Ulcerative colitis is a chronic, remitting-relapsing disease with symptom-free periods followed by flare-ups. This disease course can negatively affect the patient’s quality of life and normal day-to-day functioning. Research indicates that in the absence of any regular treatment strategy, almost 70 percent of patients experience a relapse of symptoms within a year.1 A large part of managing ulcerative colitis is to prevent the next relapse and to prolong remission as much as possible. Yet when a flare does occur, management is focused on minimizing symptoms and ending the flare up as quickly as possible.
The key to dealing with an ulcerative colitis flare is in:
- knowing what causes flares
- knowing the options to deal with flares
What Is an Ulcerative Colitis Flare?
An ulcerative colitis flare refers to aggravation of the symptoms of bowel inflammation that is marked by disabling symptoms such as:
- moderate to severe abdominal pain (or cramps) that is not helped by ordinary pain or anti-spasmodic medications
- bleeding from the rectum or blood in the stool
- moderate to severe diarrhea that may lead to dehydration in severe cases
- weight loss due to loss of appetite and diarrheal symptoms
- inability to have a satisfactory bowel movement
- frequent and severe flaring may lead to nutritional issues
What Are the Common Triggers of Ulcerative Colitis?
- Besides creating new life, pregnancy causes a state of altered biochemistry and profound physiological alterations. Changes in the level of hormones during pregnancy can induce a relapse of symptoms or acute flares in more than 50 percent of patients. Anyone with ulcerative colitis who is considering getting pregnant should discuss the decision with a physician.
- Any condition or infection that alters electrolyte levels in the body can also induce a flare (this includes diarrhea from any infectious or non-infectious cause like traveler’s diarrhea).
- Certain medications, like broad-spectrum antibiotics, can affect the natural balance of gut flora by eliminating all the bacteria (pathogenic, as well as protective). Moreover, NSAIDs (non-steroidal anti-inflammatory drugs) and other painkillers are also strongly associated with flaring episodes. It is very important to identify the triggers (especially medications) and speak to your healthcare provider regarding suitable substitutes (2).
- Abrupt withdrawal from medications can also induce a flare. This is especially common with abrupt withdrawal of steroids or even maintenance therapies. Younger individuals are at a higher risk of flaring as compared to older individuals, believed to be mostly due to poor adherence to treatment regimens. Consider discussing your regimen with your doctor.
Dealing with Flares by Stopping the Flare
While patients with ulcerative colitis tend to dislike corticosteroids, one of the best ways to manage flares is to stop them as quickly as possible. Corticosteroids like prednisone or budesonide are among the most helpful agents that doctors have to stop a flare.2 Steroids are not always effective, but if the flare is severe, steroids are usually the best agents to try first.
Lifestyle Modifications to Prevent Ulcerative Colitis Flares
Certain lifestyle modifications are very helpful in decreasing the intensity and frequency of ulcerative colitis flares. There is an association between emotional stress and the exacerbation of ulcerative colitis flares.3 Likewise, stress relief such as hypnosis and meditation may improve symptoms.4 Other healthy options are yoga, aerobics, and static exercises.
Practical Ways to Deal with Flares
Chronic diarrhea can irritate the anus. Apply soothing pads to the area as needed. Diaper rash cream is not just for babies—it can make your life more comfortable, too. Watch your fiber intake. Fiber is a difficult thing for a person with ulcerative colitis because it can have unintended consequences. Normally it helps maintain regularity, but it may not be helpful for diarrhea. On the other hand, if you are certain that you do not have a bacterial infection of the bowel (after clearance from your doctor), a bowel-slowing agent (anti-diarrheal) may be useful. Drink plenty of water—you might be surprised at how much water you lose with severe diarrhea. Remember, you can avoid the stress and embarrassment of ulcerative colitis flares if your friends know you have it and what to expect. The more people you tell, the larger your potential support system.