Crohn’s disease is a type of inflammatory bowel disease (IBD) that can cause a range of symptoms. Stress, some foods, and certain medications can trigger or worsen flare-ups. A person experiencing a flare-up can ask their doctor about the treatment options.
The symptoms that a person experiences will depend on the severity of their condition and which area of the intestinal tract it affects. However, flare-ups typically include a mix of gastrointestinal symptoms, such as diarrhea, and other symptoms, such as fever and joint pain.
This article explores the causes, symptoms, treatment, duration, and prevention of a Crohn’s flare-up.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) states that although experts do not fully understand what causes Crohn’s disease, they suspect that various factors may play a role. These include:
- Autoimmune reaction: In this response, a person’s immune system attacks healthy cells. The damage causes inflammation, which leads to symptoms of the disease.
- Genes: Studies show that having an immediate family member with Crohn’s disease increases an individual’s risk of developing it.
- Smoking: Smoking may double the likelihood of developing Crohn’s disease.
- High fat diet: This may slightly raise the risk.
- Certain drugs: Some medications — including antibiotics, birth control pills, and nonsteroidal anti-inflammatory drugs (NSAIDs) — may slightly increase the risk.
The NIDDK notes that the most common symptoms of a Crohn’s flare-up are:
- weight loss
- pain and cramping in the abdomen
Other symptoms may include:
Crohn’s disease is chronic, which means that it is a long-term condition.
People with Crohn’s disease experience flare-ups, during which the symptoms of the condition are active. In these periods, a person will likely have various symptoms from the list above.
Between flare-ups, people with Crohn’s have periods of remission, during which they do not have any symptoms.
The durations of flare-ups may vary from a few days to weeks or months.
It is helpful for a person to keep a record of the duration of their flare-ups and the symptoms they experience. The Crohn’s & Colitis Foundation (CCF) provides this symptom tracker that someone can fill out and share with their doctor.
The goal of treatment is to prevent flare-ups and keep a person in remission.
Various treatment options are available, including medications, bowel rest, and surgery.
Although medications do not cure Crohn’s, they can provide symptom relief. Medical treatment options for people with Crohn’s include:
- Aminosalicylates: Aminosalicylates help control inflammation, but they can cause side effects, such as diarrhea, vomiting, and heartburn. Examples include balsalazide and mesalamine.
- Corticosteroids: Doctors may prescribe corticosteroids for people with moderate-to-severe symptoms. They reduce inflammation and decrease the activity of the immune system, but possible side effects include weight gain, high blood pressure, and high blood sugar. Examples of corticosteroids include hydrocortisone and prednisone.
- Immunomodulators: Doctors may prescribe immunomodulators to individuals who do not respond to other treatments. These drugs lower immune system activity, which decreases inflammation in the intestinal tract. Possible side effects include inflammation of the pancreas and a low white blood cell count, which increases the risk of infections. Examples of these medications include 6-mercaptopurine and cyclosporine.
- Biologic therapies: Biologic therapies neutralize certain proteins, which results in decreased inflammation in the intestinal tract. Examples include antitumor necrosis factors, such as certolizumab, and anti-interleukin-12 drugs, such as ustekinumab.
- Other medications: Doctors may sometimes prescribe drugs to treat specific symptoms or reduce complications. For example, they may recommend antibiotics for infections, acetaminophen for mild pain, and loperamide to slow severe diarrhea.
If a person has severe symptoms, a doctor may advise them to rest their bowel for at least a few days and possibly up to several weeks.
Bowel rest involves consuming certain liquids that contain nutrients while refraining from eating anything. Doctors may recommend that some people take the liquids through a feeding tube or intravenous tube rather than drinking them.
In addition to medications and bowel rest, many individuals need surgery to reduce the symptoms of the disease and treat complications. The NIDDK notes that doctors may advise surgery for the following:
- Intestinal obstruction: This term describes a blockage in the small or large intestine.
- Fistula: A fistula is an ulcer that develops on the inner intestinal wall and grows to form a tunnel.
- Life threatening bleeding: A person with continuous bleeding that nonsurgical treatment cannot stop will need surgery.
Types of surgery may include:
- Small bowel resection: This is the removal of part of the small intestine.
- Subtotal colectomy: This procedure involves the removal of part of the large intestine.
- Proctocolectomy and ileostomy: A surgeon will remove the entire colon and rectum.
Individuals who experience symptoms of Crohn’s disease or lingering bowel changes should speak with their doctor. They should do so at the first sign of a flare-up because a doctor:
- can try to identify the trigger
- can prescribe medication to relieve the symptoms
- needs to know if a current treatment is not working
In addition, people with Crohn’s disease should see their doctor every 6 months during periods of remission.
The CCF states that although a person cannot completely prevent flare-ups, these measures may help:
- following the doctor’s instructions for procedures and tests
- considering taking a vitamin and mineral supplement, after consulting a doctor first
- keeping a record of any symptoms between doctor appointments
- getting regular exercise
- practicing stress management techniques
- quitting smoking, if a smoker
- drinking alcohol only in moderation
In addition to adopting the above measures, eating a well-balanced diet can help prevent the nutritional deficiencies that Crohn’s disease can cause.
Most people will benefit from avoiding fried or greasy foods during flare-ups. However, a person should try to determine all of the foods that make their symptoms worse so that they can avoid them.
People can work with a registered dietitian to develop a personalized eating plan.
A Crohn’s flare-up may last just a few days, or it may persist for several months. People should contact their doctor when they notice the first signs of a flare-up. Medications and bowel rest may help, and if severe symptoms or complications develop, surgery is an option.
Although there is no guaranteed way to prevent flare-ups, certain lifestyle practices, such as exercising regularly, may help.