Managing Crohn's Flare-Ups and New Symptoms
I’m a 30-year-old female diagnosed with Crohn’s disease and ankylosing spondylitis two years ago. Currently, I’m on Skyrizi and received my latest injection just a week back. This past week has been incredibly challenging. Between work stress and inadequate sleep, I've been struggling. Yesterday, I experienced a severe panic attack accompanied by a migraine, leading me to take three Advil, which, in hindsight, was not a wise decision. After finally managing to catch up on rest—sleeping a staggering 15 hours—I still woke up feeling drained. To make matters worse, I have been dealing with significant rectal bleeding accompanied by constipation, which is alarming as it feels like blood is just flowing without any stool. While my doctor suspects that this could be a result of a fissure or hemorrhoid—conditions I’ve previously experienced—the intensity of the bleeding this time is unlike anything I’ve encountered before. I’m feeling rather lost and unsure of how to proceed. Although my physician suggested that the bleeding and fatigue could be attributed to the fissure or hemorrhoid, I have come across information that raises doubts about that theory given the volume of blood. To tackle the constipation, my doctor recommended using Miralax, but I’m hesitant to take it if I’m experiencing a flare. A couple of months back, I briefly took 10 mg of prednisone for four days to mitigate my AS pain during a climbing and hiking trip. In retrospect, that may not have been the best idea, and it leaves me wary of resorting to steroids again. My biggest fear is that I might experience a severe flare this weekend when I won’t have anyone available to assist me. What steps should I take next?
Answers (1)
7/9/2025, 7:50:41 PM
OpenHealth AI
It's understandable to feel overwhelmed with the combination of Crohn’s disease, ankylosing spondylitis, new symptoms, and the stress of daily life. Your concerns about the rectal bleeding, fatigue, and the situation worsened by panic attacks are valid. Here’s a structured approach to address your situation thoughtfully and effectively.
Main Points:
- Monitor Rectal Bleeding: The intensity of blood loss you're experiencing requires close observation.
- Managing Constipation Safely: It's essential to address your constipation appropriately during a flare.
- Stress Management: Anxiety can exacerbate your physical symptoms; managing stress is crucial.
Explanation:
- Rectal Bleeding: While your doctor may suggest that the bleeding is due to a fissure or hemorrhoid, the volume you're describing is concerning. Crohn’s can cause inflammation and ulcers, which may also contribute to bleeding.
- Constipation and Medications: While Miralax is generally safe, during a flare is an especially sensitive time. Your discomfort may influence how you choose to manage this condition, especially if you're worried about worsening your symptoms.
- Panic Attacks and Sleep: Stress and sleep deprivation can significantly impact your conditions. A panic attack may manifest due to the stress of your symptoms, and it's important to address these aspects to alleviate your overall distress.
Next Steps:
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Immediate Monitoring: Keep track of the bleeding. If it intensifies or if you experience dizziness or significant changes in your condition, prioritize a medical evaluation, even if it means seeking out urgent care.
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Address Constipation with Caution:
- Dietary Adjustments: Focus on hydration and eating high-fiber foods such as fruits, vegetables, and whole grains. Increase your fluid intake to help soften your stool naturally.
- Miralax (if necessary): If constipation persists and your situation allows, consider using a smaller amount of Miralax (as directed). Monitor your symptoms closely. If in doubt, it's better to consult with your healthcare provider about adjusting the dosage, especially if you have concerns about how it interacts with your current condition.
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Stress Management:
- Relaxation Techniques: Practice deep breathing, mindfulness, or gentle yoga to help reduce anxiety. Consider utilizing mobile apps or online resources that guide you through relaxation exercises.
- Prioritize Sleep: Continue to ensure you are getting enough rest. Create a bedtime routine that helps signal to your body it's time to wind down.
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Prepare for Flare Management:
- Emergency Plan: Have a plan in place for when you experience a flare-up. This might include having medications on hand to manage pain or inflammation and identifying someone you can contact for help if symptoms worsen.
- Stay Informed: Know the signs of when to seek immediate medical assistance (increased bleeding, high fever, severe pain, etc.).
Reassurance:
It's okay to feel concerned, and you’re taking worthwhile steps by seeking guidance. Remember to prioritize your well-being, and don’t hesitate to reach out to your healthcare provider with any changing or worsening symptoms. You’re not alone, and there are pathways to support you through this time.
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