Crohn’s Pain: Types and 5 Ways to Manage It

Crohn’s disease can cause pain outside the intestines, too, such as joint pain or eye pain.

Although Crohn's disease can come with distinctive symptoms like diarrhea, bloating, gas, and fatigue, one of the most notable aspects of the condition is pain. But that isn't confined to just one type of pain or even one area of the body, says John Goff, MD, a gastroenterologist at National Jewish Health in Denver.

"Pain related to Crohn's can occur throughout the body, because the disease is characterized by inflammation, and that can affect everything from the spine to the skin to your eyes," he says. "That makes pain management a big challenge, but taking a multi-strategy approach can help."

Although pain is a common aspect of Crohn's disease, it doesn't have to be inevitable, says Ronen Arai, MD, a gastroenterologist with Baptist Health South Florida in Coral Springs. In fact, pain can be a wake-up call that something needs to be done for better condition management or to address a potential issue like infection or an intestinal blockage.

"People with Crohn's who suffer from ongoing or sudden pain should definitely consult with their gastroenterologist to plan out a strategy to determine the cause of the pain in an effort to treat it," he says.

There can be a breadth of pain types with Crohn's, from discomfort to shooting pains, and both acute and chronic issues can occur in several parts of the body.

Gastrointestinal Pain

By far, pain or cramping felt in the abdomen is the most common symptom of Crohn's, and it's estimated that up to 70 percent of those with the condition have gastrointestinal pain.

This is caused by inflammation in the gut, says Dr. Goff, and it can vary in terms of location, duration, and severity. But some patients with Crohn’s experience cramping even after the inflammation is healed.

"With Crohn's, you may have a dull ache that's almost constant, or you could have occasional moderate or sharp pain," he says. "Most people will have pain after eating that's only relieved by a bowel movement, but when the disease is severe, the pain can be present all day and night, which can suggest they're having a complication such as obstruction or development of an abscess."

Joint Pain

Apart from gastrointestinal challenges, joint pain is next on the list when it comes to common types of Crohn's pain, says Dr. Arai. This is related to the inflammation being caused by the Crohn's, and may affect up to one-third of people with the disease.

"Joint issues with Crohn's usually affect the knees, ankles, elbows, and hands," says Arai. "You may also feel pain in the spine and hips. It just depends on how the inflammation is affecting you."

For some, inflammation-driven joint pain (called arthralgia) can turn into arthritis, which can involve pain and stiffness in the joints. The risk of this complication can increase with age, since getting older already makes you more prone to arthritis and other joint issues.

Skin Pain

A complication of Crohn's that may seem unrelated to the disease is skin pain, which can involve small nodules (bumps) or tears anywhere on the body, Arai says. Similar to joint challenges, this comes with inflammation, which means skin problems may be worse during a Crohn's flare.

Skin conditions related to Crohn's can appear as bumps just under the skin that are painful, tender, and warm, with raised bluish-red lesions. They're usually found on the hands and feet and resemble bruises. In some cases, these nodules can form ulcers filled with pus, but this is less common.

Eye Pain

Inflammation in the gut can even affect your eyes. When this happens, it can cause several issues, but the most common are uveitis or episcleritis, depending on where the inflammation occurs. This can result in pain, redness, light sensitivity, and blurred vision. Your eyes may be sore, or feel particularly dry, which leads to rubbing them more often, says Arai. If the irritation is ongoing, it could also lead to headaches.

Problems with the eyes are more common if you also have other complications of Crohn's such as joint pain and skin pain.

Some discomfort and occasional pain from an issue like abdominal cramping may be difficult to eliminate completely, but it's often possible to get some relief. What tends to work best is to use multiple strategies, says Goff, since this can address pain at both the physical and emotional level. Here are five tips to consider.

1. Talk to Your Doctor

The first stop in addressing pain is to talk with your gastroenterologist, says Robert Meltzer, MD, a gastroenterologist with Medical Offices of Manhattan in New York City. Not only is this important for detecting serious issues, but it can also help with getting better condition management.

"Pain may increase or decrease with changes in disease activity from the primary Crohn's disease, so the best treatment is to control the underlying disease," he says. For example, that might take the form of changing your medication or considering a procedure like surgery.

2. Reduce Inflammation

Because the pain related to Crohn's is often prompted by inflammation, tamping that down throughout the body is a priority, says Dr. Meltzer. Your gastroenterologist may suggest an anti-inflammatory medication, and also review your non-Crohn's meds to make sure there are no interactions that are driving more inflammation.

One important note if you're trying to reduce inflammation on your own is to avoid over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, since these have been linked to potential flares in those with inflammatory bowel disease, he says, though it is unclear if NSAIDs directly cause flares.

3. Do Your Best to Manage Stress

Psychological stress can heighten pain in the body, no matter where it's occurring. The gut is particularly susceptible since there's a brain-gut connection that links the emotional and cognitive centers of the brain with intestinal functions.

Anxiety, depression, chronic stress, and worry have all been linked to more flares for those with inflammatory bowel disease, because these emotions create more sensitivity in the nerves that run within the bowel.

That means that doing your best to address causes of stress and practicing stress management techniques can go a long way toward relieving Crohn's pain, says Goff.

"This could take several forms, such as a mindfulness practice, adopting a deep-breathing routine, doing cognitive behavioral therapy, getting quality sleep, or trying acupuncture," he says. "All of these have been shown to address stress in a meaningful way, and that could lead to pain relief."

4. Get Gentle Movement

Particularly for joint pain, gentle movement in the form of walking, yoga, swimming, or other low-impact activity can be helpful because it's another way to reduce inflammation throughout the body, Goff says. Movement has also been shown to improve joint function and reduce arthritis pain by helping the fluid found in joints — called synovial fluid — to flow more freely, reducing friction and allowing for more mobility.

Consistent movement and exercise can also strengthen muscles around the joints, Goff says. This creates better support and can put less stress on joints overall.

5. Consider Dietary Changes

Another way to reduce inflammation throughout the body is to focus on anti-inflammatory foods, says Arai. Although dietary choices when you have Crohn's tend to depend on what brings on symptoms, which means it's based on individual reactions, there are some general guidelines that can help.

For example, avoiding certain types of carbohydrates, avoiding sugar, and adding more gut-friendly foods (such as yogurt, leafy greens, and oats, if you tolerate them well) can be part of an anti-inflammatory effort.

The most common pain for Crohn's disease is gastrointestinal, but pain can also occur in other parts of the body, such as the joints, skin, and eyes.
Crohn's pain is usually caused by inflammation, a characteristic of the disease; however, acute pain could come from an issue like infection or obstruction.
Addressing Crohn's pain often requires a multi-strategy approach, including discussions with your gastroenterologist, stress and inflammation reduction, more movement, and dietary changes.

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