he shares. “These are giving more people the possibility of gaining control over their disease process.”
