Is Your Crohn's Getting Worse? 6 Ways to Tell

Crohn's

You're experiencing a flare-up. You immediately recognize it as a sign of a gastrointestinal (GI) flare. However, there are other signs that you may not expect that can be a warning that your Crohn's disease may be getting worse.

Are You Having a Crohn's Disease Flare?

Are you dealing with potentially active Crohn’s disease? According to Joseph Feuerstein, MD, an attending gastroenterologist at the Center for inflammatory bowel disease at Beth Israel Deaconess Medical Center and an associate professor of medicine at Harvard Medical School in Boston, you have active Crohn's disease if you are experiencing the following:

Diarrhea
GI bleeding
Bowel obstruction accompanied by nausea, vomiting, not passing gas, and bloating

If you are having a flare, you may experience multiple symptoms at the same time. “It would be unusual, though, for any one of these symptoms on its own to be a sign of a Crohn’s flare,” Dr. Feuerstein tells Everyday Health.

If you experience multiple symptoms, you should see a doctor to be evaluated.

A loss of appetite and abdominal pain coupled with nausea or vomiting could be a sign of strictures (narrow passageways caused by thickening or scarring of the bowel walls).

If you experience a fistula ( an abnormal connection or passage from the bowel into other tissues or organs) accompanied by fever, night sweats and weight loss, the fistula may be infected.

Unexpected Signs of a Crohn’s Disease Flare

Approximately 40 percent of people with an inflammatory bowel disease (IBD), including Crohn’s and ulcerative colitis, experience extraintestinal manifestations (EIMs): symptoms that occur outside the GI system, Everyday Health notes. Although the causes of EIMs are unclear research suggests a genetic predisposition may be the culprit.

The following are some common EIMs.

Arthritis

Inflammation of the joints is the most common EIM, affecting up to 30 percent of people with Crohn’s, according to the Crohn’s and Colitis Foundation of America. “Arthritis can affect the joints or the axial skeleton [the bones of the head and trunk],” Feuerstein explains. Arthritis can flare up along with Crohn's disease activity or manifest as a more chronic condition that starts with a flare but then lingers.

In most cases arthritis gets better as intestinal symptoms improve. However, chronic arthritis is more difficult to treat.

“For immediate symptomatic relief, we always first recommend trying acetaminophen,” Feuerstein tells Everyday Health. You should avoid nonsteroidal anti-inflammatory drugs, or NSAIDs if you have IBD. For severe joint pain, biologics medication may provide relief.

Skin Changes

Erythema nodosum is an EIM that causes raised tender red and violet lumps. The condition usually appears on the shins affecting up to 10 percent of people with an IBD. Pyoderma gangrenosum, which starts as a small pustule and evolves into a large ulcer with irregular borders and a purplish edge, most often on the legs, is another skin change you may notice.

“These ulcers are more common with Crohn’s disease,” says Feuerstein, “but they can occur with ulcerative colitis as well.”

Liver Problems

Fatty liver disease is a common complication of those living with Crohn's. The good news is that the complication is fairly minor and doesn't usually require treatment.

Primary sclerosing cholangitis, on the other hand, is much more serious. This condition causes severe inflammation, scarring and narrowing of the bile ducts. “While this is more common among people with ulcerative colitis, it can develop with Crohn’s disease as well,” says Feuerstein. “Typically, it’s a progressive EIM and may develop into cirrhosis and cholangiocarcinoma [cancer of the bile ducts].”

Living with Crohn's disease also puts you at risk of developing gallstones, which occurs more frequently in people with Crohn's, according to a systematic review published in the June 2022 issue of Cureus.

Eye Disorders

Most of the eye complications associated with IBD are both treatable and unlikely to cause vision loss, according to the Crohn’s and Colitis Foundation of America. Episcleritis (redness on the white of the eye) typically goes away when Crohn’s symptoms begin to improve with treatment. Uveitis, which causes pain in the middle layer of the eye — as well as blurred vision, light sensitivity, and headaches — can develop gradually or suddenly.

“Early recognition and treatment of uveitis is important,” Feuerstein tells Everyday Health. When left untreated, the condition uveitis can become a medical emergency that may cause loss of vision.

Mouth Sores

During a flare, you may experience oral ulcers (canker sores). These usually go way when Crohn's is under control. “For symptomatic relief, patients often use a lidocaine-based mouthwash,” says Feuerstein. “The lidocaine provides some numbing to alleviate the pain.”

Kidney Stones

If you've had small bowel disease or have had multiple small-bowel resections, you're at risk of developing kidney stones, which cause sharp pain in the sides as well as nausea and vomiting.

Kidney stones can be avoided by making some changes to your diet. A low-fat and low-oxalate diet is a good place to start that consists of spinach, bran and nuts. Oxalate is a chemical found in plant foods, according to the Cleveland Clinic.

It's also important to drink lots of fluids, especially ones that contain electrolytes. If you are experiencing severe symptoms, you may need to consult a nephrologist or urologist to determine the best method of treatment.

By Jessica Daniels, BDO Staff Writer | Published August 15, 2023