Crohn’s Symptoms: Common Triggers
Crohn’s symptoms can reawaken for unknown reasons, but that doesn’t mean you can’t learn to identify your triggers. Some of the most common ones include:
1. Stress
The connection is poorly understood, but stress is thought to lead to flares in some people living with Crohn’s, says R. Balfour Sartor, MD, who directs the Broad Medical Research Program at the Crohn’s & Colitis Foundation and is a professor of medicine, microbiology, and immunology at the University of North Carolina in Chapel Hill. Even in people who don’t have Crohn’s, “Stress increases blood flow to the gut, which … stimulates contractions in the intestines, leading to diarrhea and nausea,” Dr. Sartor says. As someone who has Crohn’s disease you are already susceptible to cramping and diarrhea, so these symptoms can be even worse. “Beyond that, there is some evidence that stress can stimulate inflammation and activate disease activity,” he adds. “One theory is that smoking causes constriction of blood vessels and leads to inadequate oxygen flow and nutrition in the intestines and increases biochemical mediators of inflammation,” Sartor says, “which causes injury to the area.” And there may be other reasons: According to a study published in May 2020 in the journal Microorganisms, cigarette smoke is associated with an increase in symptoms, an increased risk of disease recurrence after surgery, poorer response to treatment, a higher likelihood of hospitalization, and negative long-term outcomes. The study, which used cell cultures to examine the effect of nicotine in people with inflammatory bowel disease (IBD), found that the bacterial parasite Mycobacterium avium paratuberculosis (MAP) may play a role in the development of Crohn’s disease in certain people and may also be responsible for worsening inflammatory symptoms in smokers.
3. Medications
Aspirin, ibuprofen, and certain antibiotics are a few of the medications that can trigger Crohn’s flares. (Antibiotics change the balance of bacteria in the intestines, which can activate diarrhea even in people who do not have Crohn’s, Sartor notes.)
4. Diet
Foods can change the bacterial profile in your gut, triggering symptoms. No one food will cause flare-ups in everyone, so you should track your diet to determine the culprits. In general, though, you should avoid foods that can increase gas and diarrhea, such as greasy and fried foods, beans, cabbage, and carbonated drinks. It’s also a good idea to stay away from raw vegetables, watermelon seeds, peanuts, and popcorn, especially if you are among those with Crohn’s disease who have a narrowing of the intestines, which increases the risk for intestinal obstruction, Sartor says. Unfortunately, there’s no definitive evidence of how diet impacts IBD, and doctors are not yet able to make recommendations on what to eat or avoid. In most cases, people with Crohn’s and other conditions, such as ulcerative colitis (UC), are advised to eat a healthy, well-balanced diet and steer clear of processed foods, according to an article published in August 2019 in the journal Gastroenterology. The research notes that diets high in fruits and vegetables and low in animal fat and sugar may decrease the risk for IBD. The good news, researchers are currently studying the link between diet and Crohn’s disease. They’re researching the effectiveness of certain diets, including the Mediterranean diet, in helping control Crohn’s symptoms and bring about remission.
5. Infections
Infections can also precipitate flare-ups, according to Sartor. “We know that gut infections can kick off symptoms in patients whose symptoms had been [in remission],” he says. There’s also some evidence that bacterial and viral infections can set off Crohn’s in people who have never had any symptoms. For example, he says, you may go on vacation and contract an infection — think Montezuma’s revenge — after exposure to E. coli. Though other travelers may get better without any residual problems, if you’re genetically susceptible to Crohn’s, you may lack a mechanism to turn off the inflammation, Sartor explains. Another possible Crohn’s trigger is a Clostridium difficile (C. diff) infection. According to the American College of Gastroenterology, as someone with IBD, you are more likely to contract a C. diff infection than those without IBD. “Patients with IBD are at a higher risk for C. difficile, and that can actually precipitate IBD flares,” says Kelly Cushing, MD, a clinical lecturer and gastroenterologist who specializes in IBD at Michigan Medicine at the University of Michigan in Ann Arbor. “That’s probably the most significant infection that we see for flares.” Taking antibiotics may increase the risk of C. diff. “So if someone with Crohn’s develops worsening symptoms after a recent course of antibiotics, that would lead us to think about this particular infection,” Dr. Cushing notes. Cytomegalovirus (CMV) is another virus that may trigger Crohn’s, says Cushing. “CMV tends to be a higher risk for patients who have been immunosuppressed for a period of time, such as patients on steroids,” she says.
6. Seasonal changes
You may have flare-ups at different times of the year. “One theory is that it might have something to do with allergy to pollen or exposure to respiratory infections,” Sartor says.
7. Not taking your medication
If you’re experiencing side effects or other problems that are interfering with your ability to take your medications as directed, you could experience a flare as a result. In that case, it’s important to work with your doctors to find a solution, says Cushing.
Crohn’s Symptoms: Identifying Your Triggers
Before you can avoid triggers, you must identify them. Because triggers can vary from person to person, the best strategy is to keep track of the circumstances surrounding your flare-ups. Answer these questions a doctor would ask:
Are you taking ibuprofen, aspirin, or a similar medication?Were you recently on antibiotics?Did you recently have an infection?Have you traveled recently?Do you smoke?In the week before your flare-up, did you experience stress or anything unusual?
Another useful way to identify triggers is to keep a food journal. That way, you will know everything you ate within 24 hours of experiencing symptoms. It’s probably not necessary to write down every bite, Sartor says, but it makes sense to get into the habit of listing the foods and beverages you consume each day, particularly ones that commonly trigger Crohn’s symptoms. By keeping track of your daily routine as well, you can be your own detective and uncover any common threads between your flare-ups.
Crohn’s Symptoms: Avoiding Triggers and Calming Their Effects
Once you’ve identified your Crohn’s triggers, the next step is to avoid them.
If you suspect stress is one of your triggers, do what you can to eliminate or at least reduce your stress levels. “If you’re in an occupation that’s continuously stressful, look for another job,” Sartor says. “If you’re experiencing marital stress, go for counseling.” Try yoga, meditation, breathing exercises, listening to music — whatever helps you relax. You may need to talk with your doctor about starting talk therapy or taking medications that help lower your stress levels.If you smoke, find a way to stop.Avoid aspirin and ibuprofen and switch to acetaminophen, which does not trigger Crohn’s flare-ups.Avoid foods that are more likely to cause gas or increase the risk for intestinal obstruction.
By identifying and then avoiding all possible triggers, you can reduce the number of Crohn’s flare-ups you experience.
