Shining a Light on the Lesser-Known Realities of Crohn’s Disease
Written by Dr. Antonia Repollet
Licensed Clinical Psychologist
Certified School Psychologist
GI Psychology
When most people think of Crohn’s disease, they picture abdominal pain, diarrhea, and urgent trips to the bathroom. While these are hallmark symptoms, they are far from the full story. Many people with Crohn’s live with a wide range of less-discussed symptoms that impact daily life just as much as the “classic” ones.
It’s also important to understand how Crohn’s differs from ulcerative colitis (UC), the other main form of inflammatory bowel disease (IBD). UC affects only the colon and rectum, with inflammation limited to the innermost lining of the bowel. Crohn’s, on the other hand, can cause inflammation anywhere in the digestive tract, from mouth to anus, and often extends deeper into the bowel wall (Baumgart & Sandborn, 2012). This broader reach means Crohn’s is more likely to trigger symptoms beyond the gut and affect the whole body.
Fatigue That Won’t Quit
Fatigue is one of the most common but overlooked symptoms of IBD, and it’s particularly pervasive in Crohn’s. Even when digestive symptoms are under control, ongoing inflammation, anemia, or medication side effects can lead to persistent exhaustion (van Langenberg & Gibson, 2010).
Crohn’s vs UC: While fatigue can occur in both conditions, Crohn’s patients are more likely to experience it even in remission due to disease activity outside the colon (Artom et al., 2017; van Langenberg & Gibson, 2010).
Joint Pain & Arthritis
Crohn’s is an autoimmune condition, and inflammation doesn’t always stay in the gut. Up to 20–30% of people with Crohn’s disease develop some form of arthritis, compared with about 10–15% of those with ulcerative colitis (Harbord et al., 2016; Orchard et al., 1998). Arthritis in IBD can present in two main ways:
- Peripheral arthritis: Affects large joints like knees, ankles, elbows, or wrists. This form can occur in both Crohn’s and UC, but is somewhat more common in Crohn’s.
- Axial arthritis: Involves the spine and sacroiliac joints (sacroiliitis, ankylosing spondylitis). This form is more strongly linked to Crohn’s disease than UC and can significantly affect mobility and quality of life (Van Praet et al., 2013).
Crohn’s vs UC: Both Crohn’s and UC patients may develop arthritis, but Crohn’s carries a higher overall prevalence and is more strongly associated with axial involvement (back and spine).
Mouth Sores & Skin Changes
Painful mouth ulcers and inflammatory skin conditions are another overlooked part of Crohn’s. Rashes, tender red nodules (erythema nodosum), or ulcers (pyoderma gangrenosum) may flare up alongside gut symptoms (Crohn’s & Colitis Foundation, n.d.).
Crohn’s vs UC: Mouth ulcers are much more common in Crohn’s than UC, since Crohn’s can involve the upper GI tract.
Anxiety, Depression, & Brain Fog
Chronic inflammation doesn’t just affect the gut—it influences the gut-brain axis, contributing to anxiety, depression, and brain fog. Research consistently shows that people with IBD experience higher rates of mood and anxiety disorders compared to the general population (Mawdsley & Rampton, 2005; Mikocka-Walus et al., 2016).
In Crohn’s disease, the unpredictability of symptoms (i.e. never knowing when pain, urgency, or fatigue will strike) can heighten stress and contribute to social withdrawal. Brain fog, or difficulty concentrating and remembering, often worsens during flares or medication changes, further disrupting daily life (van Langenberg & Gibson, 2014).
At GI Psychology, we work with children, teens, and adults living with Crohn’s and UC to address these challenges. Our team uses gut-brain behavioral therapies and clinical hypnosis to help patients build skills for anxiety, manage depression, medical trauma, and reconnect with their values even when symptoms are unpredictable. By treating both the gut and the mind, patients can improve their quality of life and feel more in control of their condition.
Why Talking About These Symptoms Matters
By naming and normalizing these lesser-known symptoms, we reduce stigma and help patients feel less alone. For providers, listening to these stories deepens understanding and improves care. For loved ones, awareness fosters empathy and support. Crohn’s is not “just a bathroom disease”, it’s a systemic condition that can affect the entire body.
Looking for relief from these symptoms? Our 8-week virtual IBD Psychotherapy Group, where adults with Crohn’s and colitis can learn evidence-based tools to manage stress and symptoms. Enroll today!
References
Artom, M., Czuber-Dochan, W., Sturt, J., Murrells, T., & Norton, C. (2017). The contribution of clinical and psychosocial factors to fatigue in 182 patients with inflammatory bowel disease: a cross-sectional study. Alimentary pharmacology & therapeutics, 45(3), 403–416.
Baumgart, D. C., & Sandborn, W. J. (2012). Crohn’s disease. Lancet (London, England), 380(9853), 1590–1605.
Harbord, M., Annese, V., Vavricka, S. R., Allez, M., Barreiro-de Acosta, M., Boberg, K. M., Burisch, J., De Vos, M., De Vries, A. M., Dick, A. D., Juillerat, P., Karlsen, T. H., Koutroubakis, I., Lakatos, P. L., Orchard, T., Papay, P., Raine, T., Reinshagen, M., Thaci, D., Tilg, H., … European Crohn’s and Colitis Organisation (2016). The First European Evidence-based Consensus on Extra-intestinal Manifestations in Inflammatory Bowel Disease. Journal of Crohn’s & colitis, 10(3), 239–254.
Mawdsley, J. E., & Rampton, D. S. (2005). Psychological stress in IBD: new insights into pathogenic and therapeutic implications. Gut, 54(10), 1481–1491.
Mikocka-Walus, A., Knowles, S. R., Keefer, L., & Graff, L. (2016). Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases. Inflammatory bowel diseases, 22(3), 752–762.
Orchard, T. R., Wordsworth, B. P., & Jewell, D. P. (1998). Peripheral arthropathies in inflammatory bowel disease: their articular distribution and natural history. Gut, 42(3), 387–391.
Rogler, G., Singh, A., Kavanaugh, A., & Rubin, D. T. (2021). Extraintestinal Manifestations of Inflammatory Bowel Disease: Current Concepts, Treatment, and Implications for Disease Management. Gastroenterology, 161(4), 1118–1132.
Signs and Symptoms of Crohn’s Disease. Crohn’s & Colitis Foundation. (n.d.). https://www.crohnscolitisfoundation.org/patientsandcaregivers/what-is-crohns-disease/symptoms
van Langenberg, D. R., & Gibson, P. R. (2010). Systematic review: fatigue in inflammatory bowel disease. Alimentary pharmacology & therapeutics, 32(2), 131–143.
van Langenberg, D. R., & Gibson, P. R. (2014). Factors associated with physical and cognitive fatigue in patients with Crohn’s disease: a cross-sectional and longitudinal study. Inflammatory bowel diseases, 20(1), 115–125.
Van Praet, L., Van den Bosch, F. E., Jacques, P., Carron, P., Jans, L., Colman, R., Glorieus, E., Peeters, H., Mielants, H., De Vos, M., Cuvelier, C., & Elewaut, D. (2013). Microscopic gut inflammation in axial spondyloarthritis: a multiparametric predictive model. Annals of rheumatic diseases, 72(3), 414–417.