Flares & ER
A Crohn's flare can feel like your body just pulled the emergency brake. One day you're managing, and the next you're dealing with cramping, urgent diarrhea, and the creeping fear that this one might be worse than the last. In that moment, what you do matters. Having a clear plan can turn panic into action, help you communicate better with your gastroenterologist, and potentially shorten the flare itself.
This guide walks through what to do when a flare starts, how to assess whether you can manage at home or need medical help, which medications are safe (and which can actually make things worse), and how to recognize warning signs early enough to intervene next time.
The First 24 Hours of a Crohn's Flare
When symptoms ramp up, resist the urge to wait it out and hope things improve on their own. Early action gives you the best chance of a shorter, less severe flare.
Start by contacting your gastroenterologist's office. Most GI practices have protocols for flare calls, and many can adjust your treatment plan over the phone without requiring an office visit. If you have a patient portal, send a message describing your symptoms, when they started, and what changed. Your GI team needs to know what's happening to help you.
While you wait for guidance, shift to a low-residue diet. This means temporarily reducing fiber intake to give your bowel less work. Stick to soft, easily digestible foods: white rice, bananas, applesauce, cooked potatoes, lean chicken or fish, and eggs. Small, frequent meals are easier on your gut than three large ones.
Hydration becomes critical immediately. Diarrhea depletes both water and electrolytes, and dehydration is one of the leading causes of hospitalization during Crohn's flares. Drink water throughout the day, and consider oral rehydration solutions or clear broths to replace lost electrolytes. Keep your urine light yellow as a rough hydration gauge.
How to Assess Flare Severity at Home
Not every flare requires a hospital visit, but some absolutely do. Severity assessment helps you decide what level of care you need.
A mild flare typically involves a modest increase in bowel movements (maybe one or two more than your baseline), mild cramping, and general fatigue. You can usually manage this at home with diet changes, rest, and communication with your GI team. Mild flares often settle within a few days to two or three weeks with appropriate management.
A moderate flare means more frequent bowel movements (five or more daily), persistent abdominal pain, low-grade fever, and noticeable fatigue that interferes with daily activities. At this level, your GI should be actively involved in adjusting your treatment. Corticosteroids or other prescription changes may be needed.
A severe flare involves high fever (above 100.3 degrees Fahrenheit), persistent vomiting, significant rectal bleeding with blood clots, severe abdominal pain that doesn't improve, signs of dehydration despite drinking fluids, or a swollen and tender abdomen. This level requires urgent medical attention.
When to Call Your GI vs. When to Go to the ER
Call your gastroenterologist when you notice your symptoms worsening beyond your baseline, when you have a low-grade fever, when diarrhea has persisted for more than a couple of days, or when you're unsure whether to adjust your medications. Your GI team can often intervene early enough to prevent escalation.
Go to the emergency room if you experience any of these:
Fever above 100.3 degrees Fahrenheit with chills
Severe abdominal pain with a swollen, rigid abdomen (possible bowel obstruction)
Persistent vomiting that prevents you from keeping fluids down, significant rectal bleeding with clots, or signs of severe dehydration like dizziness, rapid heartbeat, or very dark urine
These symptoms can indicate complications like obstruction, abscess, or severe dehydration that require immediate intervention. When in doubt, err on the side of going to the ER. Crohn's complications can escalate quickly.
The Critical NSAIDs Warning
One of the most common and dangerous mistakes during a Crohn's flare is reaching for ibuprofen (Advil, Motrin) or other nonsteroidal anti-inflammatory drugs to manage pain. The American College of Gastroenterology recommends that people with Crohn's disease avoid NSAIDs whenever possible.
Research shows that Crohn's patients who use NSAIDs five or more times per month have a 65% higher risk of active disease compared to those who don't. One study found that among IBD patients in remission, those assigned to take an NSAID had relapse rates between 17% and 28% over just four weeks, while none of the patients taking acetaminophen relapsed during the same period.
Acetaminophen (Tylenol) is the recommended alternative for pain relief during a flare. It does not carry the same risk of triggering or worsening intestinal inflammation. You can safely take up to 3,000 to 4,000 milligrams per day, though you should confirm the right dose with your doctor, especially if you have any liver concerns. If acetaminophen alone isn't managing your pain, talk to your GI about prescription options rather than switching to NSAIDs.
Anti-Diarrheal Medications: What's Safe and What's Dangerous
Loperamide (Imodium) can be effective for controlling Crohn's-related diarrhea in some patients. Studies have shown it can reduce daily stool frequency from eight to two within a month of treatment. But loperamide is not universally safe for all Crohn's patients.
If you have stricturing Crohn's disease (narrowing of the intestine), loperamide can be dangerous. By slowing gut motility, it can worsen an obstruction. Loperamide is also contraindicated in patients with active colitis, fever, abdominal tenderness, or any signs of bowel dilation, because it increases the risk of toxic megacolon.
Before taking any anti-diarrheal, confirm with your GI team that it's appropriate for your specific disease pattern. If you have stricturing disease, a history of obstruction, or active severe inflammation, anti-diarrheals may be off the table entirely.
Medications You Should Never Stop During a Flare
When you're feeling terrible, it can be tempting to blame your maintenance medications or to stop taking them because they don't seem to be working. This is almost always the wrong move.
Biologics, immunomodulators, and maintenance medications are designed to control underlying inflammation over time. Stopping them abruptly can lead to antibody formation (particularly with biologics), which can make the medication less effective or completely ineffective when you restart. Your GI may adjust doses or add short-term treatments during a flare, but the decision to stop or change maintenance therapy should always come from your medical team, never from you in the middle of a crisis.
If you're on corticosteroids like prednisone, stopping suddenly can cause adrenal crisis, a medical emergency. Steroids must always be tapered under medical supervision.
Home Remedies: What Actually Works
During a flare, the internet is full of suggestions. Here's what has actual evidence behind it and what doesn't hold up.
Rest is genuinely important. Your body is fighting active inflammation, and pushing through physical demands can prolong a flare. This doesn't mean complete bed rest, but scaling back activity and prioritizing sleep makes a real difference.
The low-residue diet described above is one of the most consistently recommended strategies. Avoiding high-fiber foods, raw vegetables, seeds, and nuts during active inflammation reduces mechanical irritation in the gut. Some patients benefit from liquid nutrition under medical supervision, though this should be discussed with your GI team rather than attempted independently.
Stress reduction has a meaningful evidence base. Research published through the Crohn's and Colitis Foundation shows that chronically high perceived stress is independently associated with flare relapse. During a flare, techniques like deep breathing, meditation, or simply reducing obligations where possible can support recovery.
Supplements like turmeric, probiotics, and omega-3 fatty acids are frequently recommended online, but the evidence for their effectiveness during an active flare is limited and inconsistent. They are not substitutes for medical treatment.
Recognizing Early Warning Signs Before Your Next Flare
One of the most valuable things you can do between flares is learn to recognize your personal early warning signs. Many patients report subtle changes days or even weeks before a full flare develops.
Common early indicators include a gradual increase in bowel frequency, mild abdominal discomfort that slowly intensifies, increased fatigue or general malaise, mouth ulcers, joint pain, and skin changes. Some patients notice that certain foods they normally tolerate start causing problems, or that their sleep quality declines.
Tracking your symptoms daily is the single best way to identify these patterns. By logging bowel frequency, pain levels, energy, diet, and stress, you can build a personal baseline and spot deviations early. When you catch a flare early, you and your GI can intervene sooner, potentially with less aggressive treatment and a faster return to remission.
Building Your Flare Action Plan
Every Crohn's patient should have a written flare plan developed with their gastroenterologist. This plan should cover what dietary changes to make immediately, which medications to adjust and how, clear thresholds for when to call the GI office versus when to go to the ER, and an emergency contact list including your GI's after-hours number.
Having this plan ready before a flare hits removes the decision-making burden during a crisis. Review it with your GI at your next appointment and keep it somewhere accessible, whether on your phone or taped to your medicine cabinet.
When a flare starts, open Aidy and start tracking immediately. Having day-by-day data helps your GI assess severity and adjust treatment faster, and recognizing your personal early warning signs can help you intercept future flares before they escalate.