Pain and IBD

Pain in the abdomen is also called intra-abdominal or intra-intestinal pain and it is often hard to confirm its source. The sources of abdominal pain may or may not be caused by inflammation of the intestines (active IBD), and include:

• Gastritis: inflammation of the stomach lining

• Enteritis: inflammation of the small intestine

• Colitis: inflammation of the colon

• Abscesses: pockets of pus along the intestine, caused by infection; abscesses can occur deep in the wall of the intestine

• Strictures: abnormal narrowing of a passage such as the intestine

• Fistula: a deep sore in the intestinal tract that may tunnel into other parts of the intestine or surrounding tissues of the bladder, vagina, or skin; the most common location for a fistula is between two loops of the intestine

• Obstruction: a blockage in your intestine

• Abdominal wall pain: pain in the abdominal wall that may arise from surgery

• Adhesions: scar tissue that arises after surgery (although it can sometimes arise without surgery)

• Peristomal complications: skin damage around the site of a stoma

• Fissures: a tear or split at the end of the anal canal

• Functional abdominal pain: non-inflammatory pain in the abdomen; if the pain is associated with bowel movements, diarrhea, or constipation, it may be thought of as irritable bowel syndrome (IBS)-like pain

There exist many sources of abdominal pain can also occur independently of IBD. Some examples of these type of sources include:

• Spasm (e.g. IBS): People with IBD can also be diagnosed with IBS. While these are different disorders, their symptoms tend to overlap

• Constipation

• Acid reflux 

• Kidney stones and Gallstones: People with Crohn's disease are more susceptible to these than the general population

• Pancreatitis: irritation and inflammation of the pancreas

Pain outside the abdomen is also called extra-abdominal or extra-intestinal pain and can include:

• Aphthous ulcers: canker sores in the mouth

• Arthritis: joint inflammation

• Arthralgia: joint pain without inflammation; this is quite common in IBD

• Periarticular inflammation: inflammation of structures surrounding the joints, such as tendons; examples include enthesitis (inflammation of the areas where tendons insert into the bone) and myositis (muscle inflammation)

• Spondylitis: arthritis of the spine

• Sacroiliitis: inflammation between your lower spine and sacrum (the bony area at the bottom of your spine just above your tailbone)

• Iritis: inflammation of the iris in your eye

• Uveitis: inflammation of a part of the eye called the uvea

• Erythema nodosum: inflammation of fat cells under your skin

• Pyoderma gangrenosum: a rare condition that causes large, painful sores (ulcers) to develop on your skin

• Kidney stones

• Cholelithiasis (gallstones)

• Myofascial pelvic pain: pain in the pelvis caused by muscle irritation

Pelvic pain occurs in some patients with IBD. Pelvic pain generally occurs under the navel or as low back pain. It can also occur as rectal, vaginal, or perineal (the area between the anus and genitals) pain. It is not related to pregnancy or menstruation. 

The most frequent causes of pelvic pain are disorders of the digestive system (about 38%). Another cause is pelvic floor dysfunction. Causes related to IBD include having an ileal pouch/pouchitis, infections, certain types of fistulas or abscesses, and adhesions. Pelvic pain can have a major impact on quality of life. 

Neuropathic pain, a stabbing or burning type of pain, can arise in IBD patients. This type of pain can result from any lesion or disease of the nervous system. The pain usually starts in nerves farthest away from the brain or spinal cord – so in the hands or feet. If you develop neuropathic pain, your health care provider should check for a vitamin B12 deficiency. 

Peripheral neuropathy is a condition where the nerves carrying signals from the brain and spinal cord to the rest of the body are diseased. It is one of the most frequently reported neurologic complications of IBD. Among other symptoms such as numbness and tingling, peripheral neuropathy can cause sharp, throbbing, or burning pain, usually in the hands or feet.