What Does IBD Pain Feel Like?

Pain From IBD Is Not Always Present, But Does Tend To Follow Certain Trends

Abdominal Quadrants
Knowing which quadrant your abdominal pain is located in can be helpful information to give your physician. Photo © A.D.A.M.

Symptoms of inflammatory bowel disease (IBD) can include diarrhea, blood in the stool, weight loss, and abdominal pain. The type and location of abdominal pain varies not only between the two main forms of IBD (Crohn's disease and ulcerative colitis), but also with the subtypes of these diseases. Further, pain is individualized for each person, where even people with the same subtype of Crohn's disease or ulcerative colitis may experience pain differently.

In fact, some people with IBD typically don't have any abdominal pain at all with IBD flare-ups; in addition, abdominal pain can be related to other issues entirely, such as appendicitis, gallstones, or gastroesophageal reflux eisease (GERD). But as abdominal pain is a common symptom of IBD, here is an overview of the types of abdominal pain that are most often experienced by people with IBD.

Abdominal Quadrants

Understanding and communicating where pain is located can be helpful when working with your physicians. The abdomen is typically thought of as having 4 sections: right upper quadrant, right lower quadrant, left upper quadrant and left lower quadrant. The imaginary lines between the upper and lower quadrants and the right and left quadrants intersect at the navel (umbilicus or belly button). "Right" and "left" are the patient's right and left (not the physician's). The different sections of the abdomen contain different organs, so knowing the location of the pain can help point towards which structures are affected.

Right Or Middle Abdomen Pain

A pain that feels like cramps in the middle of the abdomen or the lower right quadrant is typical of the types of Crohn's disease known as ileocolitis and ileitis. Ileocolitis is the most common form of Crohn's disease and is defined by inflammation located in the last section of the small intestine (the ileum) and in the large intestine (colon).

Ileitis is a type of Crohn's disease that affects only the ileum and is the second most common form. People with ileitis may also find that their pain or discomfort appears within a few hours of eating a meal.

Upper Middle Abdomen Pain

A type of Crohn's disease known as gastroduodenal Crohn's disease often causes pain located in the middle and upper sections of the abdomen. Gastroduodenal Crohn's disease affects the stomach and the duodenum (the first section of the small intestine). This type of Crohn's disease is far less common than ileocolitis and ileitis.

Variable Abdominal Pain

With jejunoileitis, abdominal pain varies greatly and can be characterized as either mild or severe. This type of Crohn's disease affects the jejunum (the middle section of the small intestine) and is a fairly uncommon subtype. People with jejunoileitis may also experience crampy pain after eating.

Rectal Pain

Pain that is located in the rectum (the structure located at the end of the large intestine) is a symptom of ulcerative proctitis.

Ulcerative proctitis is a type of ulcerative colitis, and is how about one-third of ulcerative colitis cases begin.

Left-sided Pain

Pain on the left side of the abdomen is one of the more classic symptoms of ulcerative colitis. Two types of ulcerative colitis that can cause left-sided pain are proctosigmoiditis and distal or left-sided colitis. In proctosigmoiditis, ulceration is located in the rectum and the sigmoid colon (the last section of the large intestine). In left-sided colitis, the rectum, sigmoid colon, and the descending colon are affected by inflammation. Left-sided colitis pain can be severe at times.

Severe Abdominal Pain

Severe pain in the abdomen can be a symptom of many different digestive conditions, but as it relates to IBD pain, it can be associated with pancolitis. Pancolitis is the type of ulcerative colitis that is characterized by ulceration throughout the large intestine.

Pain As A Tool For Diagnosis

Because pain can come from different sources, and pain in the abdomen is particularly difficult to pinpoint, pain is not typically used to diagnose IBD or a particular form of IBD. Rather, the type and location of pain is more often used in conjunction with other signs and symptoms when diagnosing IBD or other conditions.

When Pain Becomes A Concern

With IBD, some pain is considered a symptom, but certain types of pain should be considered a red flag and be discussed with your physician as soon as possible. Any pain that is new to you, is very severe, or is accompanied by symptoms such as lack of stool, abdominal bloating, nausea, constipation, or vomiting is cause for a call to your doctor or a trip to the ER. These symptoms could be due to a more serious condition, such as toxic megacolon, or a bowel obstruction.

Sources:

Crohn's and Colitis Foundation of America. "Types of Crohn's Disease and Associated Symptoms." CCFA.org. 2013. 6 Sept 2013.

Crohn's and Colitis Foundation of America. "Types of Ulcerative Colitis." CCFA.org. 2013. 6 Sept 2013.

Tan WC, Allan RN. "Diffuse jejunoileitis of Crohn's disease." Gut. 1993 October; 34: 1374–1378. 6 Sept 2013.

Walfish AE, Sachar DB. "Ulcerative Colitis." The Merck Manual. Dec 2012. 6 Sept 2013.

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