How to Handle a Crohn’s Relapse

Crohn's is a disease that comes in cycles. When you don’t have symptoms, that’s remission. When symptoms come back, it’s called a flare or relapse.

Medicines that calm your immune system and bring down inflammation will help you stay in remission longer, and prevent your disease from getting worse. Yet relapses can still happen, and often when you least expect them.

Most people with Crohn’s who are in remission -- about 80% -- don’t relapse within a year. But over a decade, 76% will have a relapse.

Exactly when a relapse happens can be hard to predict. To help prevent them, stay on your medicine and avoid things that trigger your symptoms. And be ready to take action if it does happen.

Treatments

One of your first steps will be to tell your doctor about the symptoms you’re having and when they started.

Your doctor may consider these types of drugs to help you feel better and get back to remission.

Corticosteroids like budesonide (Entocort EC) and prednisone bring down inflammation in your body. They can cause side effects like bone loss and high blood pressure, so your doctor might prescribe them for only a few months: just long enough to put you back into remission.

Aminosalicylates like mesalamine (Asacol HD, Delzicol) and sulfasalazine (Azulfidine) curb inflammation in your gut.

Biologics like adalimumab (Humira), certolizumab pegol (Cimzia), and infliximab (Remicade) stop certain natural chemicals in your immune system from causing inflammation and damage.

Immunomodulators like azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan) calm your overactive immune system.

Take these medicines exactly as prescribed. Tell your doctor if your symptoms get worse or don't improve. You might need a different dose or type of drug to get back to remission.

What Triggers Relapses?

Doctors don’t always know why a relapse happens. But they do know it’s more common among women than men, and among people who are diagnosed with Crohn’s before age 25.

The location and type of disease you have can also affect your risk of flares. About half of people with Crohn's have a kind of inflammation called a granuloma. Those who have a granuloma have more severe disease and more flares than those who don't.

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Other relapse triggers are things you can control, such as:

Missed medicines. Your symptoms can get worse if you skip doses of your Crohn's medicine or you take the wrong dose.

Smoking. Cigarette smoking doubles your chance of getting Crohn's disease in the first place and makes you more likely to have flares.

NSAID pain relievers. Large doses of aspirin, ibuprofen, or other NSAID drugs -- especially if you take them for a long time -- may make you more likely to have a flare.

Birth control pills. They’ve been linked to a bigger chance of getting Crohn's. And these contraceptive meds might also contribute to relapses.

Stress. People with less stress, and better ways of handling the stress they can’t escape, relapse less often than those who are under a lot of stress.

Vitamin D. People who are low on this vitamin tend to have more active Crohn's disease. But it’s not clear that being short on vitamin D actually causes that.

How to Deal With Relapses

It can be tough to deal with diarrhea, belly pain, and fatigue again -- especially if you haven’t had symptoms for a while.

Work with your doctor. Let them know what’s going on, and check in about what the right treatment might be. Keep up with your regular appointments, too, so you can talk about how you’re doing.

Give yourself time to recover. Take breaks and rest when you feel extra tired. You may want to see if you can make changes at work, school, or home to get some breathing room. You may need to talk with your supervisor, teacher, or family members about what changes would help as you get back to feeling better.

Tend to your emotions. If you feel overwhelmed, anxious, or down, see a psychologist or therapist. There’s help, including learning new ways to handle the stress Crohn’s can cause.

Plan for outings. You might worry that you’ll have a problem when you’re out and about. Or you might hesitate to go out to eat with friends and family if you’re not sure the food will be friendly to your diet. You can scope out bathrooms and menus in advance to feel more confident, so you can still join in.

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Lean in. Turn to friends, family members, and other people around you for help. Join a support group for people with Crohn's disease. You'll meet people who know what you’re dealing with and who can offer advice.

Keep a diary of your symptoms. Note what makes them worse. Try to avoid anything that seems to set them off. Or if those things aren’t avoidable, look for new ways to manage them.

Tame stress. Out-of-control stress is a well-known trigger for flare-ups. Cut down on it as much as possible, and then lean into how you handle the stress you can’t get rid of. Practice yoga, tai chi, or meditation. Breathe deeply. Go for a walk. It may help cut down on flares.

Eat for your health. No specific foods have been proven to trigger or improve Crohn's flares. But you know your body best, including how it tends to react to your food.

Choosing a mix of fruits, vegetables, lean protein, and whole grains may help you feel better overall. Because Crohn's can make it harder for your body to absorb nutrients, make sure to get enough calories, protein, and “good” fats (from nuts, seeds, fish, olives, and most plant-based oils). You may want to check in with your doctor or a nutritionist to find out what changes might help meet your dietary needs.

WebMD Medical Reference Reviewed by Minesh Khatri, MD on March 14, 2018

Sources

SOURCES:

Academy of Nutrition and Dietetics: "Crohn's Disease and Diet."

Crohn’s & Colitis Foundation: "Facts About Inflammatory Bowel Diseases," "Managing Flares and Other IBD Symptoms," "Signs and Symptoms of Depression."

Crohn's & Colitis UK: "Crohn's disease."

Current Gastroenterology Reports: "Environmental triggers for inflammatory bowel disease."

Gastroenterology: "Shifting away from estrogen-containing oral contraceptives in Crohn's disease."

Gastroenterology & Hepatology: "Vitamin D and inflammatory bowel disease."

Mayo Clinic: "Crohn's disease: Diagnosis & treatment," "Crohn's disease: Symptoms & causes."

World Journal of Gastroenterology: "Clinical significance of granuloma in Crohn's disease," "How to predict clinical relapse in inflammatory bowel disease patients."

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