Symptoms of Crohn's Disease in Women
Women with Crohn's disease typically present with chronic abdominal pain, diarrhea (often non-bloody), and weight loss, along with systemic symptoms of malaise, anorexia, and fever that are more prominent than in ulcerative colitis. 1, 2, 3
Core Gastrointestinal Manifestations
- Abdominal pain is a hallmark symptom, typically colicky in nature and occurring daily during active disease, reflecting transmural intestinal inflammation 1, 2, 4
- Diarrhea is the most common presenting symptom, ranging from mild (few stools per day) to severe (≥10 loose stools daily during flares), and is characteristically non-bloody (unlike ulcerative colitis where bloody diarrhea is cardinal) 1, 2, 3
- Weight loss develops from both malabsorption and reduced oral intake, serving as a key indicator of disease severity 1, 2, 3
- Chronic symptoms persisting >6 weeks help differentiate inflammatory bowel disease from acute infectious causes 5
Systemic Symptoms
- Fever is more common in Crohn's disease than ulcerative colitis and helps distinguish between the two conditions 1, 2, 4
- Malaise and anorexia are prominent systemic features that differentiate Crohn's from other inflammatory bowel conditions 1, 2
- Fatigue is extremely common, affecting patients even during periods of inactive disease, with prevalence around 30-50% in remission 1
Extraintestinal Manifestations
- Joint symptoms (arthritis/arthralgias) occur in up to 40% of patients and are uncommon in celiac disease, supporting Crohn's diagnosis when present 5, 6, 4
- Skin manifestations including erythema nodosum affect approximately 20-40% of patients 6, 4, 7
- Eye involvement such as uveitis or scleritis can occur 4, 7
- Gynecological manifestations are particularly relevant in women, including vulvovaginal involvement in 20-40% of female patients, which is often underrecognized and difficult to treat 6
Disease Complications Specific to Presentation
- Intestinal obstruction from strictures may present with cramping abdominal pain and inability to pass stool 1, 3
- Perianal disease including fistulae and abscesses occurs frequently and may be the presenting complaint 1, 3, 4
- Abdominal masses may be palpable on examination, representing inflammatory phlegmons or abscesses 4
Laboratory and Nutritional Findings
- Anemia is common, resulting from chronic inflammation, malabsorption, and occult gastrointestinal bleeding 5, 4
- Elevated inflammatory markers including C-reactive protein and erythrocyte sedimentation rate correlate with disease activity 2, 4
- Nutritional deficiencies including low vitamin B12, folate, albumin, and vitamin D reflect malabsorption and chronic inflammation 4
- Elevated fecal calprotectin serves as a noninvasive marker of intestinal inflammation 2
Clinical Pitfalls
- Pain may persist even without active inflammation due to visceral hypersensitivity, functional bowel disorder, or psychosocial factors, requiring investigation beyond inflammatory markers 1
- Symptoms can mimic irritable bowel syndrome in women, leading to diagnostic delays; maintain high suspicion when symptoms include weight loss, nocturnal diarrhea, or systemic features 1
- Absence of rectal bleeding does not exclude inflammatory bowel disease—this feature distinguishes Crohn's from ulcerative colitis 1
- Depression and anxiety are common comorbidities in women with Crohn's disease and adversely affect quality of life and disease outcomes 1