Crohn Disease Flare-Up: If you recently received a Crohn’s diagnosis, it’s understandable to feel a bit overwhelmed by the idea of having a form of inflammatory bowel disease (IBD). But learning about what comes next can help you take important steps to prioritize your physical and mental well-being.
Depending on how long you’ve experienced symptoms, you’re probably aware that they tend to feel nonexistent some days (periods of remission) and pretty debilitating on others (periods of relapse or recurrence). Crohn’s disease flare-ups are tough to predict—but they’re to be expected for anyone living with the condition. “[A flare-up] is the time period when the inflammation of Crohn’s becomes active,” Aniruddh Setya, a board-certified gastroenterologist with KIDZ Medical Services in Florida.
Crohn’s is a complex autoimmune condition with no single cause or cure, but there’s some hopeful news here: There are many effective treatments that can help you feel better.1 You’ll also want to learn a bit more about what may cause your symptoms to resurface, so you can do your best to prevent them. Here’s what you should keep in mind if you’re figuring out Crohn’s flare-ups for the first time.
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What happens during a Crohn’s flare-up?
“During a flare, your disease is active, meaning there is inflammation in the gut being driven by your immune system,” Matilda Hagan, board-certified gastroenterologist and medical codirector at The Center for Inflammatory Bowel and Colorectal Disease at Mercy Medical Center in Baltimore, says.
That inflammation drives the recurrence of symptoms, which can persist for months to years without effective treatment, Douglas Nguyen, a board-certified gastroenterologist with Providence Mission Hospital in Southern California, says. Other times, symptoms come on quickly and disappear as fast as they show up.
It’s also common to have more severe symptoms during a flare-up, Dr. Nguyen says. This includes gastrointestinal symptoms like worsening abdominal pain, urgent bowel movements, or rapid weight loss, as well as systemic symptoms linked to chronic inflammation like intense eye or joint pain. All of these changes can also take a toll on you mentally and emotionally.
In one 2019 study, researchers from Northwestern University’s Feinberg School of Medicine tried to gain a better understanding of how people with Crohn’s describe their flare-ups.2 Here are a few responses that stood out to them:
- “I am tired and generally homebound and often stuck in bed and near a bathroom.”
- “The most impactful part is the lack of energy. I generally try to maintain my daily schedule, but by the evening I’m too exhausted to really do anything.”
- “It makes the simplest tasks seem impossible. My self-worth hits rock bottom.”
- “My family is affected by my IBD as they are constantly worrying about me, making sure I am feeling okay, and trying to help me fight back.”
- “I can’t do things I want to do.”
A Crohn’s flare-up can hit at the most unexpected and inconvenient times. When your disease dominates in full force like this—or anytime your symptoms heavily influence your quality of life—it’s important to reach out to your doctor as soon as you can to figure out a game plan, Dr. Nguyen notes.
What causes a Crohn’s flare-up?
Though this varies greatly from person to person, the Crohn’s and Colitis Foundation notes that there are common triggers that may either worsen inflammation or symptoms in general:3
- Missing prescribed medication or taking the wrong dosage
- Using nonsteroidal anti-inflammatory drugs (NSAIDs) or antibiotics
- Gastrointestinal tract infections like C. difficile
- Intense or persistent emotional stress4
- Smoking tobacco
- Eating specific foods that have been linked to triggering your symptoms
What to do when a Crohn’s flare-up hits
It’s really tough to avoid a flare-up completely, Dr. Nguyen says, but staying calm and having a plan in place can help immensely when one hits.
The best thing you can do to manage the intensity and minimize the frequency of flares, Dr. Hagan says, is to get on a medication that works for you at the correct dosage, which can take a bit of trial and error. “It’s important to have regular follow-ups with your doctor even if your disease is under control,” she says. Routine tests, including those that check drug levels, inflammatory markers, or blood counts, can suddenly come back as “abnormal,” which suggests a flare-up may be lurking even if you’re feeling generally okay.
“Sometimes a short course of corticosteroids may be needed to control the inflammation, and the health care professional might need to change your medication if you have stopped responding,” Dr. Setya says. Depending on your personal circumstances, your doctor may also consider antibiotics if you have an infection, antidiarrheal meds to help control this symptom, or switching your biologic medication if you’re on one and have stopped responding to it.
If you’re feeling lousy, your doctor will also go over any lifestyle factors that could potentially be contributing to your symptoms. For example: Did your diet change drastically recently? Have you felt super stressed at work or in your relationships? Are you missing out on sleep or exercise? Prioritizing your overall well-being by making time for regular movement, nutritious meals, sound sleep, and de-stressing all play a role in staying well when living with Crohn’s disease. If you’re struggling with any of these, your doctor can help you through it, Dr. Nguyen says.
Living with Crohn’s certainly comes with its challenges, but learning how to prevent and manage flare-ups when they do strike can make a big difference in how you feel about your condition—and that starts with getting a solid care team in your corner, if you can. An empathetic gastroenterologist, clinical dietitian, and therapist can make a huge difference in the journey and provide you with tools to help you thrive.
“The goal of treatment,” Dr. Nugyen stresses, “is to reduce the risk for flare-ups and to maintain prolonged remission to ensure that you have an enhanced quality of life free of complications.”