Overview

Symptoms

Without treatment, symptoms of Crohn's disease can be constant or may come and go every few weeks or months.

When the symptoms come back, it's called a flare-up or relapse. The periods between flare-ups are called remission.

Common symptoms

The main symptoms of Crohn's disease are:

• diarrhoea - which may come on suddenly
• stomach aches and cramps - most often in the lower-right part of your tummy
• blood in your poo
• tiredness (fatigue)
• weight loss

You might not have all these symptoms.

Other symptoms

Some people with Crohn's disease also have:

• a high temperature (fever)
• feeling and being sick
• joint pains
• sore, red eyes
• patches of painful, red and swollen skin - usually on the legs
• mouth ulcers

Children with Crohn's disease may grow more slowly than usual.

When to see a GP

See a GP if you or your child have:

• blood in your poo
• diarrhoea for more than 7 days
• frequent stomach aches or cramps
• lost weight for no reason, or your child isn't growing as fast as you'd expect

A GP will try to find out what's causing your symptoms and may refer you for tests to check for Crohn's disease.

Diagnosis

Crohn's disease can sometimes be difficult to diagnose because it can have similar symptoms to lots of other conditions.

Your GP can check for any obvious causes of your symptoms and refer you for more tests if needed.

Seeing a GP

To find out what the problem might be, the GP may ask about:

• your symptoms
• your diet
• if you've been abroad recently - you might have an infection
• any medicines you're taking
• if you have a family history of Crohn's disease

They may also:

• feel and examine your tummy
• take a sample of blood
• ask you to provide a poo (stool) sample

Blood and stool samples can be tested for things like inflammation - which could be due to Crohn's disease - and infections. It may take a few days or weeks to get the results.

Referral to a specialist

If they think you could have Crohn's disease, your GP may refer you to a doctor called a gastroenterologist for tests to confirm the diagnosis.

Tests you may have include:

• a colonoscopy - a thin, flexible tube with a camera at the end is inserted into your bottom to look for inflammation in your bowel
• a biopsy - tiny pieces of your bowel are removed during a colonoscopy and checked for signs of Crohn's disease
• an MRI scan or CT scan - you may have a special drink first to make your bowel show up clearly on the scan

What happens if you're diagnosed with Crohn's disease

If a doctor thinks you have Crohn's disease, they'll tell you about the condition and the treatment options.

It might be difficult to take in everything they tell you.

If you're unsure about something later, write down any questions you have and make another appointment to go over them.

The charity Crohn's and Colitis UK has information for people diagnosed with Crohn's disease.

Treatment

There is currently no cure for Crohn’s disease, but treatment can control or reduce the symptoms and help stop them coming back.

Medicines are the main treatments, but sometimes surgery may be needed.

Steroids

Most people with Crohn's disease need to take steroids (such as prednisolone) from time to time.

Steroid medicines:

• can relieve symptoms by reducing inflammation in your digestive system - they usually start to work in a few days or weeks
• are usually taken as tablets once a day - sometimes they're given as injections
• may be needed for a couple of months - don't stop taking them without getting medical advice
• can cause side effects like weight gain, indigestion, problems sleeping, an increased risk of infections and slower growth in children

The charity Crohn's and Colitis UK has more information about steroids.

Liquid diet

For children and young adults, a liquid diet (enteral nutrition) can also help reduce symptoms.

This involves having special drinks that contain all the nutrients you need, instead of your usual diet, for a few weeks.

It avoids the risk of slower growth that can happen with steroids.

Enteral nutrition has few side effects, but some people may feel sick or have diarrhoea or constipation while on the diet.

Crohn's and Colitis UK has information on food and Crohn's disease

Immunosuppressants

Sometimes you might also need to take medicines called immunosuppressants to reduce the activity of your immune system.

Common types include azathioprine, mercaptopurine and methotrexate.

Immunosuppressants:

• can relieve symptoms if steroids on their own are not working
• can be used as a long-term treatment to help stop symptoms coming back
• are usually taken as a tablet once a day, but sometimes they're given as injections
• may be needed for several months or years
• can cause side effects like feeling and being sick, increased risk of infections and liver problems

Crohn's and Colitis UK has more about azathioprine and mercaptopurine.

Biological medicines

If other medicines are not helping, stronger medicines called biological medicines may be needed.

The biological medicines for Crohn's disease are adalimumab, infliximab, vedolizumab and ustekinumab.

Biological medicine:

• can relieve symptoms if other medicines are not working
• can be used as a long-term treatment to help stop symptoms coming back
• are given by injection or a drip into a vein every 2 to 8 weeks
• may be needed for several months or years
• can cause side effects like increased risk of infections and a reaction to the medicine leading to itching, joint pain and a high temperature

Crohn's & Colitis UK: adalimumab and Crohn's & Colitis UK: infliximab

Surgery

Your care team may recommend surgery if they think the benefits outweigh the risks or that medicines are unlikely to work.

Surgery can relieve your symptoms and help stop them coming back for a while, although they'll usually return eventually.

The main operation used is called a resection. This involves:

1. Making small cuts in your tummy (keyhole surgery).
2. Removing a small inflamed section of bowel.
3. Stitching the healthy parts of bowel together.

It's usually done under general anaesthetic (while you're asleep).

You may be in hospital for about a week and it might take a few months to fully recover.

Sometimes you may need an ileostomy (where poo comes out into a bag attached to your tummy) for a few months to let your bowel recover before it's stitched back together.

You may need to take medicine after surgery to help prevent symptoms returning.

Crohn's and Colitis UK has more information about surgery for Crohn's disease.

Living with

Living with Crohn's disease can be difficult at times, but there's no reason you cannot have a normal life if your symptoms are well controlled.

Diet and lifestyle

There's no special diet for adults with Crohn's disease, but children may sometimes need a special liquid diet to control their symptoms. Aim to have a healthy, balanced diet.

Some people find that certain foods seem to make their symptoms worse.

If you think a particular food is triggering your symptoms, see if avoiding it helps.

But don't make any big changes to your diet without speaking to your GP or care team first.

Crohn's and Colitis UK has more about food and Crohn's disease.

If you smoke, stopping smoking may reduce the risk of flare-ups.

Pharmacy medicines

You may need to be careful taking some pharmacy medicines if you have Crohn's disease.

Some pharmacy medicines can trigger symptoms and others may stop your Crohn's disease medicines working properly.

For example, anti-inflammatory painkillers like ibuprofen can make some people's symptoms worse.

Ask a pharmacist, a GP or your care team for advice before taking a medicine bought from a pharmacy, including medicines to relieve stomach cramps or diarrhoea (such as loperamide).

Vaccinations

You're more at risk of infections like flu if you're being treated with either:

• immunosuppressant medicines - such as azathioprine, methotrexate and mercaptopurine
• biological medicines - such as adalimumab and infliximab

It's recommended you have the flu jab every year and the one-off pneumococcal vaccination.

But avoid having any live vaccines, such as the MMR vaccine, because they could make you ill.

Pregnancy

If you have Crohn's disease, it's likely you will n have a normal pregnancy and healthy baby.

However, some Crohn's disease medicines can harm an unborn baby, so you should:

• tell your GP or care team as soon as possible if you get pregnant accidentally – do not stop taking your medicines without getting advice first
• speak to your GP or care team if you're planning a pregnancy – they may recommend changing your treatment

Women may find it harder to get pregnant during a flare-up, but fertility should return to normal in between.

Some Crohn's disease medicines can temporarily reduce sperm count.

Crohn's and Colitis UK has more information about fertility and Crohn's disease.

Contraception

Make sure you use contraception if you do not want to get pregnant.

Ask your GP or care team about the best contraception to use because some types, such as the pill, may not work as well as usual if you have Crohn's disease.

Possible complications

Crohn's disease can increase your risk of other problems, including:

• damage to your bowel that may require surgery – such as scarring and narrowing (strictures), ulcers and small tunnels running from one part of your bowel to another (fistulas)
• difficulty absorbing nutrients from food – this can lead to problems like weak bones (osteoporosis) or a lack of iron (iron deficiency anaemia)
• bowel cancer – you may need regular cancer screening to check for this

Cancer screening

You're more likely to get bowel cancer if you have Crohn's disease.

The risk is low at first but increases the longer you have the condition. For example:

• after 10 years the risk is about 1 in 50
• after 20 years the risk is about 1 in 10
• after 30 years the risk is about 1 in 5

If you've had Crohn's disease for more than 10 years or it affects several parts of your bowel, your care team may recommend screening to check for cancer.

This involves having regular colonoscopies. This is where a thin, flexible tube with a camera at the end is inserted into your bottom.

Getting help and support

The unpredictable flare-ups of Crohn's disease can be hard to cope with emotionally and practically.

It may help to:

• tell your friends and family about your condition – so they can understand the effect it has on your life
• talk to your GP or care team – they can offer support, treatment and referral to a specialist such as a counsellor if needed
• use support groups like Crohn's and Colitis UK