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Visceral hypersensitivity in Crohn's disease and ulcerative colitis
Learn how visceral hypersensitivity affects pain, nerve signaling, and gut-brain communication in Crohn's disease and ulcerative colitis, even during periods of remission.
Living with Crohn's disease or ulcerative colitis often involves more than visible inflammation in the digestive tract. Many people experience ongoing abdominal pain, cramping, bloating, or digestive discomfort even when inflammation appears mild or well-controlled. One reason for this may be something called visceral hypersensitivity.
Visceral hypersensitivity refers to increased sensitivity in the internal organs, especially the digestive system. In people with inflammatory bowel diseases (IBD) like Crohn's disease and ulcerative colitis, the nerves in the gut can become overly reactive after repeated inflammation or irritation. As a result, sensations that might normally feel mild (or go unnoticed) can become painful or uncomfortable.
Researchers continue studying how gut inflammation, nerve signaling, and communication between the gut and brain contribute to these symptoms. Understanding visceral hypersensitivity may help explain why digestive discomfort sometimes persists even when inflammation improves.
What is visceral hypersensitivity?
The word "visceral" refers to the internal organs, including the stomach and intestines. Visceral hypersensitivity happens when the nerves connected to these organs become more sensitive than usual. Normally, the digestive system constantly sends signals to the brain about things like stretching, digestion, and movement through the intestines. Most of these signals stay below conscious awareness, but when visceral hypersensitivity develops, the nervous system may begin reacting more strongly to normal digestive activity.
Some people who experience visceral hypersensitivity may experience normal digestive sequences, like gas moving through the intestines, mild stretching in the digestive system after eating, or normal bowel contractions may suddenly feel painful, uncomfortable, or urgent. Some people describe this as feeling like their gut is "overreacting" to everyday digestion.
Visceral hypersensitivity is commonly discussed in conditions like irritable bowel syndrome (IBS), but it can also play a role in Crohn's disease and ulcerative colitis. Inflammatory bowel diseases involve chronic inflammation in the digestive tract, and repeated inflammation may affect how nerves process pain and sensory signals over time.
How inflammation affects gut nerves
Inflammation does not only affect tissues in the digestive tract. It can also affect the nerves that help regulate sensation and communication throughout the gut. During active inflammation, the immune system releases chemicals that help fight injury and infection. While these immune responses are important, they can also make nearby nerves more sensitive. Repeated inflammation may lower the threshold for pain signals, meaning the nervous system begins reacting more strongly to stimulation that would not normally feel painful.
Over time, this process can change how pain signals are transmitted between the gut and the brain. Some researchers believe inflammation may essentially "train" the nervous system to stay on high alert, even after inflammation decreases.
This may help explain why some people with Crohn's disease or ulcerative colitis continue experiencing abdominal pain despite improvements in lab work, imaging, or endoscopy results. The digestive tract itself may appear less inflamed, but the nervous system may still be reacting as though irritation is present.
Inflammation can also affect the protective lining of the intestines, gut bacteria, and the movement of food through the digestive tract. Together, these changes may contribute to bloating, cramping, urgency, and discomfort.
The gut-brain axis and digestive symptoms
Researchers now know that the gut and brain are closely connected through a communication network often called the gut-brain axis. This connection involves the nervous system, immune system, hormones, and gut microbes all working together to share information between the digestive tract and the brain. The gut contains millions of nerve cells, sometimes referred to as the "second brain," because of how extensively it communicates with the central nervous system.
When inflammation, stress, or digestive irritation occurs, signals travel back and forth between the gut and the brain. In some cases, this communication system can become more sensitive over time. Stress and emotional health may also influence digestive symptoms through the gut-brain axis. Many people notice that anxiety, chronic stress, or emotional distress can worsen abdominal pain or digestive discomfort. This does not mean symptoms are "all in your head." Instead, it reflects the strong biological connection between the nervous system and the digestive tract.
Researchers believe the gut-brain axis may help explain why some people continue experiencing pain even during periods of remission. The brain and nervous system may continue amplifying digestive sensations, especially after long periods of inflammation or symptom flare-ups. Sleep disruption, stress, and anxiety may further increase sensitivity within this system, potentially making digestive symptoms feel more intense.
Active inflammation vs. ongoing sensitivity
One of the more confusing aspects of Crohn's disease and ulcerative colitis is that symptoms do not always perfectly match inflammation levels. During active flare-ups, inflammation can directly damage tissue and trigger symptoms like diarrhea, bleeding, cramping, fatigue, and pain. In these situations, treating inflammation is a major priority because uncontrolled inflammation can lead to complications over time.
However, some people continue experiencing abdominal pain or digestive discomfort even when tests show reduced inflammation or remission. In these cases, visceral hypersensitivity may be contributing to symptoms. This distinction is important because pain does not always mean severe inflammation is present. A person may still experience very real digestive discomfort due to heightened nerve sensitivity, changes in gut signaling, or altered communication along the gut-brain axis.
At the same time, ongoing symptoms should never be ignored or automatically dismissed as sensitivity alone. Crohn's disease and ulcerative colitis can still cause active inflammation, strictures, infections, or other complications that require medical treatment. Healthcare providers often use blood tests, stool tests, imaging, and endoscopy to better understand whether symptoms are related to inflammation, sensitivity, or a combination or both. Understanding the difference between inflammation and hypersensitivity may help patients and providers make more informed treatment decisions.
Why symptoms can persist after inflammation improves
The nervous system does not always "reset" immediately after inflammation decreases. Similar to how an injury can leave an area temporarily more sensitive while healing, inflammation in the digestive tract may leave lasting changes in nerve signaling.
Researchers believe repeated flare-ups may gradually increase sensitivity within both the gut and the central nervous system. This process is sometimes called sensitization. Over time, the digestive system may become more reactive to normal sensations like stretching, pressure, or bowel movement activity.
Changes in the gut microbiome may also play a role. Inflammation can alter the balance of bacteria in the digestive tract, and these microbial changes may influence immune activity, nerve signaling, and communication with the brain. For some individuals, this may create a cycle where inflammation increases sensitivity, sensitivity increases symptom awareness, and stress surrounding symptoms further amplifies gut discomfort. This doesn't mean that symptoms are psychological or imagined. The pain and discomfort are real. Rather, it highlights how digestive symptoms can involve multiple overlapping systems beyond inflammation alone.
Managing symptoms and supporting gut health
Treatment for Crohn's disease and ulcerative colitis usually focuses heavily on reducing inflammation, but symptom management may also involve addressing nerve sensitivity and gut-brain interactions.
Lifestyle habits that support overall digestive health may help some people better manage symptoms alongside medical treatment. Stress management techniques, regular physical activity, sleep support, hydration, and nutrition may all influence how the gut and nervous system function together. Some patients benefit from approaches that target both digestive symptoms and nervous system regulation, including behavioral therapies, mindfulness-based stress reduction, or dietary adjustments recommended by healthcare providers.
It's also important for patients to communicate openly with their care providers, even during remission. Persistent pain or digestive discomfort should always be evaluated to rule out active disease or complications. Researchers continue learning more about visceral hypersensitivity and the gut-brain axis in inflammatory bowel disease. As understanding grows, these insights may help improve how Crohn's disease and ulcerative colitis symptoms are managed in the future.
While inflammation remains a central part of IBD, it is increasingly clear that the nervous system, brain, immune system, and digestive tract all work together in complex ways that influence how symptoms are experienced.
Evidation and your health journey
Whether you're dealing with digestive health issues or are simply working to feel your best, Evidation can help. When you download the Evidation app, you'll be prompted to share the health data you're already tracking. We'll use the information you choose to share to help you find patterns, provide insights, and offer personalized, content-based material to help you move your health forward. Click here to get started with Evidation today.
8 Fresh Summer Ideas
Don’t let summer pass you by this year! We chatted with our team and consolidated some of our favorite activities.
Don’t let summer pass you by this year! We chatted with our team and consolidated some of our favorite activities.
- Connect with brainy folks all around the world with Atlas Obscura’s Trivia Night! Rally together a virtual team and participate for $7.
- Celebrate Blues Artist Mavis Staples and listen to other folk artists including Brandi Carlile, Jason Isbell, Ben Harper, and Phoebe Bridgers for a Livestream concert. Tickets cost $12. Tune in this Friday, July 31st at 8:30pm EST.
- Join host Saleem Reshamwala as he goes on global expeditions and learns from people around the world who are creatively working to make their communities better. Tune into this Ted podcast to transport to another world virtually in the absence of travel.
- Host a virtual book club with friends. The benefit of talking about your latest read via Zoom or video chat is that you can connect with friends across time zones.
- Jump on the geocaching bandwagon. We recently heard from some Achievers that they’ve been geocaching with their family members for an active, outdoor treasure hunt.
- Make a box fort/cat castle for your cat children if you’re a cat mom or dad. :)
- Set up a socially distanced front yard hang! Dust off your lawn chairs and pick up some of your favorite snacks and head outdoors.
- Choose a road trip and safely travel to a closeby spot! Know you’re not alone in opting for a road trip as a staycation during these unusual times. Read up on some of the best road trips in America.
- Host your very own hot sauce competition with your “quaranteam.” Find some new hot sauces you’ve always wanted to try online and order them in to have a mini hot sauce competition. Pro tip: the Heatonist has some of our favorites.
- Channel your inner artist with a paint by number kit. Tune into a favorite playlist and enjoy a leisurely weekend art hour.
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Representation in Research Matters
We’re collaborating with BlackDoctor.org to ensure that the effects of COVID-19 are investigated in a representative population.
Historically, minorities have been inadequately represented in research studies. We’re committed to enrolling a more diverse and representative population in Evidation for studies.
We’re collaborating with BlackDoctor.org to ensure that the effects of COVID-19 are investigated in a representative population.
We, in partnership with BlackDoctor.org and Myovant Sciences, have launched Forward Momentum, a cross-sector coalition working to improve the lives of men with prostate cancer. Forward Momentum is committed to addressing the complex set of challenges that hold back the representation, information, and conversations that all men deserve. By bringing together organizations from diverse sectors and investing in novel digital initiatives, Forward Momentum strives to accelerate progress for men with prostate cancer.
Stay tuned for more updates from us on these research efforts!
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Hear from Us About the Future of Health
Evidation partners with the world’s leading healthcare companies and enables everyone to participate in research.
Our CEO, Deborah Kilpatrick, recently spoke on a podcast about the importance of everyday behavior data and the future of health. After working in the medical technology space, she joined Evidation Health in 2014. Evidation partners with the world’s leading healthcare companies and enables everyone to participate in research. We’re focused on helping people measure everyday activities. We’re also invested in connecting our community to opportunities that will help them better understand the conditions that impact them and their loved ones. Listen more on this podcast here.
Together We Can Achieve More
At Evidation, we’re focused on meeting people where they are and helping them along their health journey.
At Evidation, we’re focused on meeting people where they are and helping them along their health journey. Our engaged community of members represents 96% of U.S. counties and includes individuals across ages, ethnicities, and socioeconomic backgrounds. This community puts us in a unique position to learn from one another and contribute to meaningful health research.
With a mission of helping people participate in better health outcomes, we're committed to identifying opportunities that are inclusive of all and educating ourselves on the social issues that are impacting the world. To truly achieve our mission of helping people participate in better health outcomes, we recognize we have more work to do. Our commitment going forward:
- Provide our members with educational content around health and race curated by our team of researchers.
- Put in place more inclusive study opportunities for members to participate in.
- Do our part as a research company to participate in inclusive clinical research practices to ensure diverse and generalizable results through diverse participant recruitment and participation.
- Hold ourselves accountable by reporting our progress out to our members.
We’re committed to supporting long-term systematic change and stand in solidarity with our Black teammates, Evidation Members, and the entire Black community. We know this is only the beginning of the conversation, and we need to continue to fight for equality. We’ll continue to listen, educate ourselves, take action, hold ourselves accountable, and pledge to do our best to support all communities to participate in better health outcomes.
An immediate change we’re pleased to share is that Evidation Members can now donate their rewards to these charities:
American Civil Liberties Union
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Evidation Health and BARDA Partner on Early Warning System for COVID-19
On June 4th, Evidation Health announced a new effort to develop an early warning algorithm to detect symptoms of COVID-19 and to understand susceptibility to infection, funded by the Biomedical Advanced Research and Development Authority (BARDA), part of the Office of the Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services (HHS) and the Bill & Melinda Gates Foundation.
Here at Evidation, we’ve been identifying opportunities to contribute to COVID research. THe Evidation app is a product of Evidation Health, and has a community of over 3 million and members all around the United States. With an engaged research population representing a variety of zip codes and demographics, we’re uniquely positioned to help researchers and organizations conduct meaningful research about the pandemic.
On June 4th, Evidation Health announced a new effort to develop an early warning algorithm to detect symptoms of COVID-19 and to understand susceptibility to infection, funded by the Biomedical Advanced Research and Development Authority (BARDA), part of the Office of the Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services (HHS) and the Bill & Melinda Gates Foundation.
“Many infected individuals are asymptomatic but still able to spread the virus, making efforts to prevent and slow transmission of COVID-19 difficult,” said Luca Foschini, Ph.D., Evidation’s co-founder and chief data scientist. “This initiative will use novel behavioral and physiological data to more effectively identify when and where people may contract COVID-19, and can potentially enable real-time interventions to limit spread and monitor outcomes.”
The analysis, performed in collaboration with non-profit 4YouandMe, will use de-identified data generated by self-reporting and wearable devices to track symptoms of COVID-19 in those at particularly high risk, including health care workers and other first responders, in order to better understand susceptibility to SARS-CoV-2 infection. One potential outcome of this work is an early warning algorithm to help individuals better understand and monitor their respiratory disease symptoms and take precautions against their spread.
“The ability to self-monitor and be informed of health status will empower Americans in their decisions to help slow the spread of this pandemic and improve health outcomes for people with COVID-19,” said BARDA Acting Director, Gary Disbrow, Ph.D. “This pilot study is not only an early step in demonstrating the utility of models developed using person-generated health data but also may provide data to better understand the varied symptoms of COVID-19.”
This program follows Evidation’s work with BARDA to monitor individuals for respiratory infections, such as influenza. Evidation’s existing research on influenza utilizes person-generated health data and population-based models with the goal of improving real-time respiratory infection monitoring at the individual and population level. BARDA is contributing a $720,000 award as part of BARDA’s COVID-19 Rapidly Deployable Capabilities program to identify and pilot near-term innovative solutions for COVID-19. Support from the Bill & Melinda Gates Foundation is from the $250 million the foundation has committed to address the COVID-19 pandemic.
How Evidation Members Rallied Together Through COVID Pulse Survey
Through this challenging time, we we've been inspired by our members who responded to many questions with great empathy and creativity as they have adapted to new routines
We’ve been continuing to monitor sentiment in the community around the coronavirus through an Evidation Survey called COVID Pulse. Since kicking off the survey on March 12th right after the coronavirus was declared a pandemic, we’ve been sending out a weekly survey to our members.
We wanted to quantify participation and interest and share some of the latest trends from our most recent surveys. After we released the first survey, we received over 120,000+ responses in five days from over 20,000 United States zip codes. The highest percentage of responses came from the age groups in the range of 30–39, followed by the 18–29 age range, and lastly, the 40–49 range. Though, we did see representation from members ages 18–80+! We’ve been pleasantly surprised by the number of members who have continued to check in week over week to share their sentiment surrounding coronavirus. In fact, 11% of survey respondents have completed all five COVID Pulse Surveys to date and 22%+ completed four out of five COVID Pulse Surveys.
Most recently, we saw that over 85% of respondents said that if social distancing and stay at home orders were lifted today, they would know what to do to reduce chances of contracting the coronavirus. We also saw that members would continue to take the necessary precautions even if social distancing guidelines and stay at home orders were lifted. Over 60% would continue to stay at home and maintain social distancing behaviors. Additionally, nearly 70% said they would continue to start to wear protective equipment (for example a face mask) in public settings. For those who responded in locations where shelter in place has been lifted, only ~25% of respondents said that they were attending small social events.
Through this challenging time, we were also inspired by our members who responded to many questions with great empathy and creativity as they have adapted to new routines. In fact, when asked about their concerns if they were to be diagnosed, 75% of respondents expressed concern over getting others sick in their worries. This fear was followed by 60% of respondents expressing their worry over the physical discomforts of getting sick. Regarding ways to minimize changes to physical and mental health, we’ve seen an uptick in individuals sharing the importance of maintaining whatever routines possible, avoiding or taking breaks from the news, and a continued connection through video chats with friends and family. In fact, maintaining connection through social media scored high for Evidation Members as a method to socialize with others. Both last week and this week, 70% of respondents said they used social media to socialize with other people.
Get Your Cooking Game On
We know that being stuck indoors can be tough, but hopefully getting creative in the kitchen continues to be a fun pastime for many.
As we continue to be home during the coronavirus, we wanted to share another collection of snack ideas that you can make at home. We know that being stuck indoors can be tough, but hopefully getting creative in the kitchen continues to be a fun pastime for many.
- Try your hand at making a sweet or savory dip at home! Check out this greek cucumber yogurt dip from the Today Show or this three ingredient Healthy Honey Mustard Dip from the blog Cupcakes and Kale Chips.
- Experiment with no-bake bars like this No Bake Chocolate Oat Bar from All Recipes.
- Make your own cup of Dalgona Coffee (the Coronavirus trend that’s bringing out everyone’s internal barista)
- Test out the dessert that’s on the rise — make this three ingredient crème brûlée.
- Bring Disneyland to your home with Disney’s official homemade churro recipe.
- In the absence of a trip to Benihana’s, learn how to make this chicken fried rice at home.
- Check out Wacky cake. It’s an old favorite that came from the Depression when there was less access to ingredients. This cake only takes a few, simple ingredients.
- Have some Nutella handy in your pantry? Make these DIY Nutella pops with two other ingredients and a popsicle stick.
- Eat breakfast like one of the royal family by trying out Prince Charles’ famous cheesy baked eggs
- If you’re feeling fancy, you can also give Queen Elizabeth’s drop scones a try.
Oura Ring + Evidation = Match Made in Heaven
We know a big part of your Evidation experience is connecting apps and wearables to your account. Did you know here are more than 15 apps you can connect to help you earn points faster?
We know a big part of your Evidation experience is connecting apps and wearables to your account. To date, there are 15+ apps that you can connect to Evidation to track different activities that you take. For a reminder of which apps are available and where you can connect these apps to your experience, check out the Connect Apps page here.
We’re pleased today to share that the Oura Ring is now available to connect to Evidation. To connect your OURA ring and app, please follow these directions below:
- Log into the Evidation app or website > middle tab (apps section)
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2. Connect > Oura > Log in to OURA account
Note: it may take a few minutes to sync. If the app shows ‘not yet synced’
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Please go back to the middle tab and click down to refresh the app. If all dates did not retroactively sync, we recommend to disconnect the app from Evidation and reconnect.
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Can a furry friend help you cope with COVID?
You may be wondering, can owning a dog help you live a bit healthier? It turns out that new dog owners in general are a promising sign of better health!
We know that the last few months have put everyone into a new funk. Work, lifestyles, and exercise are all uniquely different than they may have been back when 2020 started.
That’s why we decided to look at how Evidation Members were resting and perhaps coping with some of these changes. To better understand our community, we decided to look at members who logged fitbit data in 2019 and 2020 between January and April to see if the pandemic was causing people to change up their nap schedule (hopefully for the better). Total number of naps per user per day were counted and the average nap count per day was calculated across our Evidation population. See the figure below:
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It appears that members are indeed napping far more than they were in 2019, beginning at about the time shelter in place orders began (which was around March 15, 2020, see grey in graph). On average, after shelter in place began, Evidation Members napped 14.37% more compared to the previous year during this time period. That’s many more naps! And hopefully, people are using this time to rest and recuperate.
We know that being mindful of sleep is one way people can take care of their health. However, we also observed in the news that fostering dogs has been at an all time high. It has become so popular that there’s even a waitlist.
So, in addition to users napping far more compared to last year, we delved more into what other things users are doing differently during this uncertain time. We released a survey a few weeks ago asking our members about their dogs, what type of relationship they have with their pets, and their activity habits with their pets. We received over 35,000 responses!
The first thing we wanted to know about our members and their pets was whether they had recently fostered a dog. It turns out that many people have begun to foster dogs, likely due to the pandemic. In total, 1,500+ Achievers indicated that they fostered their dog in between February and April of this year. Compare that to only 450+ Achievers during that time period last year. It definitely appears that the pandemic is causing people to go out and lend a helping hand to a homeless dog.
Of the people who recently fostered a dog, 55% indicated that they are now working from home due to the coronavirus. 39% said that they are still going into work, and 5% indicated that they had worked at home prior to the pandemic. These newly remote workers appear to be helping keep these shelters empty.
You may be wondering, can owning a dog help you live a bit healthier? It turns out that new dog owners in general are a promising sign of better health! For those that got their dog in 2019 or 2020, we found that members walk on average about 350 steps more per day, comparing the 30 days prior to getting a dog with the 30 days post getting a dog. Even in pandemic times (though members are walking far less than their 2019 dog owner counterparts, by about 1000 steps per day for those that got their dogs in March and April), members with new dogs are getting a 200 step increase in steps pre vs post dog ownership! Of course, this is expected, and we’re happy to report that dogs can help you get more steps. This trend turned out to be especially true for the older folks in our population. The 50+ population increased their steps by about 500 steps on average, compared to the ~200 step increase for those who are less than 50. Take a look:
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Another interesting question we asked our members was whether or not they sleep with their pets and how often per week they sleep with their pets. While we didn’t see a necessary difference in sleep quality or total time when our members had their dog buddies snoozing with them, we did see many people report that they sleep next to their dogs. In fact, 73% of Evidation Members said they nap or sleep next to their dog, at least once per week. For members who said they nap or sleep next to their dog, over 19,000 reported to nap or sleep next to their dog at least 4 times a week! This may sound surprising for the folks who may not have furry pals, but many can attest that sleeping next to their dogs can be a comforting ritual.
The last thing we wanted to explore was whether we could learn anything about our members who had reported that having a dog had helped them manage with their health-condition (heart condition, limited mobility, etc). We found that 1000+ members agreed that having a dog helped. It seemed as though having a furry friend was very helpful for emotional support and well being. We did not find any concrete information around managing conditions, but were glad to hear that those who had self reported with many conditions (specifically anxiety, asthma, chronic pain, depression, diabetes, high cholesterol, hypertension and migraines) and who had a higher resting heart rate found having a pet to be supportive.