Crohn’s disease is a type of inflammatory bowel disease (IBD). Its incidence and the increased risk of other conditions or complications are different in males and females. Although symptoms and treatment may vary, these differ for each individual, rather than across age or gender.
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Crohn’s disease is a chronic condition that causes inflammation in the digestive tract. It affects approximately 780,000 Americans.
Although IBD incidence varies with age and gender, symptoms differ among individuals based on where the inflammation occurs. Some people may experience milder symptoms, while others have severe symptoms.
Read this article to learn more about the onset of Crohn’s disease, symptoms, common causes, conditions associated with it, and ways to treat and manage IBD.
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth.
The onset of Crohn’s disease
Research suggests that Crohn’s disease has a peak prevalence in 30–39 and affects genders differently based on population.
For example, in Canada and New Zealand, females are 10–30% more likely to acquire the condition, while in Japan and Korea, males are up to three times more likely to develop Crohn’s disease.
Further research from 2019 suggests that females have a lower risk of Crohn’s disease than males during childhood, until the age range of 10–14 years. Females have a higher risk after age 14. Males may be more likely to develop Crohn’s at a younger age than a person who is older.
In addition, males may be at more risk of developing ulcerative colitis, another form of IBD, than females.
Symptoms
Since Crohn’s disease can affect both genders, the symptoms generally present the same across males and females.
Common symptoms of Crohn’s disease include:
- chronic diarrhea
- abdominal pain
- blood in stools
- weight loss
- fatigue
The Crohn’s & Colitis Foundation developed a symptom tracker that individuals can fill out and share with their doctor to better help them understand how this disease affects them.
By keeping track of symptoms and triggers, individuals can work with their doctor to develop a treatment plan that may better help them manage the condition.
When to contact a doctor
Individuals may experience flare-ups or a relapse, where symptoms of the condition are active and range in severity. Flare-ups may last from a few days to weeks or months. A person should consult their specialist or IBD nurse to discuss managing these.
Between flare-ups, individuals may be in remission and not experience any symptoms.
People who are experiencing severe symptoms or symptoms lasting longer than a few weeks should consult their gastroenterologist or a doctor for medical assistance.
A prolonged flare-up can negatively impact an individual’s quality of life and can lead to additional problems in the gut. These include intestinal structures.
Doctors characterize strictures as uncontrolled inflammation where the diameter of the intestine narrows. They may treat this type of inflammation with anti-inflammatory medications.
However, if the inflammation is ongoing, scar tissue starts forming, requiring procedures (surgical or endoscopic). Anti-inflammatories will not have as much effect on scar tissue.
Strictures can result in blockages referred to as bowel obstruction or fistulous tracts.
Complications
At present, there is insufficient research investigating differences in complications of Crohn’s disease in males and females.
However, other complications of Crohn’s disease symptoms and flare-ups include:
- ankylosing spondylitis — chronic arthritis
- episcleritis — inflammation of the episcleral, the coating of the eye wall
- erythema nodosum — painful red bumps on the skin
- pyoderma gangrenosum (Crohn’s disease rash)
- kidney stones
- gallstones
- anemia
- a blood disorder such as hypercoagulability
- osteoporosis
In rare cases, perforation of the bowel may occur during a severe flare-up. Symptoms include severe abdominal pain, fever, nausea, and vomiting. In some cases, the leak will form an abscess. A person must consult a doctor or visit an emergency room as this could be life threatening.
Causes
The exact cause of Crohn’s disease is not fully known.
However, scientists have made major advances over the past few years, particularly in the role of genetics.
Research from 2021 associated more than 100 genes with IBD, meaning genetics may play a crucial part in causing Crohn’s disease.
Researchers believe that Crohn’s correlates to a combination of environmental factors, such as:
- viruses
- bacteria
- diet
- smoking
- certain medications
- stress
Scientists are still investigating whether any factors may influence the risk of males getting this disease more than females.
Risk of additional conditions
Individuals with Crohn’s disease are at a higher risk of developing other conditions. The complications include:
- increased risk of viral and gastrointestinal infections
- the link between depression and IBD is likely bidirectional, with one affecting the other
- higher risk of colorectal cancer
- the impact of food not being digested and malabsorption may lead to vitamin deficiencies and malnutrition
Other conditions may differ across males and females. Males are more likely to develop the following:
Sexual dysfunction
While there is limited research on this topic, a 2019 study showed that 39% of males reported having some form of sexual dysfunction. 94% of males newly diagnosed with IBD reported erectile dysfunction.
A recent review from 2021 showed that males with IBD felt sexually compromised due to active disease and had a lower sexual desire.
Many factors can influence the decrease in sexual desire among IBD patients, including:
- fatigue
- fear of incontinence
- depression
A person may wish to speak with a doctor to discuss ways to improve sexual function and desire.
Infertility
Active Crohn’s disease appears to affect male reproductivity.
Research also associates inflammation with elevated levels of oxidative stress. These levels may have a negative effect on male fertility.
Due to insufficient data, researchers have yet to draw definitive conclusions regarding the effects of IBD medications, including corticosteroids to help reduce inflammation, on male fertility.
Doctors may explore other IBD medications or fertility options for males, where possible.
Bone health
According to the Crohn’s & Colitis Foundation, approximately 30–60% of people with Crohn’s disease have lower than average bone density. In some people, this will cause osteoporosis (weaker joints), while osteopenia (low bone density) or osteomalacia (softening of the bones) may occur. These conditions are often more common in females than in males.
However, low bone density can affect people with IBD at any age.
Doctors may also use steroid treatment, but this drug can contribute to bone loss. Steroids lower the rate that bone-building cells work.
A person may also absorb less calcium due to the medications they take. Inflammation also damages the intestinal lining, interfering with the organ’s ability to absorb nutrients properly.
To help with lower levels of calcium or other nutrients, a person may take supplements.
Prostate cancer
If a male has Crohn’s disease, it may increase the risk of prostate cancer. This risk could be because the body is in a chronic state of inflammation.
There is also evidence that the body’s inflammatory response and IBD treatment increase the risk of other extraintestinal tumors, such as skin and hematopoietic disorders.
A male should ensure they attend prostate exams and tests to help detect and treat this type of cancer in its early stages. A person should speak with a doctor to discuss any concerns.
At present, Medicare covers an annual prostate-specific antigen test for males age 50 and older.
Rare liver disease
Males with chronic Crohn’s are more likely than females to develop a type of liver disease called primary sclerosing cholangitis (PSC).
Although rare, PSC can lead to other hepatic (liver) related issues such as:
- cirrhosis of the liver
- an increased risk of liver cancer
- the need for a liver transplant
If a person has any concerns or questions, they can speak to their doctor about liver function testing.
Management of Crohn’s
At present, there is no cure for Crohn’s disease, but people can manage IBD with treatment options that help reduce the severity and frequency of flare-ups and symptoms. This management of Crohn’s tends to apply to both males and females, including:
Medications
There are several types of medications available to help treat Crohn’s disease, such as:
- steroids, including prednisone
- antibiotics
- anti-inflammatory drugs, such as mesalamine
- antidiarrheal drugs
Biologics is another type of treatment available for people with Crohn’s disease. It helps reduce the body’s immune response by targeting proteins that lead to inflammation. Examples are antitumor necrosis factor agents, such as infliximab (Remicade) and adalimumab (Humira).
Individuals can also speak with their doctor to see if alternative medications are available to help treat their symptoms.
Side effects of medications
Some prescribed medications may have side effects and require close monitoring, such as blood tests and follow-up visits with an IBD nurse.
Research has shown that certain medications to treat Crohn’s disease may cause infertility issues in males.
Long-term use of steroids can also lead to osteoporosis, a condition that 30–60% of people with IBD are already susceptible to.
Lifestyle changes
Some lifestyle habits and choices can also help minimize symptoms.
- Exercise: Regular exercise is safe and beneficial for people with Crohn’s disease.
- Reducing stress: Research indicates that stress has a link to dysbiosis — an imbalance of gut microbiota — which further associates with IBD. Stress-management techniques, such as relaxation exercises, are beneficial to IBD. Read more about relaxtion methods.
- Supplements: Antioxidant supplements, such as omega-3 fatty acids, may help those with Crohn’s disease to maintain and recover gut functions.
Dietary choices
Some foods can trigger flare-ups in Crohn’s, including:
- fat
- insoluble fiber
- dairy
- sugar
Individuals with this condition may benefit from keeping a food journal to document what they ate and how that food made them feel. A journal may help them identify what foods cause flare-ups.
An appointment with a registered dietitian can also help determine what foods to avoid and what foods to consume to minimize symptoms specific to that person.
Surgery
Many people with Crohn’s disease may need surgery to relieve symptoms that have not responded to medication.
Doctors most often recommend surgery to treat the following complications:
- fistulas
- bleeding that is life threatening
- intestinal obstructions
- side effects from medicines when they threaten health
A person may need a colectomy, in which a surgeon removes the whole colon or large intestine.
Alternatively, doctors may suggest removing part of the small intestine in small bowel resection surgery. Removing part of the intestine can help, but it does not cure Crohn’s disease.
Surgery is not an option for everyone, but it may be a suitable treatment in severe cases of Crohn’s.
Outlook
Individuals with Crohn’s disease may start to recognize symptoms they experience due to certain foods and environmental triggers, which may help minimize the risk of a flare-up.
If a person cannot identify the triggers, a doctor will develop a strategy as quickly as possible to reduce the frequency and severity of flare-ups and associated symptoms.
A person can consult a doctor to explore IBD medications’ benefits and more serious risks. Doctors advise that flares may occur when people do not take medications as prescribed.
However, if people take their medications as prescribed and still experience flares, they should speak with their doctor. They may suggest changing the dose or type of medication to help manage IBD.
Even if a person does not experience side effects or symptoms (in remission), taking the prescribed medication is important for managing Crohn’s and long-term effects.
Summary
At present, there is little research that differentiates how Crohn’s disease affects males and females differently.
However, any individual experiencing symptoms of Crohn’s disease should speak with their doctor. The sooner an individual gets a Crohn’s diagnosis, the sooner they can start managing their symptoms and preventing the severity and frequency of flare-ups.
A male with Crohn’s disease may have an increased risk of fertility, liver, and prostate issues. However, they can speak with a doctor to ensure they help manage Crohn’s and other conditions effectively.
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