What are the Symptoms of IBD?

Jan 21, 2017 by

You can have me read this article to you instead of reading it yourself…

Or you can read it the old-fashioned way below…

We’ve already gone over my take on what IBD is and what can cause it to occur.  Now we’re going to jump into discussing what the symptoms are.  I think you might find that this is where my description diverges the most from what you have found on other sites.

Ulcerative Colitis

Standard Symptoms

Ulcerative colitis, as we have discussed, stays in the colon and does not spread to other parts of the GI tract.  It also tends to be a little bit less invasive (the inflammation doesn’t spread into every single layer of tissue as often) than Crohn’s disease.

The fact that all the inflammation occurs in the colon impacts how the condition presents and what symptoms it causes.  The most common symptom is bloody, mucous-y diarrhea, a symptom that makes a lot of sense considering the cause.  And this diarrhea is not something that just happens sometimes.  It is constant, urgent, uncomfortable, and often debilitating for people.  In fact, six or more of these stools per day is considered severe colitis.

That leads us into the other most common symptoms, some of which go hand in hand with this diarrhea.  One is a continual or recurring need to go to the bathroom, and another is abdominal cramping and pain.  The diarrhea, cramping, and pain can come together to cause weight loss and significant blood loss for some people.


Sometimes symptoms can get out of hand, or the condition can attack so severely that it causes more than symptoms – it causes complications.

The most common complications associated with ulcerative colitis include some that make sense from the symptoms we already discussed, such as uncontrolled bleeding and alterations in the body’s electrolytes.

There are other, very serious complications that can also occur.  One of these is referred to as toxic megacolon.  This occurs when one of the deepest layers of intestinal tissue is exposed to fecal matter, causing the function of that section of the intestine to shut down entirely.  When this happens, the colon begins to swell, blocking the intestine, and the tissue begins to die off.

In the worst cases, toxic megacolon can lead to a rupture of the colon, spilling the contents throughout the abdomen.  In some cases of severe colitis that do not involve toxic megacolon, the intestine can still “spring a leak” (perforate) and spill its contents into the abdomen.  Both of these situations are medical emergencies that can cause severe infection and issues throughout the body.

Crohn’s Disease

Standard Symptoms

Crohn’s disease most commonly occurs in the small intestine, but can technically occur anywhere in the GI tract, including in the colon and all the way up into the esophagus or mouth.  As you might imagine, if the disease spreads to these other areas, it can change the types of symptoms that occur pretty dramatically.

The most common symptoms that are reported with Crohn’s disease are related to an occurrence of inflammation in the small intestine.  These include persistent diarrhea, cramps, abdominal pain, and fever.  The diarrhea is typically not mucous-y the way that is seen with ulcerative colitis (unless, of course, the Crohn’s is occurring in the colon), and is also often not as bloody.

Some people with Crohn’s disease will also experience symptoms outside of the GI tract.  This will not happen to everyone, but it is important to be aware of in case it does.  Possible symptoms include issues with the bile duct (inflammation and blockage), inflammation of a part of the eye (called uveitis), an inflammation of various joints of the body (polyarthritis), and a very specific red rash that typically happens on the legs (erythema nodosum).  You may notice a common theme here – these are all forms of inflammation.  They are all extensions of the body setting out to attack its own tissues.


When symptoms get out of control or the disease attacks very severely, it can cause larger complications.

Because the small intestine is the place in the GI tract where most of the nutrients from our foods are absorbed, damage to the tissue in the small intestine can make it less capable of absorbing nutrients.  In these cases, malabsorption and nutritional decline can occur.

Another potentially severe complication that can occur with this condition is when the inflammation spreads through all of the layers of tissue, causing that tissue to latch onto other tissues in the body.  These latches are called fistulas.  They most often occur with other sections of the intestine (because the intestine loops all over itself, two sections can fuse together).  There are also cases where the fistula can occur with the bladder, vagina, or abdomen.  This is highly problematic because it exposes these areas to intestinal contents and also disrupts intestinal flow.

Finally, long-term inflammation and re-healing of the tissue in the intestine can cause it to become so thick that it actually closes off the passage through the intestine – blocking (obstructing) the flow of contents through the GI tract, which can lead to an array of severe complications from there.

Flares, Remission, and Relapse

Some people have very different experiences with IBD than others.  In fact, some people experience a really awful bout of symptoms one time and then never experience it again.  Others will get better and then get worse again, while some will never experience a ‘get better’ period at all.

There is a lot of discussion out there regarding flares, relapses, and remission for this very reason.  So let’s see what these are and how they relate to symptoms.


These are the periods of time when the inflammation is highly active.  This is when the symptoms show up and they show up in full force.  These will typically last for no less than weeks or months and can continue indefinitely.


This is the time frame when the inflammation in the intestine subsides.  This means that the intestine starts to heal itself and all of the symptoms that are caused by the inflammation start to go away.  In fact, you might even say you begin to feel normal and healthy again during periods of remission.


This is marked by the end of a remission period and the return of a flare.  The inflammation has come back and so have the symptoms.  Many people often experience shorter periods of remission and longer periods of relapse until they identify a treatment that works for them.

What Do the Numbers Say?

We are always learning more about these conditions the more that people are tested and diagnosed, so the numbers are in a constant state of flux.  But for now, this is what we’ve got…

For those with ulcerative colitis:

  • 10% of people will have only one attack with no future relapse after reaching remission
  • <5% will experience such a severe first attack that it is a medical emergency requiring surgery

For those with Crohn’s disease:

  • 10-20% will experience decades free of symptoms after the first attack
  • 20% of people will never experience a remission/relapse cycle and will have continuous symptoms

For all people:

  • The introduction of more and better medications is changing the landscape for “normal” rates of remission and relapse
  • If surgery is required and all affected intestine is removed, the concept of relapse and remission may no longer apply


Interested in more information on IBD?

Next: How is IBD Diagnosed?

Or refer back to the IBD Info Hub.


Trivia and Terminology:

Fissures  are caused by inflammation that eats away through all of the layers of the intestinal tissue, top to bottom

Fistulas occur when fissures cause that tissue to latch on to other areas of tissue, which could be the intestine or other parts of the body

Abscesses form when a fistula latches onto an open area, such as the abdomen or the outside skin

String Sign is a term used to describe a result on a barium test that shows that the intestine has become so thick in areas that there is barely a ‘string’ of movement through it

Pseudopolyps are the little pieces of intestinal tissue that are trying to heal from inflammation, so they bulge upwards in comparison to the rest of the tissue that is still inflamed


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