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6 Ways to Prevent a Crohn’s Flare-Up

Medically Reviewed by Melinda Ratini, DO, MS on June 17, 2022

Your Crohn’s disease is ever-present, unfortunately, and so is the possibility of a flare-up. What can you do? While nothing offers guaranteed protection against a return of symptoms, you can take steps to make flares less likely.

What Is a Crohn’s Disease Flare-Up?

A flare is a return of your Crohn’s disease symptoms after a period of remission, which is when you have no symptoms or only mild ones. Symptoms you may have during a flare include:

1. Follow Doctor’s Orders

Crohn’s is a long-lasting, or chronic, disease in which your immune system attacks healthy tissue in your digestive tract. These attacks cause inflammation that irritates your intestines, triggering symptoms. The goal of treatment: keep inflammation at bay.

Medications that modify the way your immune system operates help prevent inflammation. But they only work when you take them. If you skip doses, that’s an invitation for symptoms to return. So stick with the instructions your doctor gave you and take your medication as prescribed, even when you feel fine.

Do you have flares even when you take your medications correctly? That may be a sign that it’s time for a change. Talk to your doctor, who can adjust your dose or the medication schedule you follow. If that doesn’t work, your doctor may prescribe a different medication.

2. Avoid Taking NSAIDs

Short for nonsteroidal anti-inflammatory drugs, NSAIDs are a type of painkiller you see on drugstore shelves. They include aspirin, ibuprofen, and naproxen. They reduce inflammation, so you might think they’d be helpful. But research indicates that they can contribute to flares when you take them regularly.

Experts don’t know precisely why NSAIDs present a risk for Crohn’s flare-ups. But it may be because they irritate the stomach. Such irritation may trigger flare-ups. In a 2017 study, researchers found that people with Crohn’s disease were 65% more likely to have active disease if they took NSAIDs five or more times per month. The same study showed a higher risk of active disease for regular users of acetaminophen, which is not an NSAID.

A 2018 review of past studies on NSAIDS, acetaminophen, and Crohn’s disease also found that NSAIDs appear to boost the risk of flares. Less clear: whether acetaminophen also increases your chances of a flare.

The American College of Gastroenterologists strongly recommends against the use of NSAIDs by people with Crohn’s disease. If you have arthritis or another condition that causes frequent pain, talk to your doctor about your options.

3. Quit Smoking and Avoid Secondhand Smoke

Here’s another great reason to kick the nicotine habit. Smoking kicks Crohn’s disease activity into overdrive and makes the disease progress faster. Not only does smoking increase the odds that you’ll need surgery, it also makes flares more frequent. After you stop smoking, the number of flares you have should drop. You also may need fewer Crohn’s disease medications if you quit smoking.

Secondhand smoke also increases the risk of flares, so avoid being around people who smoke even if you don’t smoke yourself.

It won’t be easy to quit smoking, but you can do it with help. Your doctor can guide you. Or try a smoking cessation program like the American Lung Association’s Freedom from Smoking program.

4. Manage Your Stress

Stress is common among people with Crohn’s disease. While experts can’t yet fully explain the link, it’s clear that stress causes an uptick in inflammation, and people with Crohn’s and other irritable bowel diseases have more flares when they’re under stress.

There are many ways to address stress. According to the Crohn’s and Colitis Foundation, they can be equally effective at managing stress levels. So pick the one that sounds the most appealing to you and give it a try. If it helps, great. If not, keep in mind that you have plenty of other options to explore.

For example, breathing exercises, such as deep breathing, can help calm you. By paying attention to your breath and practicing deep breathing, you can prepare yourself to practice other relaxation techniques, such as mindfulness meditation, yoga, tai chi, and guided imagery. You’ll get the best results if you practice regularly.

Support groups, psychological counseling, and exercise also can help you reduce the stress in your life.

5. Get Regular Exercise

Not only does it reduce stress, but regular exercise may improve your body’s immune response and reduce inflammation. That, in turn, could reduce flares.

Right now, doctors don’t have specific guidelines on the type, intensity, or frequency of exercise that could provide the most benefit for people with Crohn’s. So focus on types of movement that you enjoy doing, and be sure to mix it up. That way, you’ll stay interested and stick with it. Start with moderate, low-impact exercises like walking, biking, swimming, and yoga.

If you don’t feel like exercising during a flare-up, rest until you feel better. Before you start an exercise program, talk to your doctor about what might work for you.

6. Eat Right

There’s no one diet that helps everyone with Crohn’s disease feel better. But you may find that certain foods trigger your symptoms. To help you figure out which foods may not be right for you, start a food journal. Write down what you eat and how it makes you feel. If a certain food brings on symptoms, eliminate it from your diet.

Here are some items that could trigger a flare for some people:

  • Foods with lots of insoluble fiber, which makes them harder to digest. These include whole grains, raw green vegetables (especially broccoli and other cruciferous veggies), whole nuts, and fruits with skins and seeds. Talk to your doctor or a dietitian about how much and what type of fiber is best for you.
  • Foods that contain lactose, a sugar found in dairy foods like milk, cream cheese, and soft cheeses
  • Foods with a lot of sugar, like candy, juice, and pastries
  • Foods high in fat, like butter, margarine, and heavy cream, as well as greasy and fried foods.
  • Spicy foods
  • Alcohol
  • Caffeinated beverages

Show Sources

SOURCES:

Cleveland Clinic: “Crohn’s Disease.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Treatment for Crohn’s Disease.”

Crohn’s and Colitis Foundation: “Managing Flares and IBD Symptoms,” “Causes of Flares,” “Exercise,” “What Should I Eat?” “Stress.”

Journal of Clinical Gastroenterology: “Role of Non-Steroidal Anti-Inflammatory Drugs in Exacerbations of Inflammatory Bowel Disease.”

Alimentary Pharmacology & Therapeutics: “Systematic Review and Meta-analysis: Association Between Acetaminophen and Non-steroidal Anti-inflammatory Drugs (NSAIDs) and Risk of Crohn’s Disease and Ulcerative Colitis Exacerbation.”

American Lung Association: “I Want to Quit Smoking.”

Gastroenterology: “Acceptance and Commitment Therapy Reduces Psychological Stress in Patients With Inflammatory Bowel Diseases.”

Harvard Medical School: “Relaxation techniques: Breath control helps quell errant stress response,” “Living with Crohn’s disease: Recognizing and managing flares.”

Mt. Sinai Hospital: “Crohn’s Disease - Discharge.”

Clinical and Experimental Gastroenterology: “Exercise in patients with inflammatory bowel diseases: current perspectives.”

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