If you look up “Crohn’s Disease Symptoms,” the first one on almost every list you find is “abdominal pain, acute or chronic.” In my ongoing battle to live with Crohn’s, I find that I most often have acute abdominal pain that comes both suddenly and apparently from nowhere. It is a stabbing and intense pain, usually in the lower right quadrant of my abdomen. This used to cause me some confusion, as there are several possible causes for lower-right quadrant acute pain.
The first time I had acute abdominal pain from Crohn’s, I thought it must either be appendicitis, or something wrong with my right ovary. It was in a place that could have been either one of those two, and it was sudden and excruciatingly painful. I went to my gynecologist, as I’d previously had an infected ovarian cyst, and this pain felt just like that pain. My gynecologist did a quick exam, and told me that it wasn’t my ovary, but that she was hearing “a lot of bowel noise” and thought that it might be appendicitis, so she sent me to the emergency room at the hospital that was across the street from her office. They did a number of tests, including a barium enema, and found that it wasn’t my appendix, but was from my Crohn’s Disease. The ER doctor told me that it was probably caused by muscle contractions in my intestines, which are common in Crohn’s disease, especially after eating, and probably would “only” last a few hours. I put “only” in quotes because by that time the abdominal pain was so acute, so intense, that I could barely straighten up, and a few hours sounded like an eternity.
That doctor gave me a prescription for a drug called Bentyl TM (the brand name for dicyclomine), an anti-spasmodic drug. Another name for contractions is spasms, and that is the name used in the drugs. He also suggested that I curl up with a heating pad, and that if I was still having the acute pain in the morning, I should see my gastro-enterologist (the specialist who typically deals with Crohn’s, among other diseases). Both the medication and the heat seemed to help, and by morning I was almost back to normal, but I made an appointment with my gastro-enterologist to learn more about this acute abdominal pain, and if there was anything I could do to prevent it.
The gastro-enterologist explained what I should have already realized, that acute abdominal pain or distress is very common with Crohn’s, with as many as half the patients describing the pain as “very severe” or about a 9 on the pain scale where 1 is no pain, and 10 is the worst pain you’ve ever experienced. I’m not sure if that first attack of acute abdominal pain was a 9, but if it wasn’t, it was pretty close. He told me that while sometimes it happens for no obvious reason, it often happens as a result of eating a specific food. He suggested I keep a food diary, and note what foods caused no symptoms, and what foods did cause symptoms, and what and how severe those symptoms were. He said I should do this for at least 2 months, to have a good idea of what foods worked for me and what didn’t. He also told me that if the acute abdominal pain lasted for more than a few hours, I should see him or go to the emergency room; although the main cause of acute abdominal pain for Crohn’s patients is intestinal contractions or spasms, it can also be caused by a severe intestinal ulcer, or a fistula (a tunnel around the anus or rectum), or even a perforated diverticulitis, which means that a “diverticulum” (a sort of pouch or sac branching off the intestine) has sprung a leak or even ruptured, causing fecal matter to escape outside the intestines, which requires almost immediate surgery. So clearly, acute abdominal pain, for Crohn’s patients, is nothing to mess around with.
So my first step was to start a food diary, and it didn’t take long to figure out which foods caused me pain, whether mild or acute. Everyone is a little different, but most Crohn’s patients can suffer pain from too much insoluble fiber, such as a lot of fresh or raw vegetables and fruits, from spicy food, and many get pain from tomatoes and tomato products, even ketchup. Coffee, alcohol, and tobacco also cause acute abdominal pain for most Crohn’s patients. I can also get pain from diet cola, which is a problem both because of the carbonation and because of the acid, and some would add because of the aspartame, although there’s no scientific evidence for that. Since sugar can also cause intestinal pain for me, I try to avoid sweets, very difficult for me because I have a major sweet tooth.
Once I knew what foods to avoid, I’d hoped that sudden pain would stop. It didn’t, of course; periodically, and often for no obvious reason, I would have a bout of acute abdominal pain. My doctor started me on a daily dose of Bentyl, which helped; other anti-spasmodics include Levsin (hyoscyamine) and Donnatal (belladonna/phenobarbital) — that last one is pretty strong and according to my doctor, should probably not be taken daily. You should consult with your physician to determine if a prescription for an anti-spasmodic medication is right for you, and if so, which one. They should all be taken half an hour to an hour before a meal, and each has the potential for unpleasant side effects like headache, dizziness, nausea, and urinary tract problems. I didn’t experience any side effects with Bentyl, but I’m told that’s rare.
Some non-physicians recommend peppermint oil for acute abdominal pain; this may work for some people, but it is a risk for Crohn’s patients, as the peppermint oil can cause irritation of the anus, and can also contribute to acid reflux or heartburn. Low doses of tricyclic anti-depressants are another class of medicines sometimes prescribed for Crohn’s patients to prevent acute abdominal pain; tricyclics include drugs such as Elavil (amitriptyline), Aventyl (nortriptyline), and Tofranil (imipramine). My doctor told me that these are most often prescribed to Crohn’s patients for diarrhea, rather than intestinal spasms, and are usually taken at night. He also said it can take six to eight weeks for them to help at all, and that they all come with a host of side effects. Again, what works varies from one individual to another; this is something that you can bring up with your physician if you believe it might help. I’ve chosen not to use tricyclic antidepressants for acute abdominal pain.
When I have a sudden attack of acute abdominal pain, even though I’m on Bentyl and being careful about what I eat, I remember the ER doctor’s advice, and curl up with my heating pad. It almost always lessens the pain, and sometimes stops it after a half hour or more. If you decide to try the heating pad, use some common sense, and remember not to use it with a sports cream (such as Ben-Gay or Icy-Hot) as that can make your skin burn; don’t fall asleep with it (again, risk of burns), and don’t use it on bare skin. It’s also better not to lie on top of it, as the pressure from your body can also cause a burn. I then stick to a liquid diet for about 24 hours, just to give my intestines a break. And if my pain lasts for more than 6 hours, I call my doctor, and so should you, if you suffer from Crohn’s. Even if you don’t, given that the pain may be caused by a ruptured appendix, or a ruptured ovarian cyst, calling your doctor or going to a walk-in clinic is not a bad idea.
