IBD Pain: Types and Causes

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GI pain | Pain outside of the gut |
Acute vs. chronic pain

Gastrointestinal or abdominal pain


Gastrointestinal (GI) pain is one of the most common symptoms of IBD, with 50-70% of patients reporting GI or abdominal pain when their IBD symptoms began and/or when their disease is active.1,2 Patients with IBD experience GI pain for any of the following reasons:

Severe inflammation in the gut

When a part of our body is inflamed, a flood of pain-related chemicals is released in our body as warning signals that something is wrong. 

Strictures, or narrowing of the intestines, and adhesions (scar-like tissue causing tissue and organs to stick together)

Strictures can lead to painful blockages, or bowel obstructions, when food tries to pass through that part of the intestines.


Sometimes chronic inflammation brought on by IBD causes sores, or ulcers, on the inside wall of the intestine. In some IBD patients, these ulcers create connections, almost like a tunnel, to other parts of the body such as the skin, bladder, vagina, or a different part of the bowels known as fistulas. These can lead to painful infections and drainage.

Small Intestinal Bacterial Overgrowth (SIBO)

When certain bacteria increase too much in the small intestines, these bacteria then release methane. The methane causes gas may lead to bloating and cramping.

Food-related issues

Poorly absorbed/digested carbohydrates (called “FODMAPs”) commonly cause excess gas and abdominal discomfort. 

Beyond the gut: Pain from extraintestinal complications

IBD patients may also experience pain that occurs extraintestinally, or outside of the bowels. This includes:

  • Swollen and painful joints
  • Skin complications
  • Redness or pain in the eyes
  • Oral ulcers
  • Perianal pain (pain at or near the anus) 

Psychological stress can also heighten pain in the body, regardless of the source of pain. The gut is especially susceptible to this because of the brain-gut connection - the linking of the emotional and cognitive centers (knowledge and understanding center) of the brain with intestinal functions.3  Anxiety, worry, depression, and post-traumatic stress disorder can all heighten pain experiences in IBD patients. Increased sensitivity of the nerves that line the bowels, known as “visceral hypersensitivity,” can make normal digestive function uncomfortable or even painful.

Types of pain: acute vs. chronic 

The pain you experience from IBD can occur in the gastrointestinal (GI) tract or outside of it. Additionally, it can be both acute (lasting less than six months) or chronic (lasting longer than six months).


Acute Pain Chronic Pain

Active inflammation in the gut

Active inflammation in the gut

Full or partial bowel obstruction 

Building up of scar tissue (adhesions) in the bowels causing chronic narrowings (strictures)

Pain following a surgery

An abscess or infection

Joint inflammation

Visceral Hypersensitivity disorders (ex: Irritable bowel syndrome (IBS), gastroparesis, non-ulcer dyspepsia)

Increased sensitivity of the nerves that line the bowels (visceral hypersensitivity)

Serious side effects from certain medications

Overlapping IBS

Extraintestinal symptoms Nerve pain after surgery
  1. Klaus Bielefeldt, MD, PhD,* Brian Davis, PhD,* and David G. Binion, MD , Pain and Inflammatory Bowel Disease, Inflammatory Bowel Disease, 2019, May, 15 (5): 778-788 
  2. Michael J Dochert, MD, R Carteer W Jones, III, MD, PhD, and Mark S Wallace, MD, Managing Pain in Inflammatory Bowel Disease, Gastroentoerogy & Heptaology, 2011 Sep: 7 (9): 592-601
  3. Cross RK1Wilson KTBinion DG, Nacrotic use in patients with Crohn’s disease, American Journal Gastroenterology, 2005 Oct;100(10):2225-9., accessed PubMed.gov, July 1, 2019