Living with Crohn’s disease can feel overwhelming, especially during a flare-up when symptoms intensify and your daily life becomes increasingly difficult to manage. Sometimes we need addition options such as using specific steroids for Crohn’s like prednisone or budesonide. As someone dedicated to helping patients navigate the complexities of inflammatory bowel disease (IBD), I want to take the time to walk you through some considerations if you are taking steroids for crohn’s or other types of IBD.
Crohn’s disease is a chronic inflammatory condition that affects the gastrointestinal tract, most commonly the small bowel, though it can impact any part of the digestive system from mouth to anus. This condition causes the immune system to mistakenly attack healthy tissue in the digestive tract, leading to persistent inflammation, abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition.
Unlike ulcerative colitis, which only affects the colon and rectum, Crohn’s disease can penetrate deep into the layers of affected bowel tissue, creating complications that significantly impact your wellbeing. Crohn’s disease affects approximately 780,000 Americans, with numbers continuing to rise globally. This condition doesn’t discriminate by age, though it’s most commonly diagnosed in people between the ages of 15 and 35.
The unpredictable nature of Crohn’s disease and ulcerative colitis means that you might experience periods of remission followed by sudden flare-ups, making it challenging to plan your life, maintain employment, enjoy social activities, or simply feel comfortable in your own body. However, there are nutrition strategies that can reduce the risk of flare ups.
The impact on quality of life cannot be understated. Many patients describe feeling chained to the bathroom, experiencing constant fatigue, dealing with embarrassing symptoms, and living with chronic pain that others can’t see or fully understand. The emotional toll of managing a chronic condition like inflammatory bowel disease (IBD) adds another layer of complexity, often leading to anxiety, depression, and social isolation.
Fortunately, taking certain medications can help during flare-ups, providing much-needed relief and helping you regain control over your symptoms. Among these treatment options, steroids are commonly used as one of the anti-inflammatory medications used in the treatment of Crohn’s flare-ups.
These powerful drugs work quickly to reduce inflammation and provide symptom relief, often when other treatments haven’t been effective. However, while steroids can be remarkably helpful, there are certain things to consider when taking steroids for Crohn’s, including potential side effects, proper dosing, duration of treatment, and the importance of medical supervision.
That’s why I’m dedicating this post to talk about steroids for Crohn’s in detail. My goal is to provide you with comprehensive, evidence-based information that empowers you to have informed conversations with your healthcare team and make decisions that support your health and wellbeing.
Understanding Steroids For Crohn’s Disease
Before we dive into the specifics of how these medications work in your body, I want to take a moment to explain what steroids are and why understanding this medication is so valuable for you as a patient. When you know how your treatment works, you become a more active participant in your care and this knowledge can help reduce anxiety about taking these medications.
In this section, I’m going to talk about what steroids are at a fundamental level, breaking down the science into understandable terms. This foundation will help you understand how the medication works within your body to combat the inflammation that’s causing your symptoms. We’ll explore the mechanism of action, the different types available, and why your doctor might recommend one form over another.
Additionally, understanding steroids can help you recognize what to expect during treatment, including both the benefits you’re hoping to achieve and any potential side effects you should monitor. This information empowers you to be vigilant about your health, communicate effectively with your medical team, and make informed decisions about your treatment plan. Knowledge truly is power when it comes to managing chronic conditions like Crohn’s disease.
What Are Steroids?
When we talk about steroids in the context of Crohn’s disease, we’re specifically referring to corticosteroids, which are very different from the anabolic steroids some athletes may use for muscle building. Corticosteroids are synthetic versions of hormones that your body naturally produces in the adrenal glands, particularly cortisol.
Cortisol is a hormone that plays numerous essential roles in your body, including regulating inflammation, metabolism, blood pressure, and stress response. When you have Crohn’s disease, your immune system becomes overactive and attacks healthy tissue in your digestive tract, causing chronic inflammation. The corticosteroids prescribed for Crohn’s mimic and amplify the anti-inflammatory effects of your body’s natural cortisol.
These medications work by suppressing the immune system’s inflammatory response. They interfere with the production of substances that trigger inflammation, including cytokines and prostaglandins. By dampening this inflammatory cascade, steroids help reduce the swelling, pain, and damage occurring in your intestinal tissue. This is why they’re classified as anti inflammatory drugs and are so effective at providing rapid relief during acute flare-ups.
The term “steroid therapy” encompasses various formulations and delivery methods, each designed to target inflammation in different ways. Some steroids work systemically throughout your entire body, while others are designed to act locally within the digestive tract, minimizing systemic absorption and reducing the risk of side effects.
Are Steroids Given For Crohn’s Disease?
Steroids are one of the most commonly prescribed medications for Crohn’s disease, particularly during moderate to severe flare-ups when symptoms become debilitating. In fact, studies suggest that up to 60-70% of patients with Crohn’s disease will require steroid treatment at some point during their disease course.
These medications have been used for Crohn’s since the 1950s, making them one of the longest-established treatments in the management of inflammatory bowel disease. The decades of clinical experience with steroids have taught us a tremendous amount about their effectiveness, optimal dosing strategies, and potential risks. This extensive history means your doctor is prescribing a well-understood medication with predictable outcomes.
Steroids are typically used as a short term treatment for inducing remission during active disease flares. They’re not generally recommended for long term maintenance therapy because of the significant side effects that can develop with prolonged use. Instead, your doctor will likely use steroids to quickly bring your inflammation under control, then transition you to other medications that can maintain remission with fewer risks.
It’s important to understand that while steroids are highly effective, they’re usually part of a broader treatment strategy. Your healthcare provider might use them in combination with other therapies, or as a bridge treatment while waiting for slower-acting medications to take effect. The goal is always to use the lowest effective dose for the shortest possible duration while achieving adequate disease control.
Many patients with Crohn’s disease worry about needing steroids, often because they’ve heard about potential side effects. These concerns are valid, and your healthcare team takes them seriously. However, when used appropriately under medical supervision, steroids remain an invaluable tool for managing severe inflammation and preventing complications like strictures, fistulas, or the need for emergency surgery.
How Do Steroids Help Crohn’s Disease?
Understanding the specific mechanisms by which steroids provide relief can help you appreciate why these medications are so valuable in the treatment of Crohn’s disease. Let me walk you through the key ways steroids work to improve your symptoms and overall health.
Reducing Inflammation Throughout The Digestive Tract
The primary benefit of steroids is their powerful ability to reduce inflammation in the affected areas of your intestinal tract. When you have Crohn’s disease, the inflammation penetrates deep into the bowel wall, causing ulceration, swelling, and damage to healthy tissue. Steroids work at a cellular level to suppress the inflammatory response, allowing the damaged tissue to begin healing.
This anti-inflammatory action reduces inflammation not just superficially, but throughout the full thickness of the intestinal wall. As inflammation subsides, the ulcers begin to heal, swelling decreases, and the intestinal lining can start to repair itself. This healing process is crucial for restoring normal digestive function and preventing long-term complications like strictures or fistulas.
Suppressing The Overactive Immune System
Crohn’s disease is fundamentally an immune system disorder where your body’s defense mechanisms mistakenly identify parts of your digestive tract as foreign invaders. Steroids help by suppressing this overactive immune response, reducing the production of inflammatory chemicals and preventing immune cells from attacking healthy tissue.
By modulating the immune system, steroids interrupt the cycle of inflammation that perpetuates Crohn’s symptoms. They reduce the production of inflammatory mediators like tumor necrosis factor (TNF), interleukins, and other cytokines that drive the inflammatory process. This is why steroids work differently than nonsteroidal anti inflammatory medications, which only block certain pain and inflammation pathways without addressing the underlying immune dysfunction.
Providing Rapid Symptom Relief
One of the most appreciated benefits of steroid therapy is how quickly it works. Unlike some Crohn’s medications that can take weeks or even months to show effects, steroids often begin providing noticeable symptom relief within days. This rapid action makes them particularly valuable during severe flare-ups when you’re experiencing debilitating abdominal pain, frequent diarrhea, or other urgent symptoms.
The quick relief steroids provide isn’t just about comfort—it’s medically important. Severe, prolonged inflammation can lead to malnutrition, dehydration, and potentially life-threatening complications. By rapidly controlling inflammation, steroids help prevent these serious outcomes and can often avoid the need for hospitalization or surgery.
Facilitating Healing And Preventing Complications
Beyond just managing symptoms, steroids actively promote healing of the damaged intestinal tissue. As inflammation decreases, the intestinal lining has the opportunity to regenerate and repair itself. This healing process is essential for restoring the barrier function of your intestinal wall, improving nutrient absorption, and reducing the risk of complications.
By inducing remission and allowing the bowel to heal, steroids can help prevent the development of strictures (narrowed areas of the intestine), fistulas (abnormal connections between organs), and abscesses. These complications can require surgical intervention, so preventing them through effective medical management is always the preferred approach.
What Steroids Are Used For Crohn’s Disease?
Your doctor has several different steroid options to choose from when treating your Crohn’s disease, and the choice depends on factors like the severity of your symptoms, the location of inflammation in your digestive tract, your previous treatment history, and your individual risk factors for side effects. Let me explain the main types of steroids used in the treatment of Crohn’s disease.
Prednisone and prednisolone are among the most commonly prescribed oral steroids for Crohn’s disease. These systemic corticosteroids work throughout your entire body and are typically used for moderate to severe disease activity. Prednisone is actually a prodrug that your liver converts into prednisolone, which is the active form. Your doctor will typically start you on a high dose—often 40-60 mg daily—to quickly control inflammation, then gradually taper the dose over several weeks as your symptoms improve.
Budesonide is another important option, particularly valued because it’s designed to act locally in the intestine with less systemic absorption than traditional steroids like prednisone. This medication comes in different formulations targeting different areas of the digestive tract. Budesonide EC (Entocort) releases in the ileum and ascending colon, making it ideal for Crohn’s affecting the small bowel and right side of the colon. Budesonide MMX (Uceris) releases throughout the colon and is sometimes used for colonic Crohn’s, though it’s primarily approved for ulcerative colitis.
The advantage of budesonide is that it undergoes extensive first-pass metabolism in the liver, meaning less of the medication circulates throughout your body. This results in fewer systemic side effects while still providing effective local anti-inflammatory action. However, budesonide is generally less potent than prednisone and may not be sufficient for severe disease.
Methylprednisolone is a systemic corticosteroid similar to prednisone but with slightly different properties. It’s sometimes given intravenously in hospital settings for very severe flare-ups or when oral medications aren’t appropriate. The IV formulation allows for rapid delivery and can be particularly helpful if you’re experiencing severe nausea or vomiting that would prevent you from keeping oral medications down.
Hydrocortisone is occasionally used, particularly in enema or suppository form for inflammation in the rectum or lower colon. While this is more commonly used for ulcerative colitis, some patients with Crohn’s affecting the rectum may benefit from this localized treatment approach.
Your doctor might also consider newer formulations or combination approaches depending on your specific situation. The key is finding the right medication, dose, and duration that effectively controls your inflammation while minimizing potential side effects.
How To Take Steroids For Crohn’s Disease
Taking steroids properly is crucial for maximizing their benefits while minimizing risks. Below is comprehensive guidance on how to approach steroid therapy for your Crohn’s disease, including essential precautions and practical tips.
Always Consult Your Healthcare Provider Before Starting Steroids
This cannot be emphasized enough: never start, stop, or change your steroid dose without direct guidance from your healthcare provider. Steroids are powerful medications that require careful medical supervision. Your doctor needs to evaluate your specific situation, including the severity and location of your Crohn’s disease, your overall health status, any other medications you’re taking, and your risk factors for complications.
Before prescribing steroids, your healthcare team will likely perform blood tests to check your baseline blood sugar levels, electrolytes, and other important markers. They may also screen you for infections, particularly tuberculosis, because steroids suppress your immune system and can allow latent infections to become active. If you have diabetes, high blood pressure, osteoporosis, glaucoma, or certain other conditions, your doctor will need to monitor you even more closely during steroid therapy.
Your healthcare provider will create a personalized treatment plan that specifies exactly how much medication to take, when to take it, how long to continue, and how to taper the dose. This individualized approach is essential because what works for one patient may not be appropriate for another. Trust your medical team’s expertise and maintain open communication throughout your treatment.
Take Steroids Exactly As Prescribed
Once your doctor prescribes steroids, it’s critical to follow the dosing instructions precisely. Oral steroids are typically taken in the morning with food, which helps minimize stomach irritation and also aligns with your body’s natural cortisol rhythm. Your adrenal glands normally produce the most cortisol in the morning, so taking your steroid dose then is more physiologically appropriate.
If you’re prescribed a high dose that’s split into multiple daily doses, take them at the times your doctor specifies. Don’t skip doses, double up if you forget one, or stop taking the medication suddenly because your symptoms improve. Even if you’re feeling much better, the inflammation may still be present, and stopping steroids abruptly can cause a rebound flare or even a dangerous condition called adrenal insufficiency.
Adrenal insufficiency occurs because prolonged steroid use suppresses your body’s natural cortisol production. When you take steroids for more than a couple of weeks, your adrenal glands essentially “turn off” their own production. If you suddenly stop the medication, your body doesn’t have enough cortisol to function properly, which can cause severe fatigue, weakness, low blood pressure, and in extreme cases, life-threatening complications. This is why tapering is so important.
Follow The Tapering Schedule Carefully
Your doctor will provide a specific tapering schedule that gradually reduces your steroid dose over time. This might involve reducing the dose by 5-10 mg every week or two, depending on your starting dose and response to treatment. The taper allows your adrenal glands to gradually resume normal cortisol production while minimizing the risk of a disease flare.
Some patients feel anxious about tapering because they worry their symptoms will return. It’s normal to experience some mild symptoms during the taper, but if you notice significant worsening of your Crohn’s symptoms, contact your doctor rather than adjusting the taper on your own. They may need to slow down the taper or address the flare with additional treatments.
The tapering process can take several weeks to months, especially if you were on higher doses or longer treatment courses. Be patient with the process and remember that this gradual reduction is protecting your health in the long term.
Monitor For Side Effects And Report Them Promptly
Steroid therapy can cause various side effects, particularly with higher doses or long term use. Being aware of potential side effects and monitoring yourself carefully allows you to catch problems early when they’re easier to address.
Common short-term side effects include increased appetite and weight gain, mood changes (ranging from euphoria to irritability or anxiety), difficulty sleeping, fluid retention, and facial swelling (often called “moon face”). You might also experience high blood sugar levels, particularly if you’re at risk for diabetes. Your doctor may recommend checking your blood sugar regularly during treatment.
More serious but less common side effects include high blood pressure, increased risk of infections, stomach ulcers, cataracts, glaucoma, and bone loss (osteoporosis). Long term steroid use also increases the risk of avascular necrosis (also called osteonecrosis), a condition where bone tissue dies due to lack of blood supply, most commonly affecting the hip joints.
If you experience vision changes, severe mood disturbances, signs of infection like fever, severe stomach pain, unusual bruising or bleeding, or any other concerning symptoms, contact your healthcare provider immediately. Don’t wait for your next scheduled appointment if something doesn’t feel right.
Protect Your Bone Health
Because steroids can cause bone loss, your doctor may recommend calcium and vitamin D supplementation during treatment if it is going to be longer term treatment. Weight-bearing exercise, when you’re feeling well enough, also helps maintain bone density.
Your doctor might also order a bone density scan (DEXA scan) before starting steroids or during treatment to monitor for osteoporosis.
Maintain an IBD Friendly Diet And Lifestyle
While on steroids, this can be a great time to implement nutrition strategies for IBD. Adding more plants and omega 3’s in the diet can be very helpful when it comes to reducing the risk of flare ups and inducing remission in the long term. Be sure to check out our free training on What to Eat for IBD.
If you feel like you need specifics and maybe help with implementation – the Flare Guide + IBD Flare Friendly Meal Plan is our top rated resource. Our flare guide is a great low cost starting point for those wanting guidance and help with implementation.
If you are someone who struggles with adding variety, are skipping meals to avoid triggering symptoms and/or have multiple nutrient deficiencies, you may need further support from an IBD focused dietitian. An IBD focused dietitian can help you bring in better strategies to lessen symptoms and treat the overall disease with medical nutrition therapy.
One downside with steroids is that it can cause you to retain more sodium while on it which can cause blood pressure increases. Limiting sodium intake can help minimize these symptoms. Opt for fresh foods over processed ones, and flavor your meals with herbs and spices rather than salt.
Avoid Live Vaccines While On Steroids
Because steroids suppress your immune system, you should avoid live vaccines during treatment and for several weeks after stopping. Live vaccines include measles-mumps-rubella (MMR), varicella (chickenpox), and the nasal flu vaccine. However, inactivated vaccines like the flu shot, pneumonia vaccine, and COVID-19 vaccines are generally safe and often recommended because your immune system is suppressed and you’re at higher risk for infections.
Discuss your vaccination status with your doctor before starting steroids, and let any other healthcare providers know you’re taking immunosuppressive medication before they administer any vaccines.
Plan For Long-Term Management Beyond Steroids
Remember that steroids are typically a short term treatment for inducing remission, not a long-term solution. While you’re taking steroids, your doctor should be developing a maintenance plan using other medications that can keep your Crohn’s disease in remission with fewer risks.
These maintenance medications might include immunomodulators like azathioprine or methotrexate, biologic therapies that target specific parts of the immune system (such as anti-TNF medications that block tumor necrosis factor), or newer targeted therapies. Starting or optimizing these medications while you’re on steroids allows them time to become effective so you can safely discontinue the steroids.
Working with your healthcare team on this transition is essential. Be patient with the process, as many maintenance medications take weeks or months to reach full effectiveness. Your doctors are trying to find the right balance that keeps your disease controlled while minimizing medication risks.
Keep All Follow-Up Appointments
Regular monitoring during steroid therapy is essential. Your doctor will want to see you periodically to assess your symptom response, check for side effects, monitor blood work, and adjust your treatment plan as needed. These appointments are a critical part of safe, effective steroid therapy.
If you’re having trouble attending appointments due to symptoms, transportation, or other barriers, let your healthcare team know. Many providers now offer telemedicine visits that can reduce the burden of frequent office visits while still providing necessary monitoring and support.
Conclusion
Navigating the treatment of Crohn’s disease can feel overwhelming, but understanding your medication options empowers you to be an active, informed participant in your care. Steroids remain one of the most effective tools we have for managing moderate to severe Crohn’s flares, providing rapid relief when you need it most and helping prevent serious complications.
While steroid therapy requires careful medical supervision and comes with potential risks, particularly with long-term use, the benefits during acute flare-ups often far outweigh these concerns. The key is using these powerful medications appropriately: at the right dose, for the right duration, with proper monitoring, and as part of a comprehensive treatment strategy.
Remember that you don’t have to manage Crohn’s disease alone. Your healthcare team—including your gastroenterologist, primary care provider, dietitian, and other specialists—is there to support you through every step of treatment. Stay in close communication with them, report any concerns promptly, follow your treatment plan carefully, and don’t hesitate to ask questions when something isn’t clear.
This blog post is for informational purposes only and does not replace professional medical advice. Always consult with your healthcare provider before starting, stopping, or changing any medication for Crohn’s disease.
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