Overview

Most people diagnosed with Crohn's complain of crampy abdominal pain an hour or two after eating, diarrhea, nausea, and a gradual decrease in their sense of well-being. Fever, abdominal tenderness, night sweats, rectal pain or rectal bleeding, and anemia are less common symptoms. The abdominal pain is often localized in the right, lower quadrant. Because of nausea and fear of abdominal cramps, Crohn's sufferers eat less and invariably lose weight. Often, the symptoms of Crohn's disease seem vague and may drag on for some time before diagnosis. In children, the first sign of Crohn's disease may be delayed growth.

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The symptoms of Crohn's disease depend on the areas of the bowels involved. Patients with ileitis, Crohn's disease at the bottom three fifths of the small intestine, generally suffer abdominal pain and diarrhea. The symptoms are similar for people who have damage to the linings of both the ileum and the jejunum, the middle part of the small intestine, called Crohn's enteritis or ileojejunitis. Crohn's disease involving both the lower part of the small intestine and the colon, or ileocolitis, generally causes cramps and nausea but also bloody stools. The cramping after meals is caused by partial obstruction and inflammation of the small bowel. About 80 percent of patients with ileitis or ileocolitis develop diarrhea and an increase in daily bowel movements. Crohn's colitis, or inflammation confined to the colon, causes abdominal pain and bloody diarrhea. Crohn's disease in the colon may lead to abscesses, fistulas, and large bowel obstruction, which are also associated with fever, pain, and infection. Of these different types of Crohn's disease, ileitis and ileocolitis are the most common forms of the disease.

Crohn's symptoms also depend upon the extent of inflammatory damage to organs. About 30 percent of patients have inflammatory Crohn's disease, or damage to the mucosa, the first layer of the lining of the organs, and to the supporting connective tissue under it. Others suffer a more advanced form of the disease, called fistulizing or perforating Crohn's disease. In these cases, inflammation extends through the wall of the intestines leading to intra-abdominal fistulas, or abnormal passages through which fluids, secretions, and abscesses can pass. This type of Crohn's disease affects about 20 percent of people with the disease. It is common with Crohn's colitis. It usually requires surgery three to four years after diagnosis and has the least favorable outcome of all types of Crohn's disease.

The third type of Crohn's is called stenosing or stricturing Crohn's disease. About 50 percent of patients with Crohn's disease affecting the lower portion of the small intestine follow this route. Early in the course of the disease, patients develop thickening, stiffening, and scarring. The narrowing of the small bowel may eventually result in a small bowel obstruction. The symptomsof obstruction are severe painful cramping, vomiting, nausea, and abdominal distention. As a consequence of chronic narrowing of the small intestine, fistulas or perforations of the bowel wall may develop. An obstruction usually requires surgery.

Up to a third of patients with Crohn's disease also have anal symptoms, called perianal disease. These include swelling of the anal sphincter or development of fissures and ulcers in the sphincter, causing bleeding and pain with defecation. Development of perirectal abscesses can cause fever, pain, anal tenderness, or pus in the anal area. If fistulas have developed, mucus or pus may drain from openings into the skin surrounding the anus.

This section also contains information on symptoms outside the gastrointestinal tract.