When you have Crohn’s disease, it can make your digestive tract irritated, swollen, and inflamed. Steroids, also called corticosteroids, are powerful anti-inflammatory drugs often used for a short time to help.
But they don’t stop your Crohn's problems from coming back. And over time, steroids can have serious side effects.
They’ve been used to treat Crohn’s and other forms of inflammatory bowel disease (IBD) since the 1950s. They’re helpful during flare-ups, but they’re not a good choice long-term. Side effects include getting infections and causing your bones to thin.
How Can Steroids Help Crohn’s Disease?
Steroids can help reduce inflammation in your gut fast, especially during a flare-up. They can also reduce inflammation in other parts of your body, like your joints, eyes, and skin. Doctors usually recommend them if you don’t get good results with other treatments. If you’re like most people, you’ll notice improvement within a few days, but steroids don’t work at all for 20% to 30% of people with Crohn’s.
They’re meant to be used for a short time, only 3-4 months at most. There are different types of steroids, and the exact length of your treatment will depend on the one you take. The goals of steroid therapy are to ease symptoms causing your pain and push your condition into remission. Remission means you have no signs of Crohn's disease.
What Are Some Types of Steroids?
Depending on the type of steroid you use, it can be taken by mouth as pills or liquids, rectally as a suppository that you insert into your bottom, or as an injection.
Some types include:
Oral steroids
- Prednisone (Deltasone). This is commonly used to bring about remission. It can have many side effects, ranging from minor and severe.
- Budesonide (Entocort EC). This is designed to be absorbed in the small intestine and colon. Unlike prednisone, budesonide is quickly broken down by the liver. This lowers the odds of side effects.
- Budesonide-MMX (Uceris). It’s identical to budesonide, but it has a special coating that protects it until it reaches your gut. Because it’s designed to release specifically in the colon, your doctor may recommend it if your inflammation is mostly in your colon.
Rectal steroids
Rectal steroids, which you put into your bottom, are used to treat inflammation that's just in your anus, rectum, or sigmoid colon (the part of the large intestine closest to your rectum). This way your whole body isn’t exposed to the steroid and you’ll have fewer side effects. Rectal steroids include:
Suppositories (hydrocortisone). These lower inflammation in your anus and rectum when you have Crohn’s. This can help reduce the frequent and urgent need to poop. But long-term use can weaken the muscles in your anus and rectum and cause a condition called steroid myopathy.
Steroid enemas. These are available as hydrocortisone and methylprednisolone (Cortenema). They’re helpful for inflammation higher up in your gut that can’t be reached by suppositories. Like suppositories, steroid enemas can reduce inflammation in your gut without exposing other parts of your body. That reduces the odds of side effects and risks compared to oral steroids like prednisone.
Rectal foams(hydrocortisone acetate, Proctofoam-HC, Uceris). These drugs improve and limit their absorption in your rectum and the colon.
Drug and Food Interactions to Watch Out For
Oral steroids can interact with other medications, making them either more effective or less effective:
- Amphotericin B
- Aspirin
- Barbiturates (Phenobarbital, Donnatal)
- Birth control pills
- Carbamazepine (Tegretol)
- Coumadin
- Cyclosporine
- Estrogen
- Ketoconazole
- Phenytoin (Dilantin)
- Rifampin
You should avoid foods high in salt, as prednisone and other oral steroids can make your body retain water and cause bloating.
If you’re taking budesonide, avoid drugs like:
- Erythromycin
- Ketoconazole
- Itraconazole
- HIV treatment medications
Also, avoid grapefruit and grapefruit juice because they can make steroids less effective.
Before you take steroids, let your doctor know your medication history and provide them with a list of all the medications you’re taking. This includes prescription and over-the-counter medicine.
What Are the Side Effects of Steroids?
They can cause a range of health problems, from minor to severe. It’s important to work with your doctor to monitor your dosage and length of use. Side effects vary depending on which one you’re taking. Because they suppress your body's immune system, they make you more likely to get infections such as yeast infections (thrush) or urinary tract infections.
Minor side effects include:
- Acne
- Weight gain
- Facial roundness (moon face)
- Rash
- Nervousness
- Mood swings
More serious side effects include:
- Abdominal pain
- Blurred vision
- Bloody or black stools
- Painful joints
- Osteoporosis (weakening of bones)
- Depression
- Infections
- Severe fatigue
- Stretch marks
- Headaches
- High blood pressure
- Growth problems in children
- Unwanted facial hair
- Insomnia
- Cataracts
- High blood sugar levels
If you notice any side effects, let your doctor know. They may switch you to another steroid or adjust your dosage. If you have an allergic reaction, tell your doctor immediately. If it’s an emergency, call 911 or head to your nearest hospital.
Things You Should Know Before Taking Steroids for Cohn’s Disease
If you take oral steroids like prednisone, you can:
- Take them with or without food.
- Crush the pills if it’s easier to take them. Steroids are also available as liquids if you need that.
- Take them along with calcium and vitamin D supplements, as steroids can hurt your bone health.
If you’re taking budesonide, you should:
- Swallow the whole pill. Don’t crush it.
- Take it in the morning.
- Tell your doctor if you've been around someone who has chickenpox or measles.
Oral steroids are similar to cortisol, a hormone your body makes. If you take oral steroids for more than a few weeks, it can cause your body to stop making cortisol or make less of it.
Because of this, it’s important you don’t stop taking steroids suddenly. You should slowly reduce the amount you take. As you do, your body will begin to make normal amounts of cortisol again. If you’re planning to stop taking steroids, check with your doctor.
What If You Miss a Dose?
If you’re only taking an oral steroid like prednisone once a day, take it as soon as you remember. If you miss a day, take one dose the next day. Don’t double up on your dose. Let your doctor know.
If you’re taking prednisone twice a day, take the missed dose as soon as you remember and get back to taking it on your regular schedule.
