People living with Crohn’s may experience periods of flares and remission. During remission, Crohn’s symptoms may reduce or resolve completely. Remission can last months or even years in some people.
Crohn’s disease is a chronic inflammatory bowel disease. Those living with the condition will experience periods of flares in which their symptoms are active as well as periods of remission when symptoms are reduced or go away completely.
There are many types of remission in Crohn’s, and it is possible to be in one form of remission but not another.
Learn more about remission in Crohn’s disease, what contributes to remission, how to tell if you’re in remission, and what to do if you experience a flare.
Being in remission from Crohn’s generally means that symptoms are well managed. Some people may not notice any symptoms at all when in remission, while some may experience a decrease in their symptoms.
The term “remission” can mean different things. People may find it beneficial to clarify with their healthcare professional what form of remission they are referring to.
It is possible to be in one form of remission but not another. For example, a person may be in clinical remission but not in endoscopic remission.
Here are the types of remission a doctor typically refers to:
Clinical
Clinical remission refers to having no symptoms of Crohn’s.
Biochemical
A biochemical remission refers to not having markers in blood or stool samples that may be indicative of active disease.
The biomarkers often used to determine disease activity in Crohn’s are C-reactive protein (CRP) and fecal calprotectin.
Endoscopic
Endoscopic remission may also be referred to as mucosal healing. This form of remission refers to a person not having any noticeable mucosal ulceration in the area that is examined during a procedure like a colonoscopy.
Histologic
Histology is the study of tissues and organs under a microscope.
Even if a person with Crohn’s is in clinical or endoscopic remission, it is
Being in histologic remission means not showing signs of active disease, such as inflammation, at this microscopic level.
Deep remission
This refers to a person experiencing no symptoms of Crohn’s, and no inflammation is seen during an endoscopy.
Surgical
Between 66 and 75% of people with Crohn’s will need to undergo surgery to effectively manage their disease.
Surgery can lead to remission in some people. The process is referred to as surgical remission or surgically induced remission.
People living with Crohn’s will typically experience periods of active disease, or flares, and periods of remission.
During a flare, a person may experience more Crohn’s symptoms, such as diarrhea, abdominal pain, and frequent bowel movements.
If a person is in remission, they may find their symptoms either decrease or disappear completely. Some people may find that common symptoms like diarrhea and abdominal pain are no longer present. They may also feel quite healthy during a period of remission.
Some people may still experience symptoms during remission, though symptoms may not be as severe as during a flare.
Medical treatment for Crohn’s can bring the disease into remission as well as help maintain remission.
Treatments that may induce remission or help maintain remission include:
- aminosalicylates
- corticosteroids
- immunomodulators
- biologic therapies
- antibiotics
- surgery
Properly adhering to prescribed treatments is an important factor to inducing and maintaining remission.
In addition to adhering to prescribed treatments, there are other factors that can influence whether a person is in remission or experiencing a symptom flare-up.
These factors may include:
- experiencing stress
- smoking
- using antibiotics
- using nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
Some people may stay in remission for months or even years, but flare-ups can still occur. There are steps a person can take that can help reduce the chances of this happening.
Continue taking prescribed medications
Even if symptoms improve or disappear completely, it is important to continue taking the medications your healthcare professional prescribed for Crohn’s and follow their instructions.
These “maintenance” medications can help reduce the chances of a flare.
Pay attention to diet
There is no specific eating plan for Crohn’s, but the food you eat can help promote healing as well as reduce symptoms.
Every person living with Crohn’s will experience the disease differently. The intestinal area the disease affects may determine which foods work best.
A doctor may suggest a variety of eating plans based on symptoms and disease activity. They may include:
- low fat diet
- low salt diet
- low fiber diet
- lactose-free diet
- high calorie diet
Some people with Crohn’s may find certain foods make their symptoms worse. For example, some people may need to limit or avoid high fiber foods like raw vegetables, nuts, and seeds.
Other steps to consider that may help reduce symptoms include:
- limiting greasy or fried foods
- eating smaller portions more regularly
- experimenting with eating bland, soft foods instead of spicy foods (though this may not help everyone)
- avoiding carbonated beverages if gas is an issue
Avoid smoking
Smoking can trigger a flare and bring a person out of remission. Those with Crohn’s who smoke tend to have greater disease activity and require more surgeries and medications to effectively manage their condition.
In contrast, those with Crohn’s who do not smoke typically have fewer flare-ups and less need for medications to manage their condition.
Limit alcohol
Drinking alcohol can worsen Crohn’s symptoms. Consuming alcohol — whether moderately or excessively — can contribute to flares.
For people living with Crohn’s, experts advise moderate alcohol consumption if they choose to drink.
Reduce stress
While stress does not cause Crohn’s, highly stressful situations can affect symptoms.
Stress management techniques may be helpful for some people. These may include:
- breathing exercises
- yoga
- meditation
- cognitive behavioral therapy
It is difficult to predict how Crohn’s may affect a person. Flare-up occurrence can vary widely throughout a person’s life.
In people who receive surgical or medical treatment for Crohn’s, almost 50% will either be in remission or experience a mild condition over the following 5 years.
Of those who are in remission, 45% will stay in remission in the following year.
It is typical for people with Crohn’s not only to experience periods of remission but also to experience relapses and flares.
Flares may be caused by:
- inflammation in the intestine
- scar tissue
- infection
- side effects of medication
- lifestyle factors like eating patterns and stress
- not taking medications correctly
If a flare occurs, it is important to speak with a doctor. They can help determine what is causing the flare and, if necessary, adjust treatment plans.
Flares may cause more severe symptoms. Here are some suggestive ways to help manage them:
- taking over-the-counter and prescription medications under a healthcare professional’s supervision
- practicing good anal hygiene
- using moistened wipes instead of toilet paper
- bathing in warm salt water
People living with Crohn’s disease typically experience periods of flare-ups and periods of remission.
During periods of remission, symptoms may go away completely. During remission, people with Crohn’s may feel quite healthy. In other people, Crohn’s symptoms may still be present but reduced in frequency, intensity, or both.
Medical treatment can induce and maintain remission. It is also important that people adhere to prescribed treatments to stay in remission.
Crohn’s disease is a type of inflammatory bowel disease that may cause digestive symptoms such as abdominal pain, diarrhea, and bloody stool. A gastroenterologist diagnoses and treats diseases of the digestive tract. They may partner with your primary care doctor to monitor Crohn’s disease and prescribe treatments such as medication and lifestyle changes.
A well-balanced diet may help limit inflammation, reduce symptoms, and lower the risk of malnutrition in Crohn’s disease. A registered dietitian can help you develop a healthy and sustainable eating plan. They can also help you learn about the potential benefits and risks of nutritional supplements, such as vitamin, mineral, or probiotic supplements.
Your doctor and pharmacist will work together to meet your medication needs. A pharmacist can help you learn about over-the-counter and prescription medications for Crohn’s disease, including how to take them, potential side effects, and whether they may interact with other drugs or substances. They may know about discount coupons or other resources to lower the costs of medications.
Some people with Crohn’s disease need surgery to remove part of their digestive tract. Your doctor may refer you to a surgeon if you have symptoms that do not improve with medication or you develop complications that require surgery to treat. Your surgeon will perform the procedure and help support your recovery afterward.
Living with a chronic condition such as Crohn’s disease may contribute to stress, anxiety, or depression. In turn, psychological stress can worsen Crohn’s symptoms. A psychologist, clinical social worker, or licensed counselor can help you manage mental health challenges with psychotherapy or other interventions. A psychiatrist or other doctor can prescribe medication if needed.
People with Crohn’s disease have increased risk of inflammatory conditions that affect the skin, eyes, or joints. Your doctor may refer you to a dermatologist for skin symptoms, a rheumatologist for joint symptoms, or an optometrist or ophthalmologist for eye symptoms. These specialists can help diagnose and treat the cause of your symptoms.
People with Crohn’s disease have decreased immunity. Meet with your primary care physician to discuss whether you need vaccinations and which types.