Your regular maintenance treatment may not be enough.
Like many types of autoimmune diseases, Crohn’s disease can alternate between periods or remission (little or no symptoms) and flares (worsened symptoms). Of course, the goal of treatment is to maintain remission, but flares can occur even with a healthy lifestyle for Crohn’s and good medicine adherence.
“When you use the term ‘flare,’ that suggests that your Crohn’s is worse—that there’s more inflammation inside,” says David P. Hudesman, MD, associate professor at the Department of Medicine and medical director at the IBD Center at NYU Langone Health.
Not addressing this increased inflammation could heighten your risk of complications, such as colon cancer. That’s because chronic inflammation damages healthy tissue in the body, leading to other potential health problems. (Learn more about the link between colon cancer and Crohn’s disease here.)
What Causes a Flare
Certain factors can increase your risk of a Crohn’s disease flare, such as:
Not taking medicine as prescribed
Some of these flare triggers don’t necessarily cause more inflammation; they just worsen how the symptoms of Crohn’s disease feel, according to Dr. Hudesman.
What to Do About a Flare
It’s tempting to start experimenting on your own by trying OTC meds, adjusting the dosage on your prescriptions, or altering your diet—but resist the temptation.
Before making any big changes to your treatment plan, contact your doctor. “If symptoms do worsen, it’s important to communicate with the provider, so then they can better help figure out what’s driving those symptoms,” says Dr. Hudesman. “Is it Crohn’s, or is it something else?”
Talking to your doctor is crucial because it can help identify what triggered the flare—and therefore how to prevent another flare in the future. Your doctor can also suggest what to do to manage your symptoms during the flare and get you back to a state of remission.
In general, the best ways to prevent a flare are to take your medication as prescribed, and see your doctor regularly. This can help identify potential problem areas before they result in a flare.
Dr. Hudesman is an associate professor in the Department of Medicine and medical director of the IBD Center at NYU Langone Health.
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When you use the term flare,
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that suggests that your Crohn's is worse,
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that there's more inflammation inside.
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But people could have worsening stomach pain, worsening diarrhea,
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or weight loss, and their Crohn's could be just fine.
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So with Crohn's disease, how you feel
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doesn't go along with what's going on inside,
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so you can take two people with the same amount of inflammation inside,
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and one person that's on a perfect diet, has zero stress in their life,
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maybe goes to the bathroom five times a day.
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You take another patient, with a horrible diet, and a lot of stress.
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They might go to the bathroom 10 times a day.
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But the amount of inflammation on the inside is exactly the same.
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So if symptoms do worsen, it's important to communicate with the provider,
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so then they can better help figure out what's driving those symptoms.
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Is it Crohn's, or is it something else?
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I wouldn't recommend rushing to taking something over-the-counter,
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or adjusting, or increasing medications
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without getting a better sense on what's causing the symptoms.
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Common triggers for worsening of symptoms
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could be noncompliance to medication, so not taking the medication.
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Sometimes certain foods might trigger worsening of symptoms,
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not necessarily worsening of inflammation but that they feel worse.
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Stress, similarly, can make symptoms worse,
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but not necessarily cause more inflammation.
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So to minimize the risk of flaring, the most important things
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patients could do is take their medications,
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come to follow-up visits, even if they're feeling well,
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and get the required blood work and stool tests.
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I think the important thing is to give the office a call.
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I don't think that patients should go run to an emergency room.
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That's not a good idea, unless the symptoms are very severe.
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But I think just giving the office a call, whether it's getting in contact with the nurse,
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a physician assistant, or nurse practitioner,
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emailing with the doctor, whatever it may be,
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and then working with them to come up with an answer.
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Environmental triggers. New York, NY: Crohn’s & Colitis Foundation. (Accessed on December 12, 2019 at https://www.crohnscolitisfoundation.org/research/challenges-ibd/environmental-triggers.)
Patient education: Crohn disease (beyond the basics). Waltham, MA: UpToDate, 2019. (Accessed on December 12, 2019 at https://www.uptodate.com/contents/crohn-disease-beyond-the-basics.)