How to Handle a Crohn’s Relapse

Medically Reviewed by Minesh Khatri, MD on November 12, 2022
Written by WebMD Editorial Contributors
5 min read

Doctors don't know why Crohn's symptoms come and go. They know that things like diet, smoking, and stress can make them worse.

But sometimes you have a relapse, or flare-up, no matter how careful you are. During a flare, you'll have symptoms like:

  • Nausea and vomiting
  • Diarrhea or frequent bowel movements
  • Belly cramps
  • Weight loss
  • Bloody stools

The best time to stop a flare-up is before it starts. But once one begins, taking quick action may stop it from getting worse.

A relapse can happen because you miss a dose of your Crohn's medication or take the wrong amount. So even if your symptoms are gone and you feel great, keep taking your drugs as prescribed.

Repeated flares can lead to things like narrowing of your intestines. Or you might get fistulas, which are abnormal connections between the intestines and your skin or other organs.

If a drug causes side effects that bother you, don't just stop taking it. Talk to your doctor first. You might need to take a lower dose, switch to another drug, or get treatment for the side effects.

And if it seems like your medicine isn't working as well as it used to, speak up. Crohn's is an evolving disease, and your treatment may need to change with it. Frequent relapses can be a sign your doctor needs to change your medication plan.    

While you're having a flare, your doctor may prescribe corticosteroids to stop your symptoms. But this is not a long-term solution.

 

When your Crohn's disease flares, it can be hard for your small intestine to take in nutrients. So when you don't have symptoms, it's really important to eat healthy.

Keep a food diary. It can show you if certain choices make your symptoms worse. For some people with Crohn's, high-fat foods or fiber-rich fruits and vegetables (like beans and broccoli) cause problems.

When you figure out which foods might make you feel bad, let your doctor know. Along with a diet expert, they can help you plan meals that include all the food groups. You might also need to take supplements of vitamins B12 and D, iron, or calcium, or a multivitamin.

During a relapse, you may need to limit these foods and drinks to prevent gas and diarrhea:

  • Fried foods
  • Fiber-rich foods like raw fruits and veggies
  • Gas-causing foods like beans, broccoli, and sodas
  • Foods and drinks with caffeine
  • Alcoholic drinks

Eating several small meals throughout the day sometimes helps, too.

If you have diarrhea, you're more likely to get dehydrated. So it's especially important to drink enough fluids during a flare.

You already know that smoking is bad for you. It can also make Crohn's disease worse and harder to control. You could get more flares, and your symptoms during them could be worse.

Scientists are studying why. It may be because smoking lowers the intestine’s natural defenses, hampers blood flow to and from your intestines, and causes changes in the immune system that lead to inflammation.

If you have Crohn’s disease and smoke, you’re likely to:

  • Have up to 50% more flare-ups than nonsmokers
  • Have more severe complications, such as a fistula
  • Need surgery and follow-up surgery
  • Need more medicine to control the disease

If you quit smoking, your chances drop to the same as a nonsmoker with Crohn's.

Have you tried to quit smoking before, only to light up again? Hang in there. It can take a few tries to kick the habit for good. Tell your doctor that you're working on it, and ask for advice.

NSAIDs are nonsteroidal anti-inflammatory drugs. They include:

They can trigger flares or cause symptoms like those of Crohn's. So they're not a good choice to relieve pain when you're having a flare or at any other time.

The drugs work by lowering the levels of hormones in your body called prostaglandins. These chemicals can cause pain and inflammation when your body gets damaged or infected. In your gut, they do two things: They help control how much acid your gut makes to digest your food, and they help the mucus on the walls of your gut provide protection from acid. With fewer prostaglandins, you have more acid and less protection, and that irritates and inflames your gut.

Ask your doctor about other choices. Acetaminophen is not an NSAID, so it's often OK for people with Crohn's.

Everyone has stress. On top of that, your Crohn's disease brings its own stress.

It doesn't cause relapses, but it can make your symptoms worse. Try different techniques to see what helps you relax, like:

You handle problems better when you're rested, so also make sleep a priority.

People who are both depressed and anxious are more likely to have flares. If you're feeling down or upset about your health (or anything else), let your family and friends know how they can help you.

Don't hesitate to get help from your doctor, or from a counselor who has experience helping people with Crohn's or other long-term conditions. You may want to join a support group, where you get to talk to other people who know what you're going through because they've been there, too.

While you're having a flare, try these methods to ease symptoms:

  • Apply a skin-protecting ointment to help heal the area around your anus.
  • Use moist wipes instead of toilet tissue after using the bathroom.
  • Bathe in warm saltwater or take sitz baths (sit in plain warm water for 10-20 minutes several times a day). 
  • If your doctor says it's OK, take over-the-counter anti-diarrhea medicine.
  • Ask your doctor whether you can take acetaminophen for pain or fever relief.
  • If you get mouth sores, try a medicated or antiseptic mouthwash.
  • Stick to a healthy sleep schedule and pace yourself to deal with fatigue.
  • Rest and moist heat can help if you have joint pain.

Whether you're having a relapse or not, always share any symptoms you have. They could be the side effects of a drug or a sign of a medical problem caused by Crohn's. Your doctor may want to do tests or adjust your treatment so you can feel better.