Crohn’s disease flare-ups: Symptoms and how to manage

Crohn’s disease is a type of inflammatory bowel disease (IBD) that affects the gastrointestinal tract, usually the small and large intestines. 

More than half a million adults in the United States live with Crohn’s disease, according to the U.S. Department of Health and Human Services. The condition requires ongoing management, and some flare-ups may become a medical emergency. 

What is a Crohn’s disease flare?

Crohn’s disease is a chronic condition involving periods when: 

• you have mild to no symptoms, which is called remission 
• you experience more severe or prolonged symptoms, which are called flare-ups 

Experiencing a flare means you experience active symptoms that may interfere with some or most of your daily activities, including sleep, concentration, and social interactions. This is compared to inactive symptoms during remission that may be uncomfortable but may not affect the way you function.

How do Crohn’s disease flare-ups feel?  

Crohn’s disease flares often feel distressing and debilitating. Intensity may vary from moderate to severe. The most common symptoms may include: 

• persistent diarrhea, sometimes with mucus and blood 
• increased pain in your lower abdomen
• sudden abdominal cramps

Other symptoms of Crohn’s disease flares may involve: 

• loss of appetite
• nausea
• vomiting
• constipation 
• pain or redness in your eyes
• fatigue
• low grade fever
• joint soreness or pain 
• small bumps, rashes, or sores on your skin 

More severe and prolonged flare-ups may lead to weight loss and anemia. Complications are also possible, including: 

• Fissures: Tears in the anus that lead to pain and bleeding. 
• Fistulas: A connection that forms between different parts of the intestines or between the intestines and the skin, bladder, or vagina. 
• Strictures: Narrowings of parts of the intestine, which makes passing stool more difficult or painful. 

A Crohn’s disease flare-up may last a few days or several weeks or months. This may vary from person to person, and you may also find you experience different symptoms, intensity, and duration from one flare to the next.

Common causes and triggers of Crohn’s disease flares

The causes of Crohn’s disease, including flares, aren’t yet established but may include a combination of: 

• Genetics: You may be more likely to develop Crohn’s disease if a close blood relative also has the condition. 
• Autoimmune processes: Your immune system may mistakenly attack healthy cells in your digestive system. 
• Tobacco use: Smoking makes you twice as likely to develop Crohn’s disease and may make flares more frequent. 
• Medications: Some drugs such as aspirin, birth control pills, and antibiotics may slightly increase your chance of getting Crohn’s disease or experiencing a flare. 
• Diet: High fat diets may slightly increase your chance of developing the condition and experiencing flare-ups.

Common flare-up triggers may include:

• high stress levels
• spicy foods, dairy products, caffeine, or high fiber foods 
• bacterial or fungal infections 
• skipping Crohn’s disease medications 
• antibiotics or other medications that may irritate the gastrointestinal system 

How to manage Crohn’s disease flare-ups 

Depending on the intensity of your symptoms, you may manage a Crohn’s disease flare-up with diet modifications, psychotherapy, medications, bowel rest, or surgery.

1. Medications

A healthcare professional may assess your symptoms and recommend different drug options. The most common medications include:

• Corticosteroids for reducing inflammation: These may include prednisone, hydrocortisone, and budesonide.
• Immunomodulators to slow down the immune response and decrease inflammation: These may include methotrexate and azathioprine.
• Over-the-counter pain relievers: These may only include acetaminophen since ibuprofen, naproxen, and aspirin are not recommended for Crohn’s flares.
• Antidiarrheals to slow down bowel movement: These may include loperamide, diphenoxylate (Lomotil), and cholestyramine (Questran).

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2. Diet changes

Dietary changes for Crohn’s disease often involve:

• avoiding spicy and greasy foods
• limiting nuts, vegetable skins, and other high fiber foods 
• avoiding alcohol and caffeine
• eating small, regular meals 
• liquefying foods

Dietary flare-up triggers may be different for each person. You may want to keep a food diary to help identify which foods may be intensifying your symptoms. 

3. Mental health support

Crohn’s disease can often lead to mental health symptoms, including depression and anxiety.

Professional support may help you manage the cognitive and emotional effects of the condition, particularly during flare-ups. 

Stress management tools may also have an effect on your mental and physical symptoms. Mediation, yoga, and regular physical activity may improve your symptoms. 

4. Managing symptom discomfort

During a flare, you may find it more comfortable to clean yourself after a bowel movement using water, a wet towel, or a moist wipe instead of toilet paper.

Sitting in a bath with warm salt water may also help with anal soreness. 

Incorporating these strategies as soon as you notice your discomfort increasing may help with symptom intensity.  

5. Surgery

Some people with Crohn’s disease may require surgery when symptoms become too severe or complications arise. For example, you may need surgery if there’s a blockage in your intestine that doesn’t allow stool or gas to pass.

Surgery may involve removing a part of your small intestine or the cecum, the connecting part between your small and large intestines.

Surgery is often the last resource for treating Crohn’s disease.

When flare-ups are a medical emergency 

In most cases, a Crohn’s flare-up is not a medical emergency. But in some cases, you may need immediate medical attention. This may be the case if you: 

• develop a persistent high fever (above 100.3°F) 
• experience severe abdominal pain 
• have persistent or recurrent rectal bleeding
• are unable to pass gas or stools for more than 2 days
• develop dehydration symptoms like dizziness, headaches, dry mouth, and low amounts of urine

Summary 

Crohn’s disease may involve periods of mild or no symptoms, and periods of intensified symptoms called flare-ups.

Flare-ups may involve severe pain and cramping, persistent diarrhea, rectal bleeding, and fever.

Managing these flare-ups may involve dietary changes, medications, and surgery.

Discussing your symptoms with a healthcare professional may help you assess the need and urgency of these interventions.

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