How to Handle a Crohn’s Flare-Up

Crohn's disease is a form of inflammatory bowel disease (IBD) that affects the body's digestive system, causing inflammation and irritation in the bowel and large intestine (colon). This results in symptoms like abdominal pain, cramping, severe diarrhea, weight loss, bloody stools, and fever.

Crohn's disease goes through periods of remission and periods in which the symptoms and inflammation suddenly reactivate, known as flare-ups (or flares). Flare-ups aren't always predictable, but they can be managed and treated with medication, dietary adjustments, and surgery.

This article provides an overview of Crohn’s disease flare-up symptoms and the various treatment options available.

What Triggers a Crohn's Flare-Up?

Crohn's flare-ups occur when symptoms reappear. Some factors that may trigger a flare-up include:

• Missing or mismanaging medication (skipping a dose or taking the wrong dose of prescribed medication)
• Taking nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin and ibuprofen
• Stress (physical or emotional)
• Smoking
• Taking antibiotics, which can cause diarrhea and inflammation

Eating specific foods do not cause flare-ups, but they can make them worse if they irritate the digestive system.

Symptoms

Monitoring your symptoms can help you recognize and manage your Crohn's disease flare-ups.

Flare-up symptoms will vary based on the severity of each Crohn's case and the exact part of the digestive tract it affects, but common signs of a Crohn's flare-up include:

• Frequent or urgent bowel movements
  
• Diarrhea
• Bloody stool
• Abdominal pain and cramping
• Nausea and vomiting
• Weight loss
• Fatigue
• Loss of appetite
• Joint pain
• Fever

Crohn's symptoms can worsen as the disease progresses. But having a Crohn's flare doesn't automatically mean that your Crohn's disease is getting worse. Your healthcare provider can help determine whether the flare is due to an infection, a change in your body's response to medications, stress, antibiotic use, or another cause.

Treatment Options

Crohn’s disease is chronic, which means that it is a long-term condition requiring ongoing care. While there’s currently no cure, it can be managed with ongoing treatment.

Treatment options for Crohn's flare-ups can include:

• Medications
• Diet modifications
• Lifestyle adjustments
• Surgery

The goal of treatment is to get the flare under control.

Medications

Although medications do not cure Crohn’s, they can provide symptom relief during a flare-up.

Some prescription medication options include:

• Corticosteroids help quickly reduce whole-body inflammation during flares. They're usually recommended for short-term use, as long-term use can cause potentially serious side effects like high blood pressure, glaucoma (eye conditions that damage the optic nerve), and osteoporosis (brittle bones).
• Aminosalicylates can help control inflammation on an ongoing basis, particularly in more mild cases of Crohn's. This class of medications can cause side effects like diarrhea, vomiting, and heartburn.
• Biologics help target the immune system inflammatory response, typically prescribed for patients with moderate-to-severe Crohn's disease who haven't responded to other forms of treatment. Common side effects include headache, fatigue, diarrhea, upper respiratory tract infection, and rash.
  
• Immunomodulators are a certain type of biologic drug (made from the cells of a living organism) that help cut down on inflammation. They're typically prescribed for people who have not responded to aminosalicylates or corticosteroids. Side effects can include fatigue, nausea, vomiting, pancreatitis, kidney impairment, and an increased risk of infection.
  

Over-the-counter (OTC) drug treatment options for Crohn’s disease may also be used to help treat mild pain and diarrhea. These include:

• Tylenol (acetaminophen) may be recommended for mild pain relief rather than NSAIDs like aspirin, Aleve (naproxen), and Advil or Motrin (ibuprofen), as NSAIDs can cause gastrointestinal bleeding and ulcers. 
• Antidiarrheal medications like Imodium (loperamide) can help slow bowel contractions and relieve short bouts of diarrhea. They're used short term under the direction of your healthcare provider, as overuse can lead to potentially serious side effects in the colon.
  

Dietary Adjustments

While a specific diet can't cure Crohn's, and there's no specific Crohn's flare-up diet, you may be able to manage flares by making some temporary changes to the way you eat. Because normal digestive processes can be stressful on your system, certain dietary adjustments can give your digestive system time to heal.

Your healthcare provider may recommend a registered dietician or nutritionist to develop a plan that works for you. Some options include:

• Low-fiber diet: High-fiber foods like raw vegetables and whole grains require your intestines to do more work. Simple, bland, low-fiber food like plain white rice, bananas, applesauce, gluten-free bread, and clear soups or broths are easier for your body to digest.
• Low-residue diet: Some foods leave less residue in your colon, leading to fewer bowel movements, which can be especially helpful during a flare. A low-residue diet involves cutting out foods like seeds, whole grains, raw vegetables, beans, cured meats, popcorn, and crunchy peanut butter. While experts say this may be one of the best ways to calm a Crohn's flare-up, you usually don't have to stick to this diet permanently.
• Liquid diet and bowel rest: In more serious circumstances, your healthcare provider may recommend temporarily consuming high-calorie liquid foods and nutritional shakes. This approach is often necessary after bowel surgery. Soft foods will later be introduced before you're able to tolerate solid foods again.
  

Surgery

Many Crohn's patients will have surgery at some point, particularly those with moderate-to-severe cases of Crohn's that involve severe bowel obstruction, excessive bleeding, an abscess (pus-filled pocket), or an intestinal rupture (a hole that develops in the wall of the intestine).

Types of Crohn's surgery include:

• Strictureplasty is a surgical technique used to widen a narrowed intestinal passage (known as a stricture).
• Bowel resection involves the removal of part of the small intestine that is affected. It’s often used when a stricture is too large to be treated with strictureplasty. 
• Colectomy is the removal of the entire colon, or the affected part of the colon. This procedure is recommended for severe cases.
• Proctectomy involves removing the rectum and the anus. This means that another way will be needed for stool to leave the body, either through reattachment of the small intestine to the anus, or through a hole in the lower abdomen (known as an ileostomy).
  

Prevention

While there's no definitive way to predict a Crohn's disease flare-up, experts recommend implementing a few lifestyle measures to encourage healthy bowel function, rather than triggering inflammation.

• Dietary adjustments: There is no scientific evidence that a poor diet causes Crohn's disease or Crohn's flare-ups. But experts say it's still helpful to avoid certain trigger foods (including fatty, sugary, or spicy foods, along with caffeine and alcohol) that could irritate your digestive system.
• Exercise: Although Crohn's symptoms may make it challenging to be physically active, research shows that making low- to moderate-impact exercise a part of your regular routine can help prevent future flare-ups.
  
• Stress management: Stress doesn't directly cause Crohn's disease, but it can impact your symptoms. This is why it's important to find stress management strategies that work for you. Some Crohn’s patients use mind-body therapies, like meditation, deep breathing, tai chi, yoga, and biofeedback, to help prevent and treat flare-ups.
• Quitting smoking: Smokers with Crohn's disease have a much higher risk of getting flares and are more likely to require aggressive immunosuppressant therapy compared to nonsmokers. If you need help quitting, your healthcare provider can recommend the smoking cessation options that are available to you. 
• Patient-physician communication: Maintaining regular communication with your healthcare provider and healthcare team can help make management and prevention of Crohn's flare-ups easier in the long run. Contact your healthcare provider at the first sign of a flare-up, because they can help identify the trigger and tweak your treatment plan as needed.
  

Summary

People with Crohn's disease experience flare-ups, during which symptoms like diarrhea, cramping, fever, fatigue, and joint pain are active. Flares can be triggered by factors like dietary changes, new medications, antibiotic use, stress, or infections. Sometimes, the cause of the flare-up is unknown. Although there is no guaranteed way to prevent flare-ups, medications, surgery, dietary adjustments, and other lifestyle practices may help keep them under control.

A Word From Verywell

Crohn's is unpredictable, and each person's experience with Crohn's disease is different. Some people rarely experience flare-ups, while others experience them frequently. If you are prone to flares or are currently undergoing one, remember that you're not alone. Almost everyone with Crohn's will encounter a flare-up at some point. For additional support, consider checking out your local chapter of the Crohn's and Colitis Foundation.