A Crohn’s flare-up is a period when chronic inflammation in the gastrointestinal tract becomes acutely active, significantly worsening symptoms. This acute phase often involves increased abdominal pain, more frequent and urgent bowel movements, diarrhea (which may contain blood or mucus), and profound fatigue. Managing a flare requires immediate steps to soothe the digestive system and prevent complications. While self-management offers relief, contact your gastroenterologist at the first sign of a flare to discuss a comprehensive treatment plan. Professional medical guidance remains paramount for resolving the underlying inflammation.
Immediate Dietary Adjustments
The digestive system requires rest during a flare-up, necessitating a diet that minimizes the work required for digestion and reduces undigested residue passing through the inflamed bowel. This immediate shift involves adopting a low-residue diet, limiting fiber intake to approximately 10 to 15 grams per day. The goal is to reduce stool volume and frequency, lessening irritation on the intestinal lining.
Focus your intake on refined carbohydrates, such as white bread, white rice, and plain crackers, which are easier to process. Lean, tender proteins like skinless poultry, eggs, and fish are generally well-tolerated. For produce, prioritize cooked, peeled, and seedless options, such as canned peaches, applesauce, or well-cooked carrots and potatoes without the skin.
Strictly avoid foods that can aggravate the inflamed gut. High-fiber foods, including whole grains, nuts, seeds, raw vegetables, and popcorn, should be temporarily eliminated as they add bulk to the stool. Additionally, high-fat, fried, greasy, or overly spicy foods can stimulate bowel movements and worsen diarrhea.
Dairy products should be limited or avoided entirely, especially if you suspect lactose intolerance, which is common during a flare when lactase production is compromised. Instead of three large meals, consume six to eight small, frequent meals throughout the day. This strategy prevents the digestive tract from becoming overwhelmed by a large volume of food, which can trigger more intense cramping and urgency.
Managing Physical Symptoms and Hydration
Physical rest is a fundamental component of flare management, as the body requires energy to combat active inflammation. Reducing demanding activities and prioritizing sleep allows the body’s resources to be directed toward healing the intestinal tissue. Simplifying your daily routine and avoiding strenuous exercise is highly recommended until symptoms subside.
To alleviate intense abdominal cramping, applying moist heat can be effective. A warm bath or placing a heating pad on the abdomen relaxes the smooth muscles of the digestive tract, offering a non-pharmacological method of comfort. This localized heat provides temporary relief from the muscle spasms contributing to flare-related pain.
Addressing fluid loss is important because frequent diarrhea and vomiting can rapidly lead to dangerous dehydration. Prioritize clear liquids and electrolyte-rich fluids, such as oral rehydration solutions or sports drinks, to replace lost sodium and potassium. Broths are also an excellent source of fluids and electrolytes, offering a gentle way to stay nourished.
Avoid beverages that can irritate the bowel or increase fluid loss. Caffeinated drinks, including coffee and certain sodas, act as stimulants and increase intestinal motility, worsening diarrhea. Highly concentrated sugary drinks can also draw water into the intestines, exacerbating fluid loss. Stick to plain water, diluted fruit juices without pulp, and clear broths to maintain proper fluid balance.
Reviewing Medication and Knowing When to Seek Help
During a flare, maintain strict adherence to all prescribed maintenance medications, such as immunomodulators or biologics. These drugs control underlying inflammation; stopping them abruptly without approval can severely worsen the flare or cause a loss of response upon restarting. Consistent use of maintenance medications is a primary factor in preventing relapses and complications.
Consult your healthcare provider before taking any over-the-counter pain relievers for abdominal discomfort. Non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and naproxen, are generally contraindicated in Crohn’s disease. NSAIDs can irritate the intestinal lining and may trigger or prolong a flare-up. Acetaminophen is often recommended as a safer alternative for pain and fever relief, but this decision must be confirmed by your doctor.
Your doctor may prescribe a short course of a rescue medication, such as an oral corticosteroid, to quickly reduce acute inflammation. Understand the specific instructions for these medications, as they are typically used temporarily and then tapered off according to a precise schedule. Never adjust the dosage or duration of a prescribed steroid course on your own.
Certain symptoms indicate a medical complication requiring immediate professional attention. Seek urgent care if you experience a high fever (above 100.3°F or 38°C), which may signal an infection or abscess. Severe, persistent abdominal pain, especially if accompanied by vomiting, inability to pass gas, or bloating, can be a sign of a bowel obstruction.
Other signs requiring immediate contact with your care team include significant, uncontrolled rectal bleeding or passing large amounts of blood. Persistent vomiting that prevents you from keeping down clear liquids, leading to signs of severe dehydration, is also a serious concern. Having a pre-established plan with your gastroenterologist for these emergency scenarios ensures you can act quickly and safely.