Steroids

Steroids are hormones produced naturally in your body. The steroids used to treat Crohn’s and Colitis, are man-made versions of these hormones. The doses you take are much higher than your body makes. At these higher doses, steroids decrease activity of your immune system. This reduces inflammation.

The steroids used to treat Crohn’s and Colitis are not the same as the anabolic steroids used by athletes to improve their performance.

Types of steroids

Prednisolone and methylprednisolone are standard oral steroids. They enter your bloodstream soon after you take them. This makes them useful for treating severe or more widespread flare-ups. But it also means they can affect your whole body and cause a range of side effects.

Beclometasone dipropionate (Clipper), budesonide (Budenofalk) and budesonide-MMX (Cortiment) work a bit differently. They are oral medicines, but the steroid in them is not released until it reaches your bowel. This means they work directly on the affected area of your bowel. Very little gets into your bloodstream. So the risk of side effects is lower than with standard oral steroids. You may see them called delayed-release or prolonged-release tablets.

Rectal steroids, which you apply to your bottom, are also designed to work on the affected area. This means they also have fewer side effects than standard oral steroids.

Intravenous steroids go straight into your bloodstream, so work much faster. You will only have these if you need urgent treatment.

If you have Crohn’s Disease

You may have steroids when you’re first diagnosed with Crohn’s, or if you’re having a flare-up. You may be prescribed oral budesonide if you have a mild to moderate flare-up affecting the end of your small bowel. If you have a flare-up affecting your large bowel, you may need standard oral steroids.

If you have Ulcerative Colitis

You may have steroids if you’re having a flare-up of Ulcerative Colitis. Your doctor will usually only offer you steroids if aminosalicylates (5-ASAs) are not right for you. Or if they have not controlled your symptoms on their own. The type of steroid you take will depend on the part of your bowel affected. You might try budesonide MMX, beclometasone dipropionate (Clipper) or rectal steroids. If you’re having a severe flare-up you may need standard oral steroids.

If you have Acute Severe Ulcerative Colitis (ASUC)

Acute Severe Ulcerative Colitis (ASUC) is a serious condition. If you have ASUC, you’ll usually be treated with intravenous steroids in hospital. Intravenous steroids work quickly, so you should start to feel better within a few days. If you do not start to feel better, your IBD team will discuss other possible treatment options with you.

If you have Microscopic Colitis

You may have oral budesonide to treat a flare-up of Microscopic Colitis. Sometimes you can have it longer term, to keep your symptoms under control. Microscopic Colitis includes Collagenous Colitis and Lymphocytic Colitis.

There are lots of things to think about when you start a new treatment. Your IBD team will discuss your options with you. When thinking about a new treatment you might want to consider the potential benefits, possible risks and the goals of your treatment. Some things to think about include:

• How you will take it
• How well it works
• How quickly it is likely to work
• Side effects you might experience
• Whether you need ongoing tests or checks
• Other medicines you are taking

Our Appointment guide has a list of questions you might want to ask. It can help you focus on what matters most to you. You might find our information about other medicines and surgery for Colitis helpful.

Steroids are often taken alongside other medicines used to treat Crohn’s or Colitis. Your doctor might prescribe them in combination with 5-ASAs or immunosuppressants to help control a flare-up. Or you might have a short course of steroids while taking your usual Crohn’s or Colitis medicines. Your IBD team will consider all your medicines when prescribing steroids.

As you’ll usually only be taking steroids for a short amount of time, you may not see your IBD team during this period. Contact your IBD team if you have any side effects or if steroid treatment is not working for you.

Your doctor may want to check for signs of weak bones (osteoporosis). See more on this in protecting your bones.

If you need to take steroids longer-term, your doctor will also check for a serious disorder called adrenal suppression. For more information on this, see the section on Side effects.

Protecting your bones

Taking steroids can weaken your bones. Taking them for a long period of time (more than 3 months), puts you at higher risk. If you’re having a longer course of steroids, your doctor will usually give you vitamin D and calcium supplements. This will help protect your bones and keep them strong.

Your doctor should assess your risk of bone fractures when you start taking steroids. They may suggest you have a bone density scan (also known as a DEXA scan).

If you’re at high risk of bone fractures, your doctor will recommend you take a type of medicine called a bisphosphonate. This can help keep your bones strong. If you’re pregnant, or trying for a baby, let your doctor know. Bisphosphonate treatment may not be suitable for you.

Rectal steroids and budesonide are less likely to cause bone weakness than oral and intravenous steroids. This is because they work directly in your bowel and don’t tend to cause side effects in other parts of your body.

Other factors can increase the risk of developing weaker bones or osteoporosis. The Royal Osteoporosis Society has made a tool to check your risk of osteoporosis. You can use this tool to help you understand what might increase your chances of getting osteoporosis and broken bones. But, if you already know you have osteoporosis or have had your bones checked by a doctor, this tool is not for you. And it cannot tell you if you have osteoporosis. Note that this tool is not made specifically for people with Crohn’s or Colitis. And there are other factors related to your Crohn’s or Colitis can also make your risk of osteoporosis higher.

Keeping active and eating a balanced diet can help you maintain healthy bones. We have more about this in our information on Bones.

Carry a steroid card. Your pharmacist or doctor may give you a steroid card with details of your steroid treatment. This will include the dose and how long you’ll be taking steroids. Always carry this and show it to any healthcare professional treating you, even if it’s not related to your Crohn’s or Colitis. You could also consider wearing an emergency bracelet.

Speak to your doctor if you think you have an infection. Steroids affect the way your immune system works. This means your body might not be able to fight off infections as well as it usually does. Even a mild infection such as a cold or sore throat could develop into something more serious. Tell your doctor or IBD team if you feel unwell and think you might have an infection.

Avoid close contact with people who have infections. This includes chickenpox and shingles and measles. You could become seriously ill from these illnesses. Tell your doctor if you come into contact with anyone who has these infections.

Although steroids are produced naturally in your body, doses of steroid medicines are much higher. This can cause unwanted side effects. At least half of people taking steroids for Crohn’s and Colitis experience some side effects. Your doctor will try to reduce your risk by prescribing the lowest dose of steroids that works for you, and for the shortest possible time.

Rectal steroids (enemas and suppositories) and delayed-release oral steroids like budesonide cause fewer side effects than standard oral steroids. This is because they target the inflamed area and do not affect the rest of the body.

Some of the side effects that you might experience while taking steroids include:

• Fluid retention. You may develop a more rounded “moon” face, as well as more fat around your middle. This is caused by changes in your metabolism, as well as fluid retention. Reducing salt in your diet and eating more potassium-rich foods can help with fluid retention.
• Weight gain. Steroids can also increase your appetite, which can make you put on weight. Try to stick to a healthy, balanced diet and keep an eye on portion sizes to avoid too much weight gain. We have more information on healthy eating with Crohn’s or Colitis.
• Diabetes or raised blood sugar levels. This can also be a result of changes in metabolism and hormone levels. Signs of diabetes include being very thirsty and needing to pee more often than normal. You may also have blurry vision and feel very tired.
• Mood changes, such as depression, irritability or extreme highs and lows in your mood.
• Sleep disturbances. This may be more likely if you have more than one dose during the day.
• Higher risk of infections, including colds and flu and more serious infections like pneumonia and sepsis.
• Changes to menstrual cycle. Steroids may disrupt your usual menstrual cycle, causing irregularities.
• Skin changes. This includes acne, redness, increased body hair, increased sweating and stretch marks caused by thinning of your skin.
• Gut problems, such as stomach pain, stomach ulcers or nausea.
• Joint, bone and muscle problems, such as weak bones (osteoporosis), muscle and joint pain or muscle weakness. Ask your doctor for a DEXA (bone) scan if you’re taking steroids for longer than 3 months. See the section on Ongoing checks for more information.
• Eye problems, such as glaucoma, cataracts or other problems with vision.
• Delayed growth in children and young people. This is usually only with longer-term treatment. See our section on Steroids in children to find out more.

Remember, not everyone will get side effects. And if you do, they are likely to be temporary and go away once you finish treatment. Some side effects may be more serious and need treatment. Speak to your IBD team if you experience any side effects. They can give you advice on how to manage them.  

Do not suddenly stop taking steroids

For many oral steroid medicines, your body stops making enough of your own steroids while you’re taking them. This is known as adrenal suppression. You might not notice any problems while you’re still taking steroid medication. But suddenly stopping your medicines means your body won’t have had time to make its own steroids. You may develop symptoms of adrenal suppression, including:

• Fatigue
• Loss of appetite and weight loss
• Abdominal pain
• Nausea, vomiting and diarrhoea
• Headache
• Joint pains
• Dizziness
• Fever

Gradually reducing your steroid dose gives your body time to start making its own steroids. Your IBD team will guide you if you need to do this.

Sometimes reducing the dose of steroids can make your Crohn’s and Colitis symptoms come back. If this happens, you’ll be offered other medicines, to help you come off steroids completely.

Children may also have steroids to help control a flare-up of Crohn’s or Colitis. Doses of steroid are different for children. Doctors work this out depending on your child’s weight.

If your child is having a short course of steroids, they’re unlikely to get many side effects. The most common ones include:

• Changes in behaviour, like irritability and mood swings. Keep in mind that this will be temporary.
• Weight gain, due to increased appetite and fluid retention. Try to make sure your child is getting a balanced diet. Encourage them to fill up on fruit, vegetables and proteins rather than unhealthy sugary or high-fat snacks.
• Stomach irritation. Giving steroid medicines with or after meals can help to reduce this.

Steroids can affect growth in children. This is usually only a problem for children taking long courses of steroids. If your child is taking steroids for a long time, your doctor will monitor their height and weight to check they’re staying on track.

There are some other points to be aware of if your child is taking steroids.

• It’s important to keep up-to-date with your child’s immunisations. But they should not have any live vaccines while taking steroids. See the section on Vaccinations for more information.
• If your child is in contact with someone who has chicken pox and they haven’t had it before, contact your IBD team straight away. Chicken pox can be more severe in children on steroids. They may be able to have a treatment to protect them. It’s worthwhile family members having a chicken pox vaccine to prevent spreading it to the child on steroids.
• Keep an eye out for symptoms of high blood sugar levels – like increased thirst or needing to pee more often. Let your doctor or IBD team know if your child gets these symptoms.
• Adrenal suppression can be more severe in children. This is when your body stops making enough steroids. It’s important to follow your doctor’s advice on stopping steroids gradually.

Talk to your child’s doctor about possible alternative treatments. Children may be able to have budesonide instead of a standard steroid for a mild Crohn’s flare-up. This often has fewer side effects. Children with Crohn’s can also have enteral nutrition as an alternative to steroids. See the section on Alternatives to steroids for more information.

Budesonide MMX (a controlled-release formulation of budesonide) is only recommended for adults. This isn’t available for children with Ulcerative Colitis.

It’s not safe to have ‘live’ vaccines while taking steroids at the doses used for Crohn’s and Colitis. This is because steroids weaken your immune system, so you may be more likely to develop a serious infection. You’ll need to wait 3 months after you stop taking steroids before having a live vaccine.

Speak to your IBD team to make sure your vaccinations are up to date before you start taking steroids. If you have recently had a live vaccine, you should wait at least 4 weeks before starting steroids.

In the UK, live vaccines include:

• TB vaccine
• Shingles vaccine – but a non-live version is also available
• Chickenpox vaccine
• Measles, mumps and rubella vaccines
• Nasal flu vaccine used in children – but the injected flu vaccine used in adults is notlive
• Rotavirus vaccine
• Yellow fever vaccine
• Oral typhoid vaccine – but the injected typhoid vaccine is notlive

The annual flu jab and pneumococcal and COVID-19 vaccines are not live vaccines and are safe to have while taking steroids.

If someone you live with is due to have a live vaccine, ask your IBD team if you need to take any special precautions.

There’s no evidence that steroids affect your ability to get pregnant.

It’s important to make sure your Crohn’s or Colitis is under control before trying for a baby. Having an active flare-up while you are pregnant is linked with various problems. It increases the risk of your baby being smaller than normal in the womb, being born early and having a low birthweight.

You can take steroids to control a Crohn’s or Colitis flare-up during pregnancy. Some research suggests that taking steroids when pregnant may also be linked with problems such as premature birth and lower birthweight. But we can’t be sure whether that’s due to the steroids or the condition itself.

Some small studies have shown a link between steroid use and risk of babies born with cleft lip and palate. But the evidence is mixed, and more recent larger studies have not found a link.

In general, the benefits of taking steroids during pregnancy are considered to outweigh any potential risks. Risks are higher if you take steroids repeatedly while pregnant, or for a long time. Your doctor will make sure you take them for the shortest possible time to get your disease back under control.

Budesonide is sometimes considered safer to take during pregnancy. This is because not so much of the medicine reaches the baby. There hasn’t been much research into taking budesonide during pregnancy. But two small studies of budesonide and budesonide MMX did not find any negative effects in mothers or babies.

Talk to your doctor before you start trying for a baby. They can make sure that your condition is under control. This will keep the chances of you needing to take steroids during pregnancy low. If you take steroids during pregnancy, make sure you tell the healthcare team involved in your baby’s birth.

It’s usually safe to breastfeed while taking steroids. Steroids may pass to the baby in your milk, but it’s a very small amount.  If you are thinking about breastfeeding and you are taking a high dose of steroids (over 40mg prednisolone daily), check with your IBD team or your baby’s healthcare team first.

If you have Crohn’s Disease

Enteral nutrition is a special liquid diet that you have instead of food. It’s an effective alternative to steroids for children with Crohn’s.  Your child’s doctor may suggest it if there are concerns about steroids affecting their growth. Enteral nutrition doesn’t seem to be as effective as steroids in adults with Crohn’s. But you may want to consider it if you don’t get on with steroids or you’d prefer to avoid them. Speak to your IBD team if you want to find out more about enteral nutrition.

If you have severe Crohn’s and steroids and other medicines aren’t helping, you may be offered a biologic medicine instead. A biologic medicine may also be an option if you cannot take steroids for some reason, or you do not get on with them. Biologic medicines include infliximab and adalimumab.

If you have Ulcerative Colitis

You will usually only be offered steroids for Ulcerative Colitis if topical or oral 5-ASAs are not enough on their own.

If you have moderate to severe Colitis, and steroids and other medicines are not helping, you may be offered alternative medicines. These include biologic medicines and JAK inhibitors, such as filgotinib, tofacitinib or upadacitinib. These may also be options if you can’t take steroids for some reason, or you do not get on with them.

If you’re being treated for severe Colitis in hospital, you’ll usually be offered intravenous steroids first. But alternatives include intravenous ciclosporin, surgery and infliximab.

If you have Microscopic Colitis

Your doctor will suggest stopping smoking and any medicines that could be making your symptoms worse. Budesonide is usually the first medicine that doctors prescribe for Microscopic Colitis. But if you cannot, or do not want to take steroids, they may suggest medicines for diarrhoea (such as loperamide) instead. See our information on Microscopic Colitis for details.

We follow strict processes to make sure our information is based on up-to-date evidence and easy to understand.

Please email us at evidence@crohnsandcolitis.org.uk if:

• You have any comments or suggestions for improvements
• You would like more information about the sources of evidence we use
• You would like details of any conflicts of interest

You can also write to us at Crohn’s & Colitis UK, 1 Bishop Square, Hatfield, AL10 9NE, or contact us through our Helpline: 0300 222 5700