How to Manage 10 Common Crohn’s Disease Triggers

Crohn’s disease flare-ups can occur due to internal or external triggers, which vary by person. Knowing your triggers and working to control them is a key aspect of treating your disease. It can also help you reduce the impact of flare-ups on your daily life.

1. Stress

Research suggests that stress and other psychological factors can impact the course of Crohn’s disease. These emotions can work to trigger a flare-up or promote a relapse for people with this disease by interfering with the brain-gut axis.

The vagus nerve connects the brain and gut. This connection allows signals to travel between your brain and nervous system and gut (the gastrointestinal, or GI, tract) in both directions. When psychological factors like stress affect your brain, they can also impact your digestive health. This can create a cycle in which stress worsens your symptoms of Crohn’s disease, which causes more stress. This chronic cycle of stress can make you more sensitive to pain signals from your gut and trigger symptoms.

2. Medications

Certain over-the-counter and prescription medications are linked with the onset of Crohn’s disease flares. The following medications can contribute to flares in the following ways:

3. Diet

Research indicates that eating certain foods can trigger symptoms in people with Crohn’s disease. However, the impact of certain foods differs from person to person. If you have Crohn’s disease, you must identify which foods trigger symptoms in order to avoid them. Some common trigger foods and beverages include:

• Alcohol
• Caffeinated beverages such as coffee, tea, and energy drinks
• Foods high in fat, such as butter, fried foods, and cheesy dishes
• Foods high in fiber, such as Brussels sprouts, cauliflower, cabbage, and asparagus
• Foods high in insoluble fiber (the type of fiber that does not dissolve in water) and hard to digest, which include raw kale, apple skin, and sunflower seeds
• Foods high in lactose, such as cow’s milk, cream, ice cream, and custard
• Foods with sugar alcohols and artificial sweeteners such as xylitol, sorbitol, sucralose, aspartame, mannitol, and saccharin
• Spicy foods, such as those that contain sriracha or chili powder
• Sugary foods and foods with added sugars, such as cookies, coconut sugar, pastries, honey, and maple syrup
• Sugar-sweetened beverages such as soda, juices, and coffee/espresso drinks with sugar/syrup

4. Smoking

While the exact connection between smoking and Crohn’s disease isn’t fully understood, research indicates that you are likely to have more flare-ups if you smoke. Smoking with Crohn’s disease is also linked with having more severe disease and complications, including strictures (a narrowing in the bowel that can cause a blockage) and perianal disease (conditions in the area around your anus).

Smoking may be a factor in flare-ups because it affects your body in the following ways:

• Changes the level and balance of bacteria in your digestive system
• Alters the way your genes work
• Interferes with the health of your immune system
• Makes your gut lining more leaky, allowing more bacteria and other foreign substances to pass into your blood and trigger an immune response

5. Infections

Bacterial and viral infections can act as triggers for a flare-up of Crohn’s disease. Clostridioides difficile (commonly referred to as C. diff) infection is a common bacterial gut disease that produces infectious colitis. As a result, C. diff is linked with worse clinical outcomes in people with inflammatory bowel disease (IBD) like Crohn’s and ulcerative colitis. If you have C diff, you need antibiotic therapy to eradicate the bacteria.

Norovirus is another common infection thought to trigger flare-ups in Crohn’s disease. Research suggests that most people with Crohn’s disease have a genetic mutation (a permanent change in DNA sequence of a gene) that makes their gut lining cells more vulnerable to damage from a viral norovirus infection, which triggers symptoms.

6. Environmental Irritants

There is evidence that a wide range of external environmental factors play a key role in the onset of symptoms of IBDs, like Crohn’s. These environmental irritants include:

• Air pollution
• Water pollution
• Changes to the gut microbiome
• Sleep disturbances
• Surgical removal of the appendix

7. Vitamin D Deficiency

Growing evidence indicates that vitamin D may play a key role in regulating flare-ups of IBD like Crohn’s disease. Studies show an association between vitamin D deficiency and greater disease activity. It is also linked with a higher risk of relapse.

8. Incorrect Medication Use

Missing a prescribed medication dose or taking a prescription medication incorrectly can also trigger Crohn’s flare-ups. Skipping a dose, doubling a dose, or weaning off a medication can increase your risk of symptoms recurring. It’s important to continue taking prescribed drugs for Crohn’s disease even during times of remission (when there is little to no disease activity) to avoid a flare-up.

9. Food Additives

Food additives such as aluminum, titanium dioxide (TiO2), and microparticles/nanoparticles. Evidence suggests that these ingredients may worsen intestinal inflammation, thereby contributing to disease progression and flare-ups after remission of Crohn’s disease.

10. International Air Travel

There is evidence that people with IBD often experience disease flare-ups during international air travel. Research shows that people most likely to have flare-ups during international air travel were those who had an elevation in levels of fecal calprotectin (a measurement of inflammation in the intestines) before air travel, a history of emergency room visits, and the presence of a comorbid (co-occurring) disease.

How to Manage a Flare-Up

Depending on the severity of your Crohn’s disease, a flare-up can last from a few days to as long as a few months. Your healthcare provider can help you determine the best ways to manage a Crohn’s disease flare-up and return to remission based on your condition.

You may be able to improve symptoms with the following treatment options.

Self-Care

Self-care treatments are conservative therapies that you can perform at home to relieve discomfort and promote healing. Some common self-care strategies to use for managing a flare-up include:

• Bathe in warm salt water or a sitz bath (a shallow pan of warm water) to relieve anal soreness or painful bowel movements due to an anal fissure.
• Manage your diet to avoid food triggers that can irritate or worsen symptoms.
• Practice good anal hygiene by showering with a perianal cleansing product or a hand shower.
• Prioritize rest and adequate sleep.
• Reduce anal irritation by using a moist towelette or wipe instead of bathroom tissue.
• Reduce stress with meditation or deep-breathing exercises.

Medications

Prescription medications can help improve symptoms of a Crohn’s disease flare-up. The most common medications for flare-ups include:

Corticosteroids: Also known as steroids, corticosteroids slow the activity of your immune system and decrease inflammation. They include:

Aminosalicylates: These drugs contain 5-aminosalicylic acid (5-ASA), which helps control inflammation. They include:

• Asacol, Apriso, others (mesalamine)
• Azulfidine (sulfasalazine)
• Colazal (balsalazide disodium)
• Dipentum (olsalazine)

Immunomodulators: These drugs reduce the activity of your immune system to reduce inflammation in your digestive tract. They include:

Biologic therapies: These medications neutralize proteins made by your immune system. They include:

Other medications:

Bowel Rest

Bowel rest may be advised to treat severe flare-ups. This treatment involves restricting your diet for a few days to several weeks. During this time, you may be asked to limit your diet to a liquid diet that contains nutrients. Or, you may receive nutrition through a feeding tube inserted into your stomach or an intravenous (IV) tube into your vein.

Vitamin Supplementation

People with Crohn’s disease often develop vitamin or mineral deficiencies due to gastrointestinal bleeding or malabsorption. Common vitamin supplements that may be used to treat deficiencies of vitamin D, calcium, and vitamin B12, all of which are absorbed in your small intestine.

Surgery

Surgery may be necessary to treat complications and restore normal bowel function when other treatments are inadequate for flare-ups. Common surgeries used to treat Crohn’s disease flare-ups include:

• Bowel resection: A bowel resection involves the removal of a diseased portion of your intestine. The two ends are reattached in a procedure called anastomosis.
• Colectomy: This procedure removes a diseased portion of your colon. It can involve a total colectomy (removal of the entire colon) or partial colectomy (removal of only a part of the colon).
• Fistulectomy: This surgery removes a fistula.
• Fistulotomy: This procedure treats uncomplicated perianal fistulas by opening and draining the pocket so the tissues can heal.
• Proctocolectomy: This surgery removes both your colon and rectum. It may include an ileostomy or stoma (a hole in the lower abdomen that allows waste to exit your body without passing through the rectum).
• Seton placement: This treatment places a seton in the fistula, which is a thin, flexible tubing to help a fistula drain fluid so it can heal.
• Strictureplasty: This procedure is used to widen a stricture (a narrowed intestinal passage).

Tips for Preventing Flare-Ups

Try the following tips for preventing flare-ups and reducing your risk of dealing with symptoms:

• Avoid NSAIDs, which can interfere with the ability of your GI tract to heal itself.
• Consider cognitive behavioral therapy (CBT) to identify and change negative thought patterns and behaviors that may be contributing to stress.
• Consult a dietitian to plan a healthy diet while avoiding known food triggers.
• Do not start smoking and quit if you do smoke.
• Get regular exercise to boost your immune system and reduce stress.
• Keep regular medical appointments even if you are in a period of remission.
• Lower stress levels by practicing yoga, meditation, deep breathing exercises, biofeedback, and setting personal boundaries
• Minimize your use of caffeine and alcohol.
• Research either online or local support groups, and other resources from the Crohn’s & Colitis Foundation for people with Crohn’s disease.
• Take a multivitamin to counter problems with vitamin absorption from food.
• Take medication as directed even when symptoms seem to improve.

When to Contact a Healthcare Provider

Symptoms can vary by individual and the severity of your illness. Depending on your experience with the disease, you may recognize when symptoms are too severe to manage at home. Based on your condition, your healthcare provider can also offer guidance on what to expect during a Crohn’s disease flare-up and when to seek medical assistance.

Generally, you should contact a healthcare provider if you have any of the following symptoms during a Crohn’s flare-up:

• Abdominal bloating after meals
• Any amount of blood in your stool
• Bloody diarrhea, often with mucus or pus
• Diarrhea that can’t be controlled with diet changes and medicines
• Drainage from skin rashes
• Failure to gain weight in children
• Joint pain that interferes with your normal activities
• Nausea and vomiting that lasts longer than a day
• New side effects from any drugs prescribed for Crohn’s disease or other conditions
• Persistent or recurring pain or cramps in your lower stomach
• Rectal bleeding, drainage, or sores
• Skin sores or lesions that don’t heal, usually in your mouth or the area around your rectum
• Unexplained fever that lasts more than two or three days, or a fever higher than 100.4 degrees F 
• Unexplained weight loss or poor appetite at any age
• Vision changes

Summary

Having Crohn’s disease involves dealing with flare-ups when not in remission. While you can’t cure Chron’s disease, you can help reduce your flare risk by following certain strategies and prescribed treatments.

While several known triggers exist, they can vary from person to person and change over time. Knowing your triggers can help you work to reduce or avoid them.

Contact your healthcare provider when a flare occurs. While some flares can be managed with self-care, having bloody stools and other severe symptoms may require medical treatment. Your healthcare provider can help you determine the best way to manage symptoms for your condition.