On-and-off abdominal pain and cramps are some of the most common symptoms of Crohn’s disease. Overtime, the pain may become a constant, dull ache. Pain and cramping are particularly common symptoms if you have inflammation in the small intestine, which is where most nutrients are absorbed. However, inflammation anywhere in the digestive tract could cause abdominal pain. You may feel pain around the belly button or on the lower right side of the abdomen. It often occurs 1 to 2 hours after eating, but can occur at any time with no obvious cause. The pain may be so severe that you eat less-or avoid eating-to prevent pain and cramping.

For many patients, abdominal pain gets worse when Crohn’s disease flares up.4 Active inflammation can cause pain. Pain can also be a sign of an obstruction or abscess. However, people with Crohn’s disease may have abdominal pain during remission, too. Inflammation can make the nerves more sensitive. It may cause lasting changes that contribute to pain during remission. Ongoing abdominal pain can impact your overall well-being. Fear of the pain can reduce your quality of life. Abdominal pain has been linked to depression in children and teenagers with Crohn’s disease.

How is abdominal pain treated?
If abdominal pain is a sign of a Crohn’s disease flare, the goal is to treat the underlying disease. Pain and cramps should improve within a few weeks of treatment. If there is no improvement, you may need further evaluation. Your provider may need to check for complications.

Pain medications can be helpful. Some health care providers recommend acetaminophen or COX-2 inhibitors instead of non-steroidal anti-inflammatory drugs (NSAIDs). In a high-quality study, people were randomly assigned to the COX-2 inhibitor celecoxib or fake treatment (placebo). There was no difference in disease flares between the 2 groups. In a different trial, people were less like to have a disease flare with acetaminophen than with an NSAID.

An estimated 1 in 6 people with inflammatory bowel disease use opioid medications regularly for pain. This use of opioids is controversial. Opioids often cause problems with digestive tract function. Additionally, there is a risk of abuse. Nevertheless, it is important for providers to recognize when there is the legitimate need for adequate pain relief. Patients who discuss opioid medications with their providers should not be automatically labeled as "drug-seekers."

Sometimes, the pain is very difficult to control, even with medication. Your health care provider may suggest therapy or antidepressants in order to help you cope with the unrelenting pain. Antidepressants have not been well studied in people with inflammatory bowel disease. Therapy may improve anxiety, depression, and coping skills. However, it does not improve Crohn’s disease.