If you have Crohn’s disease, you’re probably familiar with the pain of abdominal cramping. A study published in Pain in October 2021 found that “in large cohorts of patients with IBD, 60 percent report abdominal pain.” Not only is it one of the most common symptoms of the disease, but it can also present a unique set of challenges, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). But it’s often overlooked: According to a study in the journal PLoS One, abdominal pain is frequent but undertreated. Learn these key facts about Crohn’s disease and abdominal pain to better cope with cramping.

Here are nine things you should know about Crohn’s disease and cramps.

1. Abdominal Cramps Can Occur Anytime

Cramping can start during a flare or when you’re in remission, says Jessica Philpott, MD, PhD, a gastroenterologist at Cleveland Clinic in Ohio. When Crohn's disease is active, inflammation can change nerve and muscle function in the intestines, Dr. Philpott says. Even after inflammation is reduced, the functioning of the gastrointestinal tract remains altered.

2. Cramps Have a Variety of Causes

Of course, knowing the source of your cramps will help you treat them, says Susan Coe, MD, a gastroenterologist with Atlanta Gastroenterology in Atlanta. For example, if active Crohn’s disease is causing your cramps, treatment should be geared to reducing inflammation and treating any Crohn’s disease-related complications, such as a bowel blockage or fistulas, Dr. Coe says. Your doctor may recommend medications to ease your symptoms during a flare and put the disease into remission afterward. If your cramping is from a stricture, which is the narrowing in a section of the colon, a low-residue, low-fiber diet can help, says Sandra M. Quezada, MD, an assistant professor of medicine in the division of gastroenterology and hepatology at the University of Maryland Medical Center in Baltimore. Foods low in fiber are less bulky and pass through narrowed areas of the colon more easily, she says.

3. Sometimes Cramping Occurs in Response to Stress

When stress is the cause, taking steps to reduce stress can help reduce abdominal pain, Coe says. “A very real and intimate relationship exists between the mind and body,” she says. “Stress can make the digestive tract more aware of stimuli, particularly pain.” Try stress relievers such as yoga, tai chi, and meditation, suggests the Crohn’s & Colitis Foundation.

4. Your Emotions Can Play a Role

A chronic disease that causes frequent abdominal cramps can cause you to feel depressed, Philpott says. And depression doesn’t always present itself in traditional ways. Talk to your doctor if your pain leads to trouble sleeping or if you’re moodier than usual. He or she may recommend counseling or medication, such as an antidepressant. These drugs have been shown to improve abdominal pain in people with irritable bowel syndrome (IBS), which is common in people with Crohn’s disease, Dr. Quezada says.

5. Keep a Journal to Track Your Cramps

For some people with Crohn’s disease, cramps may kick in an hour or so after eating. That’s because eating triggers peristalsis, which is the normal rhythmic contraction of the intestines, Coe says. “If Crohn’s disease is in remission, abdominal pain occurring after a meal may be the result of a hypersensitive response to this normal stimulus, which is a symptom of IBS," she says. "However, if your Crohn’s disease is active, stomach pain that occurs after eating can be the result of significant inflammation or scar tissue.” Work with your doctor to figure out what’s causing your cramps.

6. Be Aware of Where You Feel Cramps

Crohn's disease can affect any part of the digestive system, from the mouth to the rectum. The site of your pain will depend on which part of your gut is affected, Philpott says. With Crohn’s disease, the last part of the small intestine is most often affected. In that case, you'll feel cramps most acutely in the lower right side of your abdomen, she says. “If you have Crohn’s disease in your small bowel, you’re also more likely to have pain soon after eating,” Philpott says. Eating frequent, smaller meals rather than larger ones is one way to reduce the likelihood of cramping.

7. It’s Not Unusual to Feel Nauseated With Cramping

Crohn’s disease can cause your small intestine to become distended, either from inflammation or gas. This often triggers the sensation of nausea, Coe says. “Some people develop nausea as their natural response to considerable pain, whether it’s gastrointestinal or otherwise,” she says.

8. Assigning a Number to Your Stomach Pain Helps Guide Treatment

Coe asks people with cramping to describe their pain on a scale of 1 to 10, with 10 being the worst pain they’ve ever experienced and 1 being the least. Quantifying your pain in this way can help your doctor determine the cause of your pain and make treatment recommendations, she says.

9. Be Aware of Any Changes in Your Abdominal Pain

Changes, like cramps that worsen, could indicate a complication of Crohn’s disease that requires immediate treatment, Philpott says. Call your doctor right away if you notice that your symptoms are getting worse.

9 Things to Know About Crohn’s Disease and Cramps