Ulcerative colitis, a type of inflammatory bowel disease (IBD), is marked by periods of remission — times when you experience few, if any symptoms — followed by relapses caused by active inflammation, typically called flares. During a flare, you’ll likely experience symptoms such as
abdominal pain and diarrhea, among others.
Staying on top of your
treatment regimen should help lengthen the time between flares, but sometimes, the
symptoms of a relapse can appear despite your best efforts. Knowing what to do during a flare will help you start feeling better sooner.
Get Help From Your Doctor
The key to
managing an ulcerative colitis flare is to use medical treatments to help you reach clinical remission. Clinical remission means you experience few, if any, symptoms, says
Oriana Mazorra Damas, MD, a gastroenterologist and an associate professor at the University of Miami Miller School of Medicine.
With the latest IBD treatment options, sustained
remission — defined in one research paper as 12 months without a relapse — typically occurs in about 30 to 40 percent of people taking medication for their condition.
But sometimes, there can be active inflammation even if
symptoms have eased. Dr. Damas says that your doctor will likely be equally focused on ensuring that your treatment also leads to objective signs that inflammation has resolved, such as endoscopic remission and histologic (sometimes called deep) remission.
In endoscopic remission, there are no findings of inflammation during a
colonoscopy, while histologic remission has no findings of inflammation in the
biopsy specimens obtained from a colonoscopy.
“Studies show that those who [have achieved] endoscopic and deep remission do best long term, as far as lower chances of hospitalizations for flare-ups and lower chances of complications, including surgery,” Damas says.
Still, a flare can occur, even if you’ve been in remission for years.
Here’s what you can do if your symptoms flare up again.
Dietary Changes to Ease an Ulcerative Colitis Flare
The best way to shorten a flare, of course, is to have your doctor adjust your
medication regimen to treat the increased inflammation.
But there are steps you can take at home too.
When you’re experiencing a flare, consider following a
low-residue diet (a type of low-fiber diet) for several weeks, Damas says. The goal is to let your colon rest. That means staying away from seeds, nuts, most fruits, raw vegetables, whole grain bread and cereal, and fatty meats.
“We’re learning more now about the influence that diet can have on control of inflammation,” Damas notes. “When patients are having an acute flare, it’s important in the short term to have a low-fiber diet. We recommend what’s called a
‘low-FODMAP’ diet. However, this diet is not recommended long term, because it has no impact on inflammation itself and only [controls] symptoms.”
FODMAPs, or fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, are indigestible carbohydrates found in plant foods — foods that also tend to be high in fiber. FODMAPs draw water from your intestines as feces travels through, which can trigger diarrhea. As a result, temporarily cutting back on FODMAPs and the high-fiber foods that contain them can help with digestive symptoms.
It can also be helpful to identify and avoid your food triggers when ulcerative colitis is flaring. Try cooking
vegetables without the skin; limiting full-fat dairy products, such as milk and cheese; and cutting down on other common triggers, such as alcohol, and fatty, sugary, or spicy
foods.
“Additionally, we recommend patients avoid eating
processed foods, as well as those high in fat and animal protein, as these have been associated with inflammation in some studies,” Damas says.
Ask your gastroenterologist about your
diet. If you don’t already have a registered dietitian on your team; they can recommend someone with experience in treating people with ulcerative colitis. A dietitian will work with you to help you formulate eating plans to use during both flares and times of remission; many insurance plans will cover dietitian visits when you have IBD.
You can also try the symptom-specific tips below, which may help you find relief.
Tips for Diarrhea Relief
Damas says it’s usually okay to take an over-the-counter antidiarrheal medication, but she recommends talking to your doctor and having your stool tested first. Having IBD puts you at a significantly higher risk of a bacterial infection called
Clostridioides difficile, or
C. diff, and if you’re fighting the infection, an antidiarrheal will slow down your colon and can allow the bacteria — and the infection — to grow.
In addition to following a low-residue diet, you may find
diarrhea relief by avoiding carbonated drinks, prune juice, milk, caffeine, and sugar-free gums and candies that contain sugar alcohols such as xylitol. Eating smaller meals more frequently may also help.
When to Seek Medical Attention
Blood in the stool accompanied by diarrhea is a cause for concern for most people, but those with ulcerative colitis almost always have blood in their stool during a flare, Damas says.
If bleeding from your bowels or
rectum is nonstop, or if diarrhea has led to
dehydration, with symptoms such as dry mouth, rapid breathing, high heart rate, headache, and fatigue, seek immediate medical attention.
Tips to Ease Abdominal Pain
As medication treats the active inflammation of a flare, your abdominal pain should get better.
Experts recommend avoiding
nonsteroidal anti-inflammatory drugs (NSAIDs), and Damas also recommends avoiding opioid analgesics, a class of prescription pain medications that can cause abdominal pain and slow gut motility. Your doctor may instead prescribe an antispasmodic medication, which relaxes the gut muscles.
There isn’t yet enough high-quality scientific research to determine whether methods such as relaxation techniques and yoga are effective for abdominal pain from ulcerative colitis specifically, according to one research review.
That said, many people with ulcerative colitis find techniques such as yoga nidra (also called non-sleep deep rest),
mindfulness meditation, and pranayama (
breath work) beneficial when it comes to stress-related symptoms.
Research has confirmed that these methods are effective at relieving stress, generally speaking.
Research on other conditions has also indicated that
mindfulness-based stress reduction practices such as meditation can help lessen the intensity of pain. Such techniques can also help with emotional regulation and resilience, cognitive function, and overall well-being.
Heating pads can be used to ease abdominal pain as well, but keep each session to 20 minutes or less, to avoid burning your skin.
When to Seek Medical Attention
People with ulcerative colitis often experience abdominal pain, but if the pain is worse or markedly different than your baseline, Damas recommends calling your doctor. Red flags that indicate immediate medical attention is required include a high fever — over 103 degrees F — with fatigue or intense abdominal
pain.
Tips to Lower a Fever
A temperature above 100 degrees F is typically considered a
fever in an adult. Choose acetaminophen (Tylenol) instead of NSAIDs such as ibuprofen, aspirin, or naproxen to bring down your temperature, and be sure to rest while drinking plenty of fluids. Lukewarm baths (around 98 degrees F) might also help ease the discomfort of a fever.
When to Seek Medical Attention
If you have a fever of 103 degrees F or higher, call your doctor immediately. Also call if you have a fever that lasts longer than two or three days.
When you have ulcerative colitis, it’s common to go through periods of
flares and remission, even when you’re sticking to your medication regimen and making other efforts.
If you have had multiple flares that have required
steroids to get the symptoms under control, it may be time to reevaluate your treatment, Damas says.
Good communication with your doctor will help you find more effective relief.
“If you’re experiencing an increase in symptoms, including increased rectal bleeding, increased bloating, increased abdominal cramping or pain, feeling like you have to go to the bathroom but can’t, unintentional weight loss, or increased fatigue, this may suggest that your current treatment is losing [efficacy],” Damas says. But remember, “Always talk to your gastroenterologist about your symptoms [rather than] changing anything on your own.
