Understanding ulcerative colitis flare-ups

A flare-up is the reappearance of disease symptoms. And for people living with ulcerative colitis (UC), an inflammatory bowel disease (IBD), flare-ups can be unpredictable, lasting hours, days, or weeks. 

Symptoms of a UC flare-up may include: 

• Frequent and/or urgent bowel movements
• Diarrhea
• Bloody stool
• Abdominal pain
• Nausea and vomiting
• Weight loss
• Fatigue
• Lack of appetite
• Joint and body aches

Because these symptoms may also be caused by something other than UC, it can sometimes be difficult to tell whether you're experiencing a flare-up. Below, we look at factors that might affect a UC flare-up, and what can help if you are experiencing a UC flare-up.

Causes of UC flare-ups

Many factors play a role in how UC symptoms manifest themselves, including: 

Missed medications, incorrect dosing, and improper medication use: Taking your medication regularly is one of the best ways to prevent a UC flare-up. Flares can occur when medications are not taken as prescribed. Avoid NSAIDs (commonly known as aspirin and ibuprofen), as they may lead to inflammation of the bowel and make symptoms worse. Antibiotics can also have an adverse effect on people with UC experiencing a flare-up. Antibiotics alter the bacteria that normally live in the intestine, which can cause inflammation and diarrhea. If you have any concerns and are taking your medications as prescribed, but still experiencing flare-ups, consult with your doctor. Clinical trials looking for volunteers with UC, testing potentially investigational treatment options, may also be an option. 

Stress: Physical and emotional stress do not cause IBD. Stressful situations or strong emotions, though, may trigger IBD symptoms. If you live with IBD and experience regular stress, it’s best to be prepared and learn some stress-management techniques.

Food choices: Every person living with IBD has different foods that may impact or trigger symptoms. Generally speaking, when experiencing a flare-up, it is best to avoid foods that can cause gas and diarrhea, including greasy and fried foods. For some people, foods high in fiber, such as fruits, vegetables and whole grains, can be an issue. Keeping a food journal might help you track which foods in your diet are better or worse for your IBD. 

Easing symptoms during a flare-up

The below suggestions can also help ease symptoms or help keep your body healthy during a flare-up.

Drink water: In UC, the large intestine can have a hard time absorbing water and salt, which can contribute to diarrhea and dehydration. Drinking plenty of water or an electrolyte replacement drink can help avoid dehydration if you're experiencing a flare.

Eat plain, easy-to-digest foods: During a UC flare, it's common to lose your appetite. To keep your energy levels up and avoid malnutrition and weight loss, it's important to continue to fuel your body with food. Unfortunately, fruits and vegetables, particularly when raw, are bothersome for many people with UC. Avoid fatty and greasy foods as well. Your doctor may also suggest meal replacement drinks if you're losing weight from UC flare-ups.

Get some exercise: If you're experiencing symptoms like stomach pain and diarrhea, exercise may sound like the last thing you want to do. But in addition to the well-known mood and health-boosting benefits of exercise, a workout can also have specific benefits for UC symptoms. Uncontrolled inflammation in the intestinal tract leads to UC symptoms. Exercise has an anti-inflammatory effect that can help these symptoms. 

How do I know if my UC has gone into remission? 

UC doesn't have a cure. Instead, the goal of any treatment plan is to send the disease into remission. 

When UC is in remission, you don't experience as many symptoms and start to feel better. If your UC medications and lifestyle changes work well for you, remission may last for months or even years. There are several different kinds of remission:

• Clinical remission: When a patient isn't experiencing symptoms and may feel better. 
• Endoscopic remission: Testing of the intestinal lining shows no inflammation 
• Biochemical remission: Blood and stool tests show no sign of inflammation 
• Surgical remission: When UC goes into remission after surgery to treat it
• Histologic remission: When both clinical and endoscopic tests didn't show signs of UC

With UC, it can feel like life revolves around symptoms. If UC symptoms keep coming back, it can be a sign that medications aren't working. Consider taking part in a clinical trial researching an investigational treatment option for people living with UC.