Ulcers are a painful symptom of Crohn’s disease. Doctors can help you manage them with medical treatment. Lifestyle factors may also help.

Crohn’s disease involves inflammation of the gastrointestinal (GI) tract, affecting the deepest layers of the intestinal walls. Developing ulcers, which are open sores, in the GI tract is a main symptom of Crohn’s.

According to the Crohn’s and Colitis Foundation of America, up to 700,000 people in the United States have Crohn’s disease. Anyone can have Crohn’s disease, but it’s most likely to affect people between the ages of 15 and 35.

Ulcers that occur with Crohn’s disease can appear anywhere from the mouth to the anus, including the:

  • esophagus
  • duodenum
  • stomach
  • small intestine
  • colon

However, Crohn’s disease rarely affects the following areas:

  • mouth
  • stomach
  • duodenum
  • appendix
  • esophagus

Ulcers in Crohn’s can present as skip lesions, which are patches of inflammation. For example, you may have ulcers throughout the colon if you have Crohn’s. You may also have a string of ulcers in only one part of the colon. Chronic inflammation can also lead to ulcers in the anus.

Oral ulcers

Oral ulcers can occur with Crohn’s disease.

Aphthous ulcers

Occasionally, people with Crohn’s develop painful sores in the mouth called aphthous ulcers. These ulcers usually appear during a flare-up of intestinal inflammation. They can resemble the common canker sore. Occasionally, much larger ulcers may appear.

Pyostomatitis vegetans

Pyostomatitis vegetans is rare. It causes multiple abscesses, pustules, and ulcers in the mouth. It can occur with inflammatory bowel disease (IBD) or Crohn’s disease. You can take oral and topical corticosteroids, as well what doctors call “immune-modulating” drugs, to treat these sores.

Oral ulcers due to medication side effects

Sometimes, oral ulcers may be a side effect of medications that treat Crohn’s and IBD. These medications can cause thrush, an oral fungal infection.

The most obvious symptom of Crohn’s ulcers is pain. In additon, ulcers from Crohn’s can have several complications:

Fistula

An ulcer can create a fistula if it breaks through your intestinal wall. A fistula is an abnormal connection between different parts of the intestine or between the intestine and the skin or another organ, such as the bladder.

An internal fistula may cause food to bypass areas of the bowel completely, which can lead to inadequate absorption of nutrients.

External fistulas may cause the bowel to drain onto the skin. This can cause a life threatening abscess without treatment. The most common type of fistula in people with Crohn’s occurs in the anal area.

Bleeding

Visible bleeding is rare, but it may occur if an ulcer tunnels into a large blood vessel or artery. The body usually acts quickly to seal off the bleeding vessel. For many people, this occurs only once. However, surgery may be necessary if bleeding happens often.

Rarely, a person with Crohn’s disease may experience sudden, massive bleeding. The bleeding may occur at any time, including during a flare-up or while Crohn’s is in remission.

A massive hemorrhage usually requires lifesaving surgery to remove the affected segment of the colon or GI tract or to prevent another life threatening hemorrhage in the future.

Anemia

Even when there’s no visible bleeding, Crohn’s can lead to iron deficiency anemia if it causes multiple ulcers in the small intestine or colon. Continuous, low grade, chronic blood loss from these ulcers can occur.

If you have Crohn’s that affects the ileum or if you’ve had surgery to remove part of your small intestine called the ileum, you may develop anemia due to an inability to absorb enough vitamin B-12.

Common treatments for ulcers from Crohn’s disease include the following:

Immunosuppressants

Crohn’s ulcers occur due to inflammation related to your body’s immune response. Immunosuppressants are drugs that suppress the immune response.

Corticosteroids are drugs that suppress the immune system to reduce the occurrence of inflammation and ulcers. You can take them orally or rectally.

However, the Crohn’s and Colitis Foundation of America reports that they can have side effects and doctors tend not to prescribe them for the long term, if possible. It’s likely your doctor will add a second line of drugs that suppress your immune system.

If you have Crohn’s that hasn’t responded to corticosteroids or is in remission, your doctor may prescribe another type of immunosuppressant, such as azathioprine or methotrexate. It usually takes 3 to 6 months for a response to these drugs to occur.

These drugs may increase your risk of cancer and viral infections such as herpes and cytomegalovirus. It’s best to discuss your risks with your doctor.

Other treatments

Additional treatments for Crohn’s include the following:

  • In the case of mouth ulcers, a topical anesthetic such as lidocaine may help numb the pain. If you receive a topical anesthetic, it’s likely that it will be mixed with a topical corticosteroid.
  • Biologic therapies such as infliximab and adalimumab are other possible treatments for Crohn’s.
  • Your doctor may also prescribe antibiotics that help reduce the number of bacteria in the intestines and reduce inflammation.

Surgery

Your doctor may recommend surgery to remove a part of the bowel that has a lot of ulcers. Surgery can’t cure Crohn’s, but it may help alleviate symptoms.

An ileum resection is a procedure in which a surgeon removes a part of your small intestine called the ileum. If you’ve had an ileum resection or you have severe Crohn’s of the ileum, you’ll need to take vitamin B-12.

Crohn’s disease is a chronic condition. No cure is currently available, but many people can effectively manage their symptoms.

Ulcers are a particularly painful symptom. Medical treatment can reduce how frequently they occur and how long they last, and lifestyle strategies may also help. Ask your doctor about lifestyle factors and medications that may help with your condition.