If you live with Crohn’s disease or ulcerative colitis – together known as inflammatory bowel disease (IBD) – you are no stranger to abdominal pain. Unfortunately, managing that pain can be complicated. The usual go-to medications for pain relief, like opioids or over-the-counter anti-inflammatories, may do more harm than good for people with IBD.
“We see IBD patients who are struggling with pain but are lacking options for treatment,” says Dr. Mehwish Ahmed, gastroenterologist at The Iowa Clinic. “Pain relief in IBD is possible, but it requires a thoughtful and individualized approach.”
Why Standard Pain Medications May Not Be Ideal for IBD
While opioids can offer fast pain relief, they can also slow down the gut, increase your risk of bowel obstruction, and carry a higher risk of dependency and death — especially for those with chronic illnesses. NSAIDs (like ibuprofen or naproxen) can increase inflammation in the gut and may trigger IBD flare-ups.
Because of these risks, many patients feel like their pain is left untreated.
“There’s a real need to address pain while also protecting patients from the complications that certain medications can cause,” Dr. Ahmed explains.
Understanding Where the Pain Comes From
They key to managing IBD-related abdominal pain is identifying the underlying cause.
Dr. Ahmed explains that pain can be grouped into two broad categories:
Inflammatory Pain
Inflammatory pain is caused by active inflammation in the intestines or related complications like infections, fistulas, or abscesses. In these cases, treating the underlying IBD activity is the priority.
Non-Inflammatory Pain
Sometimes pain happens even when your IBD isn’t active. Common causes include:
- Scar tissue (strictures) or adhesions
- Small bowel obstructions
- Bacterial overgrowth
- Sensitivity in the gut
- Narcotic bowel syndrome
The Role of the Brain-Gut Connection
Pain isn’t just physical, it’s also neurological and emotional. Stress, anxiety, and depression can heighten your perception of pain. That’s not “in your head,” it’s backed by science.
“IBD patients with anxiety or depression tend to experience more intense pain,” says Dr. Ahmed. “Managing those psychological factors is just as important as treating inflammation.”
In fact, high stress is directly linked to IBD relapses, and studies show that treating underlying mental health conditions can improve pain perception and overall quality of life.
Safe Pain Management for Your IBD
Because opioids and NSAIDs often are not recommended, doctors may turn to other options that are both safer and more effective long-term. Depending on the source of your pain, your care plan may include:
- Antispasmodics to calm cramping
- Neuromodulators that alter how the nervous system processes pain
- Topical therapies for perianal disease
- Physical therapy for musculoskeletal causes
- Dietary modifications to reduce triggers
- Mental health support, including therapy and medications
- Surgery for complications like abscesses or strictures
“We tailor treatment based on the type of pain and the individual,” says Dr. Ahmed. “There’s no one-size-fits-all when it comes to IBD.”
If you’re living with IBD and struggling with abdominal pain, know that you’re not alone – and you don’t have to suffer in silence. Talk with your gastroenterologist about your symptoms and ask about options beyond opioids or NSAIDs. Schedule a consultation online or call 515.875.9115.
MehwishAhmed , MD
Mehwish Ahmed, MD joined The Iowa Clinic Gastroenterology department because of its unique model of patient-centered care, strong physician leadership, and collaborative network of providers and administrators working together to deliver the best possible care for patients. Dr. Ahmed chose gastroenterology because she values its combination of medical and procedural care, as well as its ability to improve patients’ quality of life. She is passionate about preventing disease through screening colonoscopies and managing chronic conditions such as Inflammatory Bowel Disease (IBD).
Outside of medicine, Dr. Ahmed enjoys traveling, gardening, stargazing, and spending time with her family. She has long been fascinated by space and even minored in Astronomy during college.