Crohn’s Flare: Symptoms, Causes, When to Go to the Hospital

Crohn’s disease is a type of inflammatory bowel disease that causes inflammation in the gastrointestinal tract. It is a chronic condition that fluctuates between periods of remission and heightened symptoms.

When symptoms are active, it is referred to as a flare-up, or flare. The frequency and severity of flares depend on the individual’s case of the disease and how well they avoid triggers.

This article discusses the signs of a Crohn’s flare and when to go to the hospital.

Symptoms of a Crohn’s Flare

The severity of Crohn’s disease varies from mild to severe in different people. People do not always have symptoms of Crohn’s disease when it is in remission. However, some symptoms can be chronic but suddenly worsen, causing a flare.

Crohn’s is an unpredictable disease that requires lifelong management. Over the course of an individual’s disease, they may experience many flare-ups.

The more common signs and symptoms of a flare are diarrhea and abdominal pain with cramping. Other symptoms include:

• Reduced appetite
• Weight loss
• Mouth sores
• Joint pain
• Drainage around the anus
• Fatigue
• Bloody stool

The severity and duration of a flare depends on the individual. Symptoms can last anywhere from a few days to months.

Over time, symptoms change and get worse, especially without maintenance medication. To understand your disease and its progression, you need to regularly track and discuss your symptoms with your healthcare provider.

Several factors may trigger a flare and the severity of the symptoms, including:

• Missed medication: People who have Crohn’s disease take medication to keep symptoms at bay and prevent flares. If a person misses a dose or changes the medication, then they might experience a flare. It is essential to take prescribed medication as directed.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs include ibuprofen, naproxen, and aspirin, among others. They do not cause Crohn’s disease, but these medications may lead to inflammation of the bowel, making symptoms of Crohn’s disease worse. People with Crohn’s disease should take acetaminophen for mild to moderate pain and fever associated with other problems.
• Antibiotics: When a person takes an antibiotic for one type of infection, the antibiotic eliminates bacteria in other parts of the body as well. Changes in the balance of bacteria that normally live in the intestine can cause diarrhea and lead to a Crohn’s flare.
• Smoking: Smoking is a strong risk factor for developing Crohn’s disease, and it can also lead to a Crohn’s flare. People with Crohn’s disease who smoke tend to have more severe disease activity and more frequent flares.
• Stress: Stress does not cause Crohn’s disease, but stressful and emotional situations impact the frequency and severity of Crohn’s disease flares.
• Diet: No specific diet prevents Crohn’s disease and associated flares, but certain foods tend to worsen some symptoms. While aggravating foods are different for everyone, generally during a flare it’s best to avoid dairy, greasy and fried food, foods that tend to cause gas like beans, and foods high in fiber like raw vegetables. During a flare, it’s also vital to maintain a balanced diet with appropriate fluids and electrolytes. Instead of eliminating certain foods, it might help to eat thoroughly cooked fruits and vegetables or eat smaller, more frequent meals.
• Alcohol: Drinking alcohol tends to make symptoms of a Crohn’s flare worse.

When to See a Doctor

Symptoms of a Crohn’s flare can be highly variable and depend on the severity of illness. Always discuss any new or worsening symptoms with your healthcare provider.

If you know your disease and body well and only have mild symptoms like diarrhea and bloating without fever, you may be able to manage your symptoms at home.

However, it’s best to see a healthcare provider if you have any of the following symptoms: 

• Significant abdominal pain
• Blood clots in your stool
• Vomiting with an inability to eat
• Fever above 100.4 F
• Significant weight loss
• Diarrhea that doesn’t respond to over-the-counter remedies

Complications

You should visit your healthcare provider or go to the hospital if you experience any signs and symptoms of complications associated with Crohn’s disease.

The most common complications include:

• Bowel obstruction: Over time, the chronic inflammation of Crohn’s disease leads to scarring and narrowing of the intestine. A bowel obstruction is when digested food cannot pass through a narrowed portion of the bowel. Symptoms include abdominal expansion, significant pain, and vomiting.
• Fistula: A fistula is an abnormal connection between the intestine and another body part. In Crohn’s disease, the intestine might connect to the bladder, vagina, or skin, but it most often occurs near the anal area. Food and digested material can exit through a fistula and lead to infection.
• Abscess: People with Crohn’s disease can develop an abscess (pocket of pus) near the intestines and anus. A perianal or perirectal abscess is a tender, red, swollen area near the anus or inside the rectum. If you suspect you are developing an abscess, seek care in an emergency department or hospital.
• Anal fissures: These are small tears or breaks in the anus that can cause pain, itching, or bleeding.
• Colon cancer: People with Crohn’s disease have a higher risk of developing colon cancer.

Crohn’s disease can also cause issues and complications outside the gastrointestinal tract. People can develop joint arthritis, inflammation of the eye (uveitis), issues with the gallbladder, kidney stones, and certain types of rashes.

Discuss any new symptoms or concerns with your healthcare provider.

How to Treat a Crohn’s Flare

When you are experiencing a flare, your healthcare provider may want to pursue further testing or change your treatment regimen. You might also work together to determine a flare trigger to reverse the symptoms.

If the flare is mild and your healthcare provider doesn’t see a need to run diagnostic tests or change your medication, they might recommend using over-the-counter and home remedies to improve your discomfort. These can include:

• Practice good anal hygiene. To reduce anal irritation, use moist wipes instead of bathroom tissue.
• Apply over-the-counter skin ointments, like Desitin, to relieve skin irritation.
• Bathe in warm sitz baths.
• Control profuse diarrhea with over-the-counter medications like Imodium or Pepto-Bismol. However, you should discuss the usage of these medications with your healthcare provider first.
• Treat pain with acetaminophen instead of NSAIDs.
• Use over-the-counter numbing mouthwashes for mouth sores.
• Take an over-the-counter multivitamin or mineral supplement to treat electrolyte problems from diarrhea and decreased appetite.

Sometimes your healthcare provider will change your medication to treat a Crohn’s flare. The medication primarily used to treat a mild to moderate Crohn’s flare is a corticosteroid (an anti-inflammatory drug) like prednisone. Corticosteroids should not be used for maintenance therapy since they have significant long-term side effects.

The other medications used to manage a Crohn’s flare depend on the severity of the change from your baseline disease, the current treatment regimen, and whether you have developed resistance to your treatment.

Your healthcare provider’s goal is to control the inflammation in the intestine, which will influence your symptoms and prevent Crohn’s disease complications.

Other medications may include:

• 5-aminosalicylates (5-ASA): Sulfasalazine and mesalamine are anti-inflammatories that are effective for treating mild to moderate Crohn’s disease.
• Antibiotics: Some people think that diarrhea associated with Crohn’s disease is due to an overgrowth of bacteria and that antibiotics will help to treat the inflammation. However, antibiotics such as metronidazole and ciprofloxacin have not been shown to improve Crohn’s flare symptoms. Antibiotics should only be used to treat complications of Crohn’s disease, such as abscesses and peritonitis.
• Immunomodulators: Immunomodulators are a group of medicines that modify the immune response, which contributes to intestinal inflammation. Examples of these medications include azathioprine, 6-mercaptopurine, and methotrexate. These medications are helpful for moderate to severe Crohn’s disease, and your healthcare provider can combine them with other therapies.
• Biologics: Biologics are antibodies created in a laboratory that decrease and prevent intestinal inflammation. Unlike corticosteroids and immunomodulators, certain biologics focus only on intestinal inflammation rather than the entire body. These medications can include infliximab, adalimumab, certolizumab, vedolizummab, and more.

Summary

Crohn’s disease is a chronic illness that causes inflammation throughout the digestive tract. It is associated with common symptoms, like abdominal pain and diarrhea, but can lead to more severe symptoms during a flare-up. There are ways to manage Crohn’s disease symptoms at home, but severe symptoms may require a visit to your healthcare provider or the emergency room.

A Word From Verywell

Chronic illnesses with fluctuating symptoms like Crohn’s disease can be difficult to manage, but it’s important to not let them dictate your life. There are many ways to manage symptoms while at home, and several maintenance medications can help keep flares inactive. Crohn’s disease requires you to have a strong support network, as well as an open relationship with your gastroenterologist or healthcare provider.