Can Crohn’s Disease Cause Tingling in the Hands or Feet?

Yes, tingling (paresthesia) in the hands or feet can occur in people with Crohn’s disease, though it is not among the most common intestinal symptoms. ^[1] It typically arises from several indirect mechanisms related to Crohn’s especially nutrient deficiencies, treatment side effects, and immune or inflammatory nerve involvement rather than from gut inflammation alone. ^{[1] [2]}

---

Key Mechanisms

Several mechanisms can contribute to tingling and numbness, and more than one may be present at the same time. ^[2]

• Vitamin B12 deficiency (malabsorption): Crohn’s often affects the terminal ileum, the part of the small intestine where vitamin B12 is absorbed, which can lead to deficiency and nerve damage. ^[1] B12 deficiency can cause subacute combined degeneration of the spinal cord and peripheral neuropathy, presenting with tingling and numbness and progressive weakness. ^{[3] [2]}

• Folate deficiency: Folate is absorbed in the small intestine, and deficiency can cause a sensory polyneuropathy with tingling; in some cases, neuropathy and low folate have preceded the diagnosis of Crohn’s. ^{[4] [2]}

• Medication-induced neuropathy (metronidazole): Long-term or high-dose metronidazole, sometimes used for Crohn’s complications, can cause a sensory polyneuropathy and other neurologic effects that typically improve after stopping the drug. ^[2]

• Autoimmune or inflammatory neuropathy: Beyond deficiencies or drugs, Crohn’s has been associated with symmetrical distal sensory neuropathy and mononeuritis multiplex, likely reflecting immune-mediated nerve injury. ^{[5] [2]}

• Post-surgical malabsorption and short bowel: Surgical removal of segments of small intestine for Crohn’s can cause short bowel syndrome, leading to malnutrition and deficiencies that contribute to neuropathy and leg symptoms. ^[6]

---

How B12 and Folate Deficiencies Cause Tingling

B12 and folate are essential for nerve health and myelin maintenance; deficiencies can damage both peripheral nerves and the spinal cord. ^[3] B12 deficiency can produce abnormal sensations (tingling and numbness) and weakness that often start in both feet and hands and worsen over time if untreated. ^[3] Folate deficiency can similarly lead to sensory polyneuropathy manifesting as tingling in the feet and hands. ^[4] In Crohn’s, malabsorption due to ileal disease, inflammation, or surgeries increases the risk of these deficiencies. ^{[1] [6]}

---

Medication Effects: Metronidazole

Metronidazole-related neuropathy is a well-known, dose-dependent side effect. ^[2] With prolonged use, 10–50% of people can develop sensory polyneuropathy, typically after cumulative doses above certain thresholds; symptoms usually improve gradually once the drug is stopped. ^[2] Neurologic effects can include confusion or cerebellar signs in high doses as well, though tingling and numbness are more common peripheral features. ^[2]

---

Autoimmune/Inflammatory Neuropathy in Crohn’s

Peripheral neuropathy may occur in Crohn’s independent of B12 deficiency or metronidazole exposure, suggesting immune or inflammatory mechanisms. ^[5] Case descriptions include recurrent, predominantly sensory distal neuropathy that fluctuates with Crohn’s activity, with nerve studies showing axonal degeneration. ^[5] Reviews note patterns such as symmetrical sensory neuropathy and mononeuritis multiplex linked to immune processes. ^[2]

---

Other Contributing Factors

General malnutrition and multiple deficiencies can coexist in Crohn’s, especially with active disease or after surgery. ^[1] Short bowel syndrome from resections increases risk of malabsorption of micronutrients (including B12 and folate), which can lead to neuropathic symptoms in the legs and feet. ^[6]

---

Red Flags and When to Seek Care

Seek medical attention promptly if tingling is accompanied by progressive weakness, gait problems, bladder changes, or sudden onset of severe symptoms, as these can signal spinal cord involvement or significant neuropathy. ^[3] It is important to evaluate for reversible causes, especially vitamin deficiencies and medication effects, because timely treatment can prevent permanent nerve damage. ^{[3] [2]}

---

Practical Evaluation Steps

A focused workup can identify treatable causes of tingling in Crohn’s:

• Check vitamin levels (B12, methylmalonic acid, homocysteine, folate) and consider other nutrients (e.g., copper) if suspicion remains after initial tests. ^[2]
• Review medications for neurotoxic risk, particularly metronidazole dosing and duration. ^[2]
• Consider disease activity and recent surgeries that may suggest malabsorption or short bowel. ^{[1] [6]}
• Neurologic exam and, if needed, nerve conduction studies to characterize neuropathy pattern (sensory vs motor, axonal vs demyelinating). ^{[5] [2]}

---

Treatment and Prevention

Addressing the underlying cause typically improves symptoms:

• Replace deficient vitamins (parenteral B12 injections if ileal disease or resections limit absorption; oral or parenteral folate as indicated). ^{[3] [2]}
• Adjust or discontinue neurotoxic medications, in consultation with your clinician. ^[2]
• Optimize Crohn’s control to reduce inflammation and improve nutrient absorption. ^[1]
• Nutritional support for short bowel or malabsorption (dietary counseling, supplements, or specialized formulas) to prevent recurrent deficiencies. ^[6]

---

Summary

Tingling in the hands or feet can occur in Crohn’s disease, most commonly due to vitamin B12 or folate deficiencies, medication effects like metronidazole, and less commonly immune-mediated neuropathies. ^{[1] [3] [4] [2]} Evaluating for deficiencies, reviewing medications, and considering inflammatory activity or surgical history helps identify the cause, and targeted treatment often leads to improvement. ^{[1] [6] [2]}