Abdominal Pain and Cramps

Abdominal pain and cramping are very common symptoms of inflammatory bowel disease (IBD). IBD includes Crohn’s disease and ulcerative colitis.¹

In people with IBD, the immune system attacks healthy tissue in the gastrointestinal (GI) tract. This immune response can lead to inflammation, sores, and other damage to the GI tract. The result of this damage is symptoms like abdominal pain.¹

What is abdominal pain?

The abdomen is the part of your body between your ribs and your hip bones. Abdominal pain can occur anywhere in this area, depending on its cause and which organ it stems from. There are many organs in the abdomen, including the:²

• Stomach
• Liver
• Gallbladder
• Intestines

IBD abdominal pain typically occurs in the lower abdomen. This is where the intestines are located. The pain may come and go with IBD flares, but it can also occur outside of a flare. If the pain lasts longer than 3 to 6 months, it is considered chronic pain. The pain can feel like cramping. It may be 1 or more of the following:^1-4

• Mild
• Severe
• Sudden and sharp
• Consistent and dull

Between 50 and 70 percent of people living with IBD have had abdominal pain at some point. Along with diarrhea, this pain is one of the most common symptoms of IBD. Abdominal pain may be more common in women with IBD than in men with IBD. More than half of children with IBD experience this type of pain as well.^1,3,5

How do abdominal pain and cramps affect people with IBD?

Severe abdominal pain and cramping can interfere with your daily life. It may become hard to complete daily tasks and participate in social activities. Working may be difficult, too. You may miss a lot of work or even lose a job due to your symptoms.³

IBD pain often affects emotional well-being too. Wondering when symptoms might hit can cause stress or anxiety. And living with frequent pain can lead to depression. This may lead to a vicious cycle in which pain causes stress, and increased stress causes more pain.^1,3

Also, research shows that abdominal pain is a primary reason why people with IBD seek medical care. The pain can lead to more hospital and doctor visits, increasing your medical bills. Along with missed workdays, these bills can cause serious financial strain.³

Why do abdominal pain and cramps occur with IBD?

A major reason why many people with IBD experience abdominal pain and cramping is inflammation in their GI tract. Your body naturally releases pain signals to alert you that inflammation is occurring. And severe inflammation can occur with an IBD flare.⁵

Even after the flare passes and you enter a period of reduced or no symptoms (remission), abdominal pain may persist. This may be due to increased pain sensitivity in the brain. People who are at higher risk for long-term abdominal pain include those who have:⁴

• Other types of chronic pain
• Previous emotional trauma
• Anxiety
• Depression

Other complications of IBD in the intestines can cause pain too. These include:⁵

• Strictures – These are places where the intestines have narrowed, making it harder for food to pass through the intestines.
• Adhesions – Scar tissue can cause sides of the intestinal wall to stick together, creating a blockage in the intestines.
• Fistulas – These are abnormal tunnels that form between parts of the body. In people with IBD, fistulas may result from sores, called ulcers, on the intestinal wall.
• Bacteria overgrowth – Some people with IBD also have small intestinal bacterial overgrowth (SIBO). In this condition, the balance of bacteria in the intestines skews too much toward a certain type of bacteria. One symptom of SIBO can be abdominal cramps.
• Food intolerances – Food may trigger symptoms for some people with IBD. One category of food that many people have trouble tolerating is fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). These are specific types of carbohydrates that can lead to gas and cramping.

How are abdominal pain and cramps treated?

Doctors, typically gut specialists called gastroenterologists, aim to treat the underlying cause of abdominal pain and cramping. They may suggest a combination of treatments given by a team of health professionals. Treatment methods may include:⁴

• Medicines
• Psychotherapy
• Self-management

Medicines

Certain medicines may help lessen abdominal pain and cramping. Each works in a different way. These medicines may include:⁶

• Antidepressants – Certain types of antidepressants may help relieve abdominal pain. One way they do this is by reducing symptoms of depression and anxiety. Reducing depression and anxiety can directly relieve pain and reduce pain sensitivity.
• Antispasmodics – These medicines help relax muscle spasms in the intestines.
• Steroid drugs – Prescription steroids (corticosteroids) can help reduce inflammation in the intestines.
• Opioids – Also called narcotics, these are strong and effective drugs for pain. But they are extremely habit-forming and can be dangerous. For this reason, they are not usually prescribed.

It is important to know that several of these medicines can actually make abdominal pain worse. And some can have significant side effects. Talk to your doctor before starting any new medicine to make sure you understand its risks and possible benefits.⁶

Psychotherapy

Your emotions, thoughts, and behaviors around your pain can affect how you experience the pain. For example, if you focus on the worst possible outcomes (called catastrophizing), you may feel the pain for longer than if you focused on positive outcomes. In other words, fearing the pain can make you more sensitive to the pain.^4,6

This is not just a mental process but also a physical one. The gut and the brain are closely connected by several systems, including the nervous system. This system constantly sends messages back and forth between the gut and the brain. So, problems with one can affect the other.^4,6

In psychotherapy, a mental health professional can help train you to think about your pain differently. This can reduce stress, anxiety, and depression and help you feel more in control of your condition. Ultimately, it can reduce the amount of pain you feel. Common types of therapy for people with IBD are:^4,6

• Cognitive behavioral therapy (CBT)
• Gut-directed hypnotherapy

Self-management

There are several things you can do to help reduce abdominal pain and its effects. For example, you can:^4,6

• Get regular gentle exercise with activities like yoga or tai chi.
• Practice stress-reducing methods like meditation, breathing techniques, or guided imagery.
• Try acupuncture or massage.