Crohn's Flare Up: What to Do and When to Seek Care

What does a Crohn's flare actually feel like?

Crohn's disease affects approximately 1 million people in the United States, with disease most commonly first presenting in adults aged 20–29 3Ref 3National Institute of Diabetes and Digestive and Kidney Diseases (2024).Definition & Facts for Crohn's Disease.Epidemiological context: approximately 1 million Americans have Crohn's disease; disease most common in ages 20–29; flare-remission cycle characterizes the disease course. The disease follows a flare-remission cycle: periods of active symptoms alternate with periods of relative quiet.

A flare looks different from person to person, depending on where inflammation is located in the digestive tract. Common signs include 1Ref 1Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE (2018).ACG Clinical Guideline: Management of Crohn's Disease in Adults.Recommendations on flare recognition, evaluation, treatment escalation, and the distinction between infectious triggers and true IBD flares; corticosteroid use for moderate-to-severe flares:

• Increased frequency of loose or watery stools
• Crampy abdominal pain, often in the lower right side but potentially anywhere
• Blood or mucus in stool
• Urgency — the sudden, hard-to-delay need to use the bathroom
• Fatigue, low-grade fever, or a general sense of feeling unwell
• Loss of appetite

A flare differs from a permanently worsened baseline: symptoms that track with stress, a dietary indiscretion, or an infection may calm with conservative care. A sustained rise in symptoms over days to weeks, new patterns, or systemic signs like significant fever or weight loss warrant a call to your gastroenterologist rather than watchful waiting.

What can you do at home during a mild flare?

Home management can help bridge the gap while you contact your care team, but it does not replace medical guidance for Crohn's — the condition can silently progress even when symptoms feel manageable.

Rest the bowel temporarily. Shifting toward easily digested, low-fiber foods — plain rice, bananas, cooked carrots, lean protein — reduces mechanical irritation while the gut is inflamed 1Ref 1Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE (2018).ACG Clinical Guideline: Management of Crohn's Disease in Adults.Recommendations on flare recognition, evaluation, treatment escalation, and the distinction between infectious triggers and true IBD flares; corticosteroid use for moderate-to-severe flares2Ref 2National Institute of Diabetes and Digestive and Kidney Diseases (2024).Treatment for Crohn's Disease.Overview of medical management options for Crohn's disease flares including corticosteroids, immunosuppressants, biologics, bowel rest, and surgery; 30–55% of patients require surgery within 10 years.

Stay hydrated. Frequent diarrhea depletes fluids and electrolytes. Oral rehydration solutions or diluted sports drinks can help, particularly if you are losing more than three to four loose stools per day.

Keep a brief symptom log. Noting stool frequency, pain level (1–10), temperature, and what you ate gives your gastroenterologist useful data when you call.

Avoid known triggers. Raw vegetables, high-fat foods, caffeine, alcohol, and carbonated drinks commonly worsen symptoms during a flare for many people with Crohn's, though triggers vary individually.

Do not adjust prescription medications on your own. Stopping or doubling immune-modulating or biologic therapy without guidance can disrupt disease control or mask a more serious complication.

When should you contact your gastroenterologist?

Contact your gastroenterologist the same day or urgently if you notice:

• Fever above 38.5 °C (101.3 °F)
• Blood in the stool that is more than a streak, or bright red blood
• Abdominal pain that is severe, constant, or accompanied by a rigid or board-like belly
• Vomiting that prevents you from keeping down liquids or medications
• Significant weight loss (more than 5 lb in a few weeks)
• Swollen or tender abdomen
• Joint pain, skin rashes, or eye inflammation occurring at the same time as bowel symptoms (these can be signs of Crohn's-related extraintestinal involvement)

Your gastroenterologist may want to check inflammatory markers (CRP, fecal calprotectin), stool cultures to rule out infection, or imaging to look for abscess or stricture before changing treatment 1Ref 1Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE (2018).ACG Clinical Guideline: Management of Crohn's Disease in Adults.Recommendations on flare recognition, evaluation, treatment escalation, and the distinction between infectious triggers and true IBD flares; corticosteroid use for moderate-to-severe flares.

Is a flare always a sign that your medication has stopped working?

Not necessarily. A flare can be triggered by several factors that do not mean your maintenance therapy has failed:

• Infection — a bacterial or viral GI infection, or *Clostridioides difficile* (C. diff), can mimic or trigger a flare. C. diff is more common in people who have taken antibiotics or immunosuppressants 1Ref 1Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE (2018).ACG Clinical Guideline: Management of Crohn's Disease in Adults.Recommendations on flare recognition, evaluation, treatment escalation, and the distinction between infectious triggers and true IBD flares; corticosteroid use for moderate-to-severe flares.
• NSAIDs — ibuprofen and naproxen can irritate the GI lining and provoke flares in Crohn's. Acetaminophen is generally preferred for pain.
• Stress — psychological stress does not cause Crohn's, but it can affect gut motility and lower the threshold for symptoms.
• Antibiotic use — disruption of gut flora can precipitate flares.

When a flare persists despite conservative care, your gastroenterologist will consider whether to optimize your current treatment, check drug levels (for biologics and thiopurines), or step up therapy 1Ref 1Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE (2018).ACG Clinical Guideline: Management of Crohn's Disease in Adults.Recommendations on flare recognition, evaluation, treatment escalation, and the distinction between infectious triggers and true IBD flares; corticosteroid use for moderate-to-severe flares.

What does medical treatment of a flare look like?

Management depends on flare severity and where in the GI tract inflammation is active. Options your gastroenterologist might use include 1Ref 1Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE (2018).ACG Clinical Guideline: Management of Crohn's Disease in Adults.Recommendations on flare recognition, evaluation, treatment escalation, and the distinction between infectious triggers and true IBD flares; corticosteroid use for moderate-to-severe flares2Ref 2National Institute of Diabetes and Digestive and Kidney Diseases (2024).Treatment for Crohn's Disease.Overview of medical management options for Crohn's disease flares including corticosteroids, immunosuppressants, biologics, bowel rest, and surgery; 30–55% of patients require surgery within 10 years:

• Corticosteroids (such as prednisone or budesonide) for moderate to severe flares — effective for inducing remission, though not intended for long-term use.
• Optimizing existing biologic or immunosuppressant therapy — checking levels, adjusting dosing, or switching to a different agent within or between classes.
• Antibiotics if an infection, fistula, or abscess is suspected.
• Exclusive enteral nutrition — in some cases, particularly in children and some adults, liquid formula nutrition used exclusively can help induce remission.
• Hospitalization for severe flares with dehydration, high fever, or suspected complications.

Between 30% and 55% of people with Crohn's disease require surgery within 10 years of diagnosis 2Ref 2National Institute of Diabetes and Digestive and Kidney Diseases (2024).Treatment for Crohn's Disease.Overview of medical management options for Crohn's disease flares including corticosteroids, immunosuppressants, biologics, bowel rest, and surgery; 30–55% of patients require surgery within 10 years. Crohn's disease is managed by a gastroenterologist, not at home alone. Gale can help you prepare for that visit and coordinate the referral if you do not yet have a GI specialist.