What Inflammatory Bowel Disease Pain Feels Like

Inflammatory bowel disease pain is the result of either ulcerative colitis or Crohn's disease. Both conditions lead to abdominal pain that can be accompanied by diarrhea. However, the locations where pain is experienced are different—even though both are classified as inflammatory bowel disease (IBD).

The location of abdominal pain (e.g., lower right-sided pain or upper middle) helps to diagnose specific forms of IBD. What inflammatory bowel disease pain feels like (cramping or sudden pain after eating) varies depending on the cause.

IBD cannot be cured but the symptoms can be effectively managed in most cases.

Symptoms of IBD

As forms of IBD, ulcerative colitis (UC) and Crohn's disease (CD) have some symptoms in common. They can include:

• Abdominal pain
• Fatigue
• Diarrhea
• Nausea after eating
• Loss of appetite
  
• Unintended weight loss
• Joint pain with rashes
• Blood in stool

Why IBD Causes Pain

Inflammatory bowel disease pain is primarily due to inflammation of the lining of the digestive tract. This inflammation triggers the release of pain-signaling chemicals (a warning that damage is occurring).

Inflammation can lead to complications like narrowing of the intestines (strictures). These narrowed areas cause pain, cramping, and discomfort when food passes through.

Severe pain in the abdomen can be a symptom of many different digestive disorders. With IBD pain, though, it often points to pancolitis. This type of ulcerative colitis causes ulcers throughout the entire large intestine. However, these sores can also be seen in other types of ulcerative colitis or Crohn's disease.

Pain Caused by Crohn's Disease

Crohn's disease pain locations vary by subtype of the disease. Possible locations include:

• Right lower quadrant
• Middle lower abdomen
• Upper middle abdomen
• Middle abdomen

RLQ or Middle Lower Abdominal Pain

The right lower quadrant or middle of your lower abdomen are common Crohn's disease pain locations. It's often described as a cramping pain.

Pain in this location is most common with subtypes of Crohn's disease called ileocolitis and ileitis. Together, these subtypes account for 75% of all diagnosed cases of Crohn's disease.

• Ileocolitis involves inflammation in two places: the ileum (last section of the small intestine) and part of the colon (large intestine).
• Ileitis, which is about half as common as ileocolitis, affects only the ileum.

This pain often comes on within a few hours of eating a meal.

Upper Middle Abdominal Pain

A type of IBD called gastroduodenal Crohn's disease often causes pain in the middle and upper sections of the abdomen. These Crohn's disease pain locations correlate with problems in the following locations:

• Esophagus
• Stomach
• Duodenum (first part of the small intestine)

This disease type is rare, accounting for only about 4% of all diagnoses. It's even more rare for it to only impact the duodenum. This happens in just 0.07% of all Crohn's disease cases.

Other symptoms of gastroduodenal Crohn's disease may include:

• Fullness, or an inability to eat very much at once
• Nausea
• Vomiting
• Weight loss

Middle Abdominal Pain

The pain of another rare Crohn's disease subtype, jejunoileitis, can vary from mild to severe. It affects the jejunum (middle section of the small intestine), causing pain in the middle of your abdomen.

People with this Crohn's disease variant may have crampy pain after eating.

Pain Caused by Ulcerative Colitis

Ulcerative colitis pain locations are determined by the type of ulcerative colitis you have. Pain typically occurs:

• In the lower middle abdomen
• Both left-side quadrants

Lower Middle Abdominal Pain

A common type of ulcerative colitis is ulcerative proctitis. It accounts for 25% to 55% of all ulcerative colitis cases. It primarily affects the rectum—the last few inches of the large intestine, which connects to the anus.

Rectal pain comes from very low in the middle of the abdomen. But this type of ulcerative colitis can move up into other parts of the large intestine or down into the anus and surrounding area.

Symptoms of ulcerative proctitis may include:

• Loose or runny stools
• Rectal bleeding
• More frequent bowel movements
• Straining, even after a bowel movement
• Urgency
• Incontinence
• Constipation
  

Left-Sided Pain

Pain on the left side of the abdomen, in both upper and lower quadrants, is one of the more classic ulcerative colitis pain locations. Two common types can cause this pain:

• Proctosigmoiditis: Inflammation and pain are in the rectum and sigmoid colon, part of the large intestine that runs horizontally across the lower left quadrant. Proctosigmoiditis affects about 22% of people with ulcerative colitis.
• Distal or left-sided colitis: Inflammation and possibly severe pain are in the rectum, sigmoid colon, and the descending colon (part of the large intestine that runs down your left side from under the ribs down to the sigmoid colon).

Distal colitis accounts for almost 28% of ulcerative colitis diagnoses.

Other Possible Causes of Pain

Other conditions which may be mistaken for IBD include:

• Irritable bowel syndrome (IBS)
• Solitary rectal ulcer syndrome
• NSAID-induced ulceration
• Infections (e.g., food poisoning, norovirus)
  
• Celiac disease

Misdiagnosis of IBD may go unrecognized for years, sometimes decades. One-quarter of those mistakenly diagnosed with IBD are unnecessarily treated with immunosuppressive medications. 

Other Causes of Rectal Pain

Rectal pain has many possible causes, including less serious ones like hemorrhoids (swollen veins in the rectum) and extremely serious ones such as rectal cancer.

How to Relieve IBD Pain

In many cases, your healthcare provider may recommend an over-the-counter medication like Tylenol (acetaminophen) for pain relief. You may also need prescription medication. Keep in mind that most non-steroidal anti-inflammatory (NSAID) products can further irritate the stomach.

You also can try applying heat to the abdomen or maintaining a position that's less painful (like lying down, if that helps). Some episodes of IBD pain may be due to constipation and may improve with laxatives that promote a bowel movement.

A few lifestyle changes that are more long-term can help to limit episodes of IBD pain. Diet and nutrition, such as limiting dairy products if you have lactose intolerance, can help. Stress management also can help to limit IBD flare-ups and abdominal pain.

Summary

Most people with IBD experience pain at some point, though pain is not always a part of an IBD flare-up. The pain from Crohn's disease is most often found in the RLQ or the middle of the abdomen, though it can vary. Rectal pain is a common sign of ulcerative colitis but may also occur on the left side of your abdomen.

Knowing the location of your pain can help you to understand the symptoms and discuss them more accurately with your healthcare provider. Pain is always something you need to discuss with your healthcare provider or gastroenterology specialist.