Internal Medicine

Symptoms of Crohn's Disease

Crohn's disease is a disease that classically progresses in phases. This means that the symptoms are usually not permanent, but rather appear in phases. Such phases usually last several weeks in Crohn's disease.

Read more on the topic: Crohn's disease attack

The main symptoms of this disease are severe abdominal pain and diarrhea. The pain is mostly localized in the right lower abdomen and often occurs either after eating or before a bowel movement. In many of those affected, the diarrhea contains mucus and / or blood. Some patients also report nausea and vomiting, loss of appetite, and weight loss.

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The inflammatory response can also lead to the development of fever come. In children there can sometimes be one Growth retardation that is noticed as the first or only symptom. Due to the resulting Malnutrition various complaints that are difficult to classify can arise, such as Anemia (anemia), Bone loss (osteoporosis) or fatigue, Reduction in performance and Feeling weak.

Complications that can be aggravating include Fistulas (especially on the anus, but less often as a connection into the free abdominal cavity and in this case significantly worse), Abscesses and about a fifth of those affected even have mechanical ones Intestinal obstruction. The nature and severity of symptoms, however, varies from case to case, which is why it is not uncommon for a delayed diagnosis of one Crohn's disease comes.

In addition to the complaints that result directly from the inflammatory processes in the intestine, they also appear in about half of the patients Symptoms outside the bowel (extraintestinal manifestation of Crohn's disease). Typical are here

Problems with the joints (Sacroiliitis, Arthritis or Arthralgia),
Inflammation of the eye (Iris inflammation) or
of the skin for example the Rosacea (acne-like skin changes) or
a Erythema nodosum (red spots and nodules).

In a few cases this can Side effects occur before the actually classic symptoms of the intestine, which makes it even more difficult to diagnose Crohn's disease. If the underlying disease is then successfully treated, these symptoms also disappear in most patients.

The Life expectancy is only slightly or not at all restricted in patients with Crohn's disease, regardless of the relapse activity. An optimal drug therapy is a necessary prerequisite for this.

Dysfunction of the bowel

Functional disorders of the intestinal tract are the typical symptoms of Crohn's disease. Long-term watery diarrhea and abdominal cramps are the leading symptoms in most patients.
However, constrictions in the intestine caused by scar tissue when an inflamed area heals can sometimes lead to blockages.

diarrhea

In general, one speaks of diarrhea if more than three watery or slimy stool evacuations with or without blood, which together weigh more than 200-300g, occur in the course of a day (24 hours).
Chronic diarrhea, along with abdominal pain, is that typical symptom of Crohn's disease. This is characteristic of Crohn's disease watery consistency of stool and the duration of the diarrhea, which can last for days to weeks.
Slimy diarrhea in Crohn's disease is possible, but less common than the typical watery diarrhea. Bloody diarrhea, especially if the diagnosis has not yet been made, tends to speak for it Ulcerative colitis, a different inflammatory bowel disease than for Crohn's disease. Patients with Crohn's disease lose a lot of fluids and protein due to the diarrhea. That is why they often lose weight.

constipation

There are bloating and constipation a rather atypical symptom of Crohn's disease. Compared to the characteristic diarrhea, they occur much less frequently. The chronic inflammation of the intestine and the subsequent healing process lead to Scarring in the intestines. These scars can Bottlenecks Formation (stenoses) in the intestines that impede the passage of the stool. Constipation and gas are the result. In extreme cases, these bottlenecks can lead to acute constipation with intestinal obstruction come that must be treated surgically.
Got through the disease Abscesses and Fistulas Formed in the rectum or anal region, these also represent an obstacle to the passage of the stool and cause blockages.

Blood in the stool

Bloody diarrhea is a typical symptom of ulcerative colitis, a chronic inflammatory bowel disease that affects only the large intestine. Blood in the stool is rather untypical for Crohn's disease.
However, in Crohn's disease, the inflammation of the intestines can lead to the development of ulcers in the intestinal wall, which can sometimes cause blood in the stool.
Other causes of blood in the stool in Crohn's disease are fistulas and abscesses of the anal region, which are reflected in fresh blood deposited in the stool.

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Pain as a symptom

In addition to diarrhea, abdominal pain is the typical symptom of Crohn's disease, 87% of Crohn's patients experience pain. 20% even when there is no active thrust.
Characteristic are severe abdominal pain and long-lasting abdominal cramps. The pain can also be felt as dull or sharp. Since Crohn's disease very often manifests itself in the area of the lower small intestine and this lies in the right lower abdomen, pain in the right lower abdomen in particular is a common symptom of patients with Crohn's disease. As a result, abdominal pain is often confused with appendicitis, especially at the beginning of the disease. The pain occurs mainly after eating or before a bowel movement, but can also be non-stop due to the permanent inflammatory activity.
In addition to abdominal pain, Crohn's disease can also be accompanied by joint pain. The pain is relieved by treating the acute flare-up, but it can also be treated with painkillers.

Find out more about: Burning in the intestines

Symptoms on the skin

Symptoms of the skin in Crohn's disease are common and can cause problems for patients even before the onset of intestinal dysfunction. Two typical symptoms of Crohn's disease on the skin are pyoderma gangrenosum and erythema nodosum. In addition, Crohn's disease promotes the development of rosacea.
Pyoderma gangrenosum is caused by an excessive immune reaction that activates inflammatory cells in the skin. This leads to ulcers or the death of large areas of skin. In many cases, the shins are affected, but any part of the body can be affected. Pyoderma gangrenosum occurs not only in Crohn's disease, but also in rheumatic diseases, leukemia, after skin injuries or in hepatitis. Treatment is systemically with immunosuppressants and locally with bandages, as well as chlorhexidine and salt baths (see also: Chlorhexidine).
Erythema nodosum is an allergic overreaction of the skin, which leads to an acute inflammation of the subcutaneous fat tissue (subcutis). It also occurs in other immune diseases, infections, or in response to certain medicines. The inflammation leads to the formation of nodules in the subcutaneous fatty tissue; this is noticeable on the skin as reddish-purple to yellowish-green blurred spots and nodules. These areas are slightly raised and sensitive to pressure and mainly affect the shins, knees and ankles. The arms and buttocks are less affected. These symptoms on the skin are accompanied by fever and a general feeling of illness. Treatment is with pain relievers and potassium iodide.
Rosacea is a skin disorder that occurs mainly around the mouth and nose. Symptoms are blotchy and flaky skin redness and swelling. It is recommended to use anti-inflammatory and skin-soothing care products. On creams containing cortisone (see also: Cortisone ointment) should be avoided. Mild cases are usually treated locally with metronidazole or ivermectin (a drug in tablet form that kills parasites), severe cases systemically with various antibiotics or vitamin A acid derivatives (for skin regeneration, see also: Vitamin A).

Read more on the topic: Pyoderma gangrenosum

Symptoms around the eyes

A typical symptom of Crohn's disease in the eyes is so-called uveitis (inflammation of the choroid). It can be unilateral or bilateral.
The anterior choroidal inflammation can easily be confused with conjunctivitis by laypeople: the eye is very red, painful and watery. Patients are very sensitive to light and complain of having a foreign object in their eye.
With posterior choroidal inflammation, the eye appears normal from the outside; the patients describe blurred / cloudy or cloudy vision, which can be explained by the inflammatory process in the back of the eye. Posterior choroidal inflammation affects the part of the choroid that supplies blood to the retina and is therefore more often associated with long-term impairment of vision than anterior choroidal inflammation.

Symptoms of a flare-up

Crohn's disease occurs in relapses, which means that phases of active disease (relapse) alternate with phases in which there are no symptoms of the disease.
A flare-up can either start suddenly or develop gradually. Typical symptoms of an attack that begins slowly are, for example, frequent stomach rumbling or increased discomfort after eating, flatulence and constipation. The characteristic symptoms (including the sudden onset of the episode) are long-lasting abdominal cramps, severe abdominal pain such as watery, slimy or bloody diarrhea.
Often there is a thrust accompanied by loss of appetite, fever, nausea, vomiting, tiredness, weakness and a general feeling of illness. Weight loss is possible during an episode. Since Crohn's disease can affect the entire digestive tract (including the oral cavity and esophagus), inflammation is also possible here. The main symptoms here are pain in the mouth and discomfort when swallowing.
Crohn's disease can develop during a relapse Formation of fistulas (Connecting ducts) into the abdominal cavity, to other organs or to the outside and lead to abscesses in the digestive tract. Depending on the location of the fistulas and abscesses (closed cavities filled with pus), the symptoms vary.
Everyday life can be severely restricted depending on the severity of the symptoms of an episode. Usually an episode lasts for several weeks, less often just a few days. The duration varies from patient to patient, but also from episode to episode.

Influence on the psyche

Crohn's disease is a chronic condition that has treatment options but cannot be cured. For many patients it is a psychological challenge to suffer from a chronic illness, the progression of which and the individual prognosis of which are difficult to assess.
Since the diagnosis is usually made at a young age (between 15 and 35), patients become insecure in their life planning. Many patients develop fears of the future or even depression. The quality of life is limited.
Especially in an acute episode of Crohn's disease, the everyday life of the affected patient can be severely restricted by the severe symptoms and frequent diarrhea, appointments have to be canceled and plans changed. The complaints are often taboo, which is why the patients sometimes have no understanding for cancellations of appointments with friends or for absenteeism at work.
A lack of understanding leads to a lack of support and thus to social isolation of the patient, which in turn increases the risk of depression. So it is important to deal openly with the disease in order to maintain the social network.

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