Pain medication for crohn’s

Inflammatory Bowel Disease Overview

Ulcerative colitis and Crohn’s disease are types of inflammatory bowel disease (IBD), which affect an estimated 1.6 million Americans and involve chronic inflammation of the digestive tract.

By Celia Vimont Reviewed By Dr. Darrell S. Pardi

Ulcerative colitis affects the inner lining of the colon (large intestine), while Crohn’s disease can affect any part of the gastrointestinal tract from the mouth to the anus. While the exact cause of these conditions is not known, both diseases can run in families.

“Both are chronic conditions, which means there is no cure, but they can be managed effectively with medications, with long-lasting periods of remission,” says Darrell S. Pardi, MD, a gastroenterologist at the Mayo Clinic in Rochester, Minnesota. “There is a lot of research going on in the area of IBD treatment, and we hope to see new treatment options in the next several years.”

Ulcerative Colitis

This disease affects only the colon. “For the most part it’s restricted to the inner lining of the colon, and it’s not as painful as Crohn’s disease,” Dr. Pardi explains. About half of all patients with ulcerative colitis have mild symptoms, and those symptoms may come and go. With current medical treatment, many people with ulcerative colitis have long periods in which they do not experience symptoms.

Common symptoms include:

  • Bowel movements become looser and more urgent
  • Persistent diarrhea accompanied by abdominal pain and blood in the stool
  • Abdominal cramps
  • Weight loss due to loss of appetite
  • Feeling of low energy and fatigue
  • Sensation of needing to move bowels even after going to the bathroom

Crohn’s Disease

Some symptoms of Crohn’s disease overlap with ulcerative colitis but Crohn’s is typically more painful and may also affect other organs including the liver, eyes, skin, and joints. “Crohn’s may affect the deeper layers of the bowel,” Dr. Pardi says. “Crohn’s is more likely to cause complications like bowel blockage or perforation of the bowel or an abscess.” A person with Crohn’s who feels severe pain should be evaluated by a doctor quickly, he notes.

Common symptoms of Crohn’s include:

  • Persistent diarrhea
  • Rectal bleeding
  • Urgent need to move bowels
  • Abdominal cramps and pain
  • Sensation of needing to move bowels even after going to the bathroom
  • Weight loss and fatigue

Diagnosis

While IBD can occur at any age, many people are diagnosed between the ages of 15 and 35.

A colonoscopy is used to diagnose both ulcerative colitis and Crohn’s. A colonoscopy involves inserting a flexible tube through the opening of the anus to examine the colon. For Crohn’s, the doctor may also order a CT, MRI, or a capsule endoscopy, which involves swallowing a camera pill to obtain pictures of the small intestine.

Treatment

Treating pain for IBD can be tricky, Dr. Pardi says. Non-steroidal anti-inflammatory medications, such as aspirin, ibuprofen or naproxen, can make both conditions worse. Opioid pain medications can worsen outcomes in Crohn’s disease, and probably ulcerative colitis as well. “Opioids are associated with serious infections and even death in people with Crohn’s,” Dr. Pardi says. “If a person has an immediate complication from either condition, the doctor may prescribe short-term use of pain medication, but we try to avoid chronic use. The risks far outweigh the benefits.”

The best way to control pain from ulcerative colitis or Crohn’s is to treat the condition itself. The doctor will choose the best medication based on the patient’s age, how long they have had the disease, how severe it is, which part of the bowel is affected and what other conditions the patient has. In some cases, the doctor may recommend a combination of drugs.

Medications

Medications can control and suppress symptoms, and decrease the frequency of symptom flare-ups. They may include:

  • Aminosalicylates (5-ASA). These drugs decrease inflammation in the lining of the gastrointestinal tract, and are used for more moderate cases of colitis. Brand names include Asacol, Pentasa and Salofalk.
  • Corticosteroids.These drugs, such as budesonide (Entocort, Uceris) and prednisone, suppress the immune system and are used to treat moderate to severe disease. Because these drugs may have significant side effects and are generally not effective for more than a few months, they should not be used long-term.
  • Immunomodulators. These drugs suppress the immune response so it cannot cause ongoing inflammation. These drugs include azathioprine (Imuran, Azasan), 6-mercaptopurine (6-MP, Purinethol) and methotrexate.
  • Biologic Therapies.These medications also suppress the immune response so it cannot cause ongoing inflammation. One biologic medicine, vedolizumab (Entyvio), is less likely to cause side effects because it is more precisely targeted to particular proteins that are involved in IBD. In contrast, other IBD treatments such as corticosteroids, immunomodulators, and some biologics affect the entire body. In addition to Entyvio, other biologic drugs used to treat moderate to severe ulcerative colitis and Crohn’s include, ustekinumab (Stelara) and infliximab (Remicade), adalimumab (Humira). Dr. Pardi calls these therapies “a major advance” in the treatment of IBD.

Surgery, a Last Resort

For patients with certain complications and those whose disease is not controlled with medication, surgery is an option.

For ulcerative colitis, the colon is removed. After the surgery, the disease will not recur. With Crohn’s, surgery to remove the diseased segment of the bowel may be necessary if a person’s symptoms do not respond to medication, or if they develop an intestinal blockage, or a fistula—an ulcer that tunnels through the intestine and into the surrounding tissue, often around the anus and rectum. Other complications that may require surgery include excessive bleeding in the intestine or perforation of the bowel. The surgery does not cure Crohn’s but it can reduce symptoms and address complications that are not amenable to medical therapy.

If surgery is required for ulcerative colitis, the standard surgical procedure is removal of the colon and rectum, called proctocolectomy. In the past, patients who underwent this procedure had to wear a bag over a small hole in the abdomen to collect stool. Today, many patients undergo variations to the procedure that do not require wearing a permanent external bag.

Many patients with Crohn’s have surgery on their small bowel. urgery for Crohn’s removes the area that is most involved, leaving behind as much bowel as possible. In many cases, the surgeon removes the end of the small bowel and beginning of the colon (which is where Crohn’s is most commonly located) and reconnects those areas.

If the rectum is affected and must be removed along with the colon, the patient will need to wear an external ostomy bag to collect stool.

Lifestyle changes, including quitting smoking, getting enough sleep and eating a healthy diet, are recommended for any type of IBD. Dr. Pardi notes that many restrictive diets are touted online as treatments for IBD. “Specific diets have not been definitively shown to help either ulcerative colitis or Crohn’s,” he says. “Don’t start any diet purported to treat these conditions without first speaking with your healthcare provider. They could end up contributing to malnutrition.”

One diet advertised specifically for managing ulcerative colitis and Crohn’s is the Specific Carbohydrate Diet, which eliminates many of the foods in a typical American diet, including all simple sugars, grains, starches and most dairy. According to the Crohn’s and Colitis Foundation of America, there has been no scientific evidence supporting these diets. The group notes the diet is very restrictive and difficult to follow.

Updated on: 10/16/17 View Sources

Sources:

Interview with Dr. Darrell S. Pardi, July 2017.

When You’re Told ‘You Don’t Need Pain Medicine’ for Your Chronic Illness

Photo by J Elizabeth Photography www.jelizabethphotos.com

Battling a chronic illness is like an unwelcome adventure with lots of twists, turns and dead ends. Just when you think you have everything under control, you discover there is more to learn. July will mark 11 years since I was initially diagnosed with Crohn’s disease. When I’ve discussed my symptoms and overall health with doctors, receiving a prescription for pain medicine, just in case a flare up occurs, was always a no-brainer. No questions asked.

This week was different. Instead of the doctor understanding completely and writing a script when I asked for Tylenol with Codeine and Zofran (for nausea), I was told the following: “My patients never need pain medicine. Your pain needs nothing more than two tums and an extra strength Tylenol.”

In the moment I held my tongue. In the moment I was so shocked I couldn’t find the words. But, a couple days have passed and now I’ve found them. How dare a doctor or a person for that matter, who has never experienced or endured what it feels like to have your intestines inflamed and your body literally fighting against you, begin to underestimate not only the pain I feel, but how I choose to handle it. I consider myself to have an extremely high pain tolerance— when you live it for years, you accept it;it’s your normal.

But, there are times when the pain strikes out of nowhere. There are times when you need something more to be able to sleep or get through the day so you can function like the rest of society and not be stuck on the couch. That’s what living with Crohn’s is. It’s about finding your own balance and managing your disease process in a way that doesn’t hinder your quality of life. Sure, I wish I didn’t have to give myself injections or take five pills a night with dinner — but if that’s what it takes to get out of bed every morning and feel my best, I’ll do it. Even when you feel completely fine, there’s always a piece of you every single day that wonders and worries whether that cup of coffee or that lunch is going to throw things out of whack. You never know how you are going to respond — to food, stress, excitement, exercise (just to name a few). Every. single. decision. is like Russian roulette with your insides.

Nobody knows when the disease is going to strike next. Since I underwent my first surgery in August which involved the removal of 18 inches of my intestines, I have felt amazing and symptom-free 90 percent of the time. But a few weeks back, those unwelcome debilitating gnawing pains returned.

I was home in Chicago with my fiancé and his parents. We had my hair and makeup trial and the food tasting for our upcoming wedding in June. I don’t know if it was the stress coupled with all the delicious, out-of-the-ordinary food or what, but I had to leave the table over the course of the meal three times. I was mortified and deep down, my mind began to race. What if—what if I get sick at our wedding? What if I’m in this bathroom when I should be enjoying the night? How will this work with a wedding dress?

That night the pain persisted — in a 24 hour period I needed three Tylenol with Codeine to get through. It was the first time I needed pain medication since surgery. It was a reminder that the disease is still a part of me and always will be. When I shared that story with my doctor and she brushed it off, words can’t describe the disappointment and anger I felt.

Here’s my advice:

Doctors,

Please listen: You are a gastroenterologist because you are passionate about helping those suffering with GI diseases. Even though you’re the expert, unless you have Crohn’s or Ulcerative Colitis yourself you truly don’t know what it’s like. Please be patient, don’t interrupt and realize you can learn more by listening to each patient’s unique story.

Show empathy: We realize you see countless patients and you may be desensitized to sharing news and explaining surgeries. However, please make us feel like we’re not just another number, not just a part of a different research study or more money in the bank. If we’re upset or need time to take something in, understand the news you are sharing has an impact on our health and is a test or a procedure we are going to have to go through and heal from. I found out I was going to need major abdominal surgery during a two-minute phone call. That doctor didn’t even take the time to visit me in my hospital room to break the news.

Hear our voice: If a patient expresses the need for pain medication or help, don’t laugh or make it seem like their ideas or hopes about not being off medicine someday are unattainable. Living with an inflammatory bowel disease is no laughing matter. Offer advice for ways we can manage the disease in a way we are comfortable with. There’s a way of explaining the risks without making the patient feel like they have some type of terminal illness.

Think of us as family: If I was your daughter or your wife how would you expect me to be treated? Would you recommend a biologic medication that has long-lasting side effects to a loved one? Would you advise her to handle a pain level of an eight with tums?

Patients,

Be your own advocate: Just because you’re told you need a certain test or certain medication does not mean that’s the only option. Nobody knows your body the way you do. Listen to your body and how you are feeling. Follow your gut. It may steer you wrong most the time, but it can be trusted.

Use your words in the doctor’s office: As emotional as it can be to receive news or have difficult discussions with your doctor, don’t be afraid to stand up for what you believe in. Otherwise, you’ll walk out the door and feel like you were cheated.

Find a doctor who comforts you: Think of your doctor as a caretaker, someone who has your best interest and doesn’t look to you as just another patient. Bedside manner is really all that it’s cracked up to be. If you are uncomfortable during a routine visit, imagine how fed up you’ll feel in a hospital bed at your worst. It’s all about finding compassionate care.

Network and maintain relationships: Talk with fellow Crohnies and see who they recommend. There’s generally a consensus among those who’ve been in your shoes and “get it.” Check out hashtags on Instagram such as #Crohns and #IBD and you’ll instantly be connected with thousands of people who can serve as a sounding board. Be a part of the community and ask those people questions.

So guess what, Doc? It turns out your patients do need pain medication — not to abuse it, but to be prepared and have an improved quality of life with one less unknown.

The Mighty is asking the following: Describe a moment when you were at a hospital and a medical staffer, fellow patient or a stranger made a negative or surprising comment that caught you off guard. How did you respond to it? If you’d like to participate, please send a blog post to Please include a photo for the piece, a photo of yourself and 1-2 sentence bio. Check out our Submit a Story page for more about our submission guidelines.

Boston—Patients with Crohn’s disease and ulcerative colitis often are warned about the use of acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) because of concerns that the painkillers could exacerbate their conditions.
A new review in Alimentary Pharmacology & Therapeutics did not make a clear connection, however.
“Contrary to generally accepted belief, a recent review and analysis of published studies did not reveal a consistent association between the use of or acetaminophen and exacerbation of Crohn’s disease and ulcerative colitis,” write authors led by Massachusetts General Hospital researchers. “Nevertheless, when the analysis was limited to studies with a low risk of bias, there was a link between NSAIDs use and exacerbation of Crohn’s disease but not ulcerative colitis.”
The researchers conducted a systematic review and meta-analysis of previous studies examining the association between acetaminophen and NSAIDs including cyclooxygenase (COX-2) inhibitors use, and risk of Crohn’s disease (CD) and ulcerative colitis (UC) exacerbation.
Published manuscripts and abstracts through March 1, 2017, were collected by systematic search of Medline, Embase, Cochrane, and other trial registries. Quality assessment was done using Newcastle-Ottawa scale, while random?effect meta?analysis using pooled relative risks (RRs) and 95% CIs were calculated.
Overall, 18 publications between years 1983 and 2016 were identified. For the meta-analysis, pooled RRs of disease exacerbation with NSAIDs use were (1.42, 95% CI, 0.65-3.09), I2 = 60.3% for CD, and (1.52, 95% CI, 0.87-2.63), I2 = 56.1% for UC. The corresponding values for acetaminophen use were (1.40, 95% CI, 0.96?2.04), I2 = 45.6% for UC, and (1.56, 95% CI, 1.22-1.99), I2 = 0.0% for IBD.
Sensitivity analyses limited to studies with low risk of bias showed a significantly increased risk of CD exacerbation (1.53, 95% CI, 1.08-2.16) but not UC (0.94, 95% CI, 0.36-2.42) with NSAID usage.
“Contrary to generally accepted belief, we did not find a consistent association between NSAIDs use and risk of CD and UC exacerbation,” study authors conclude. “There was also no consistent evidence for association with acetaminophen although further studies are needed.”
“We were surprised to see that there is little data in the literature to support our common recommendation to patients with inflammatory bowel disease to avoid all NSAIDs,” added senior author Hamed Khalili, MD, MPH, of Massachusetts General Hospital.

What Should You Do About Crohn’s Disease Pain?

Crohn’s disease hurts.

When it hurts, how much it hurts and what to do about it are all worrisome to patients and their doctors.

I’m fortunate. For the past two years, I haven’t had much discomfort beyond light cramping and urgency, both of which are associated with short bowel syndrome in patients who have had as much small bowel surgery as I’ve had.

Most patients experience pain from cramping or soreness in specific spots in the abdomen from time to time in addition to other common symptoms like diarrhea. When I refer to using medication, I’m talking about more than the occasional twinge or five minutes of cramping.

The “gold standard” of using medication for Crohn’s pain says acetaminophen for mild pain. It steers clear of aspirin, ibuprofen and naproxen, all of which can aggravate symptoms of the disorder.

Then there’s the other pain. It’s the sharp stuff patients awaiting surgery sometimes experience. Before diagnosis, several times a year, I underwent attacks of horrific pain that rolled through my body with each wave of peristalsis. I invariably ended up in an emergency room every time and didn’t find out partial obstructions caused the pain until diagnosis years later. I likened the level of pain to that of the worst labor pains it was possible to experience.

Shortly before my first small bowel resection, I was driving with my daughter to the pediatrician’s office. I suddenly had a pain so sharp that it felt like a football player had kicked me in the gut. I had to pull off the road. Fortunately, it subsided, and I was able to continue driving.

This is the kind of situation that makes patients ask about narcotics, which hospitals use to control pain after surgery. It’s an appropriate question when there are days when it’s impossible to even stand up straight due to pain. Most doctors are reluctant to issue medications containing narcotics to Crohn’s patients except immediately after surgery.

The reason isn’t profound. They’re afraid of the danger of addiction.

For at least 10 years, I made a habit of keeping a small amount of a medication with a narcotic in the house. I simply asked the doctor to prescribe no more than 20 pills, which could be taken every 4 hours, with no refills. Since I was definitely prone to partial small bowel obstructions, was an experienced patient and had a history with the practice, the gastroenterologist had no problem with this.

I haven’t had any in the house for a couple of years. Being free of major pain has given me an opportunity to look at other ways to control discomfort. The first one most patients mention is changing what they eat during challenging times.

Short of a trip to the emergency room, it’s often impossible for a patient with Crohn’s disease to see a healthcare provider the same day discomfort escalates. In the meantime, one sensible way to help yourself is eliminating anything from your “normal” diet that might irritate the disease even more. Get the list from your physician before you need it.

My experience with five Crohn’s-related surgeries is that pain can suddenly strike even a couple of months after a procedure. If this happens, despite the surprise, it’s helpful to remain calm and place a call to the doctor to report what happened. Every pain that’s associated with Crohn’s disease doesn’t necessitate a trip to the ER.

Patients also talk a lot about reducing stress. Lest there be any confusion in that statement, stress does not cause Crohn’s disease. It can aggravate any major illness, including Crohn’s.

The stress I’m talking about is the one associated with tensing of the body during pain. It’s worth taking the time for a couple of sessions on meditation, deep breathing and other techniques that will help the body relax, which helps lessen the impact of pain.

Sept. 7, 2000 — Susan Johnson was taking some 400 ibuprofen tablets a month for pain when she finally saw her doctor in August. She knew she was taking way too much, because the diarrhea that is a symptom of the inflammatory intestinal disease she has battled for two decades was worse than it had been in years.

“Nobody ever told me not to take ibuprofen, but I knew it was insane to take that much,” the 43-year-old Waynesburg, Pa., woman tells WebMD. “But my pain was so bad I had to do something. When I told my doctor how much I was taking, his eyes went wide and he said, ‘You’ve got to be kidding.’ Then he told me that I shouldn’t be taking ibuprofen at all because it causes diarrhea.”

Managing sporadic and long-term pain in people with inflammatory bowel problems like ulcerative colitis and Crohn’s disease, which Johnson has, is a tricky proposition. And a new study suggests that it may be even more problematic than previously believed. Researchers from New York City’s Lenox Hill Hospital found that patients with inflammatory bowel disease should avoid not only ibuprofen preparations like Motrin, Advil, and Nuprin, but most other anti-inflammatory pain relievers as well, including Ecotrin and all medications containing aspirin.

The study, published in the August issue of The AmericanJournal of Gastroenterology, suggests that patients with inflammatory bowel disease should avoid medications belonging to the class known as nonsteroidal anti-inflammatory drugs (NSAIDs), because they both aggravate symptoms of the existing disease and may actually cause disease onset in people who are predisposed to the condition.

In this study, 60 patients with severe inflammatory bowel disease flare-ups requiring hospitalization were questioned regarding their use of NSAIDs. The authors found a correlation between NSAID use and flare-up of bowel disease symptoms in just under one-third of the patients.

“The use of these NSAIDs in general is a lot more detrimental than we had previously believed, but specifically, when we are talking about people with inflammatory bowel disease, these drugs should not be used if at all possible,” study author Joseph B. Felder, MD, tells WebMD. “Even the simplest over-the-counter medications can have serious ramifications for these patients, so they should always be careful.”

Pain Relievers

It is very common for people who have inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis, to report that they experience pain due to the disease.1 A range of symptoms and complications related to the disease can be sources of pain. Pain experienced by people with IBD can have a variety of causes, including:

  • Pain caused by inflammation
  • Pain caused by surgical complications
  • Pain caused by bacterial overgrowth in the digestive tract2

Experiencing pain can significantly affect a person’s quality of life, and can cause anxiety if the pain is uncontrollable or long lasting. For this reason, healthcare providers work with patients to develop a pain management strategy to help control and reduce pain.

What are common inflammatory sources of pain in people with IBD?

IBD is a condition caused by chronic inflammation in the digestive tract. This inflammation frequently causes symptoms and complications that are sources of pain, including:1

  • Gastritis – inflammation of the stomach lining
  • Enteritis – inflammation of the intestine
  • Colitis – inflammation in the colon, which is entirely different than ulcerative colitis
  • Abscess – an area of infection that is filled with pus
  • Fistula – a tunnel that forms between an organ and another part of the body
  • Fissure – a small tear in the tissues that line the anus

IBD can also cause symptoms and complications that occur outside of the digestive tract. These sources of pain are called extraintestinal, and can include:1

  • Peripheral arthritis – inflammation of the large joints of arms and legs (elbows, wrists, knees, and ankles)
  • Sacroiliitis – inflammation in the area where the lower spine connects to the pelvis
  • Ankylosing spondylitis – inflammation that causes the vertebrae in the spine to fuse together
  • Primary sclerosing cholangitis – inflammation that scars and damages the bile ducts in the liver
  • Erythema nodosum – skin inflammation that causes red, painful lumps
  • Pyoderma gangrenosum – chronic, deep ulcers on the skin

What are common non-inflammatory sources of pain in people with IBD?

Inflammation is not the only source of pain caused by IBD. Non-inflammatory sources of pain in the digestive tract include:1,2

• Strictures – narrowing of the intestines
• Adhesions – bands of scar tissue that can develop after surgery
• Small-bowel obstruction

Non-inflammatory sources of pain due to IBD that are outside the digestive tract include:1

• Kidney stones
• Gallstones

How can people with IBD manage their pain?

The first step in developing a pain management approach for a patient with IBD is to determine what is causing the pain. If active IBD is causing the pain, then the first strategy is generally for healthcare providers to change or increase the medication that the patient is taking to manage the disease, such as aminosalicylates, corticosteroids, antibiotics, immunosupressants, or biologics. In many cases, treating the disease and its symptoms can be effective in reducing pain.1

However, some people may continue to experience pain despite the change in medication, or they may have pain that is not due to active IBD but some other cause. In those cases, healthcare providers may recommend trying some kind of pain relievers.

What kinds of pain relievers can be used by people with IBD?

The most common type of over-the-counter pain relievers are called NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen (Advil or Motrin), aspirin, or naproxen. These medications are generally not recommended for people with inflammatory bowel disease because of the side effects that they can cause in the digestive tract. This means that taking NSAIDs for pain relief can cause the symptoms of IBD to get worse or trigger IBD flare-ups that can cause further damage to the digestive tract.1,2

Patients with IBD should consult their healthcare providers before taking any NSAID medications. In some cases, NSAIDs may be recommended for treating pain due to arthritis, but patients will be monitored closely for side effects. Instead of NSAIDs, people with IBD may be advised to try acetaminophen (Tylenol) for pain relief.1,2

Opiates are a very strong type of medication that can be used to treat severe pain. They include morphine, hydrocodone (Vicodin), oxycodone (Percocet), and codeine. While they can be very effective at treating severe pain in the short term, if they are taken long-term, opiates can cause serious side effects and can make a person physically dependent on them. For this reason, they should be taken only under close supervision from a healthcare provider.1,2

Crohn’s Disease Management: How to Calm Down an Angry Stomach

Treating or managing Crohn’s disease doesn’t involve a one-size-fits-all approach. You likely need to try out different solutions to find what works best for you. Always speak with your doctor before taking any over-the-counter drugs or beginning a new exercise program.

Take an anti-diarrheal medication

Diarrhea can be one of the most inconvenient symptoms to deal with as you try to live a normal life with Crohn’s disease. And it can also lead to further health consequences if not treated.

Several over-the-counter medications can help ease symptoms of diarrhea, gas, or bloating:

  • loperamide (Imodium A-D)
  • bismuth-subsalicylate (Pepto-Bismol)
  • psyllium (Metamucil)
  • methylcellulose (Citrucel)

Before you take an over-the-counter medication to calm down your stomach, check in with your doctor. Your symptoms may suggest a worsening of your inflammation. Your doctor may want to make a change to your prescription medication.

Ask your doctor about pain relievers

Your doctor may recommend taking acetaminophen (Tylenol) if your stomach pain comes along with joint pain.

Don’t take nonsteroidal anti-inflammatory drugs (NSAIDs) for stomach pain. This includes ibuprofen (Motrin IB, Advil) and naproxen (Aleve, Naprosyn). While NSAIDs might help relieve some joint pain, they can irritate your gastrointestinal tract, worsening your symptoms.

Avoid certain foods

You may have to give up some of your favorite foods in order to stay healthy. Certain foods and beverages can worsen your symptoms. While there’s no concrete evidence that a particular food is responsible for the inflammation associated with Crohn’s disease, you know your body best.

If you haven’t started one already, consider creating a food diary to keep track of which foods aggravate your symptoms. A few foods in particular you’ll want to pay attention to. If you find out that these types of food make your stomach angry, it’s probably best to avoid them altogether:

  • dairy products
  • fatty foods
  • high-fiber foods, such as beans, popcorn, nuts
  • raw fruits and vegetables (have them cooked instead)
  • spicy foods
  • alcohol
  • caffeine

Stick to bland foods

If you’re experiencing stomach pain, stick to bland foods, such as the following:

  • dry toast
  • rice
  • eggs
  • bananas
  • applesauce
  • boiled, skinless chicken

Eat small, frequent meals

Eat five or six small meals throughout the day rather than two or three large ones. This ensures that your body gets enough nutrients and calories for the day without putting unnecessary strain on your stomach.

Try an herbal remedy

Certain herbs may help calm your stomach. While there isn’t a lot of evidence for the efficacy of these herbs in treating Crohn’s disease, they have been used traditionally to lessen inflammation inside the digestive tract.

Herbs and herbal teas may have side effects, and some herbs interact with others. Speak with your doctor about taking herbs and supplements.

Ginger

The rhizome of the ginger plant is commonly used in cooking. But it’s also a dietary supplement to treat nausea and vomiting. Ginger is also believed to be an antioxidant and an anti-inflammatory agent. It’s available in many forms, including fresh, dried, pickled, preserved, crystallized, candied, and powdered.

Turmeric

Turmeric is a spice related to ginger. A compound found in turmeric called curcumin is thought to have anti-inflammatory properties and may be useful in treating Crohn’s disease. Small clinical studies of people with Crohn’s disease and other inflammatory conditions have shown promising results, but additional studies are needed.

You can find fresh turmeric in your grocery store. It’s also available as a powder that you can add to your meals, or in capsule form.

Peppermint

Peppermint calms the muscles of your stomach and has shown evidence of soothing inflammatory pain in the gastrointestinal tract. Peppermint is easy to find in tea or capsule form.

Slippery elm

The bark of the slippery elm tree is a demulcent — a substance that protects inflamed tissues. When the bark is mixed with water, it turns into a sticky material known as mucilage. Mucilage coats and soothes your stomach and intestines. One study found that slippery elm had an antioxidant effect in people with Crohn’s disease.

To make tea from powdered slippery elm bark, pour 2 cups of boiling water over roughly 2 tablespoons of the powder and steep for a few minutes. Slippery elm is also available as a lozenge or in capsule form.

Marshmallow

Marshmallow (the herb, not the sticky sweet confection) has been studied for its ability to protect and soothe tissues in the stomach and reduce inflammation and stomach acids. To make a tea, steep 2 to 5 grams of dried leaf or 5 grams of dried root in 1 cup of hot water.

Boswellia

The acids produced by the Boswellia genus of trees are thought to have therapeutic capabilities. In a small study in people with ulcerative colitis, 14 of 20 participants who received boswellia gum resin achieved remission of their disease. Another study, conducted in 2001, found that boswellia was just as effective as mesalazine, a standard Crohn’s disease treatment, in treating 102 participants with Crohn’s disease.

Consider juicing

If solid foods aggravate your stomach, juicing is a great way to get the nutrients and calories your body needs without adding stress to the digestive process. You can combine herbal remedies, like ginger, with a variety of fruits and vegetables. Start with a simple recipe of just one apple, one carrot, and a small piece of ginger. Because the juicing process removes fiber, the nutrients can be easily absorbed.

A Balanced Belly has some tips and tricks for juicing as well as a range of healthy juice recipes for people with Crohn’s disease.

Find ways to reduce stress

Your stomach might be feeling angry because you’re under a lot of stress. Try the following techniques to help you relax and reduce your stress levels:

  • yoga
  • meditation
  • tai chi
  • deep breathing exercises

You can set aside a specific time each day to practice, or try these techniques simultaneously while you’re doing something else, like commuting to work.

Exercise is also a great way to lower your stress levels. Even low-intensity exercises, like walking for 30 minutes, can be helpful. However, make sure to ask your doctor before starting a new exercise program. Also remember to drink extra water before and during exercise to prevent dehydration.

See your doctor

Your relationship with your doctor is very important in managing Crohn’s disease. Your doctor will likely want to monitor your symptoms to make sure your treatment is working. It’s very important that you are open and honest with your doctor about your symptoms. If your stomach pain and diarrhea become severe, let your doctor know right away. You might need intravenous fluids to prevent dehydration.

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