Ulcerative colitis (UC) is a chronic, remitting-relapsing autoimmune disease of the lining of the colon (large intestine) that can have symptom-free periods followed by flare-ups. This disease course can negatively affect a person’s quality of life and normal day-to-day functioning.
Research shows that close to 70 percent of people who have active UC in a given year will have a relapse of symptoms in the next year. A large part of treating UC is preventing the next relapse and keeping it in remission as much as possible. When you have a flare, management aims to relieve symptoms and to end the flare as soon as possible.
The key to dealing with a flare is knowing what caused it and how to fix it.
What is a UC flare?
A UC flare is an acute worsening of the symptoms of bowel inflammation. It’s marked by disabling symptoms, such as:
- moderate to severe abdominal pain or cramps that aren’t helped by ordinary pain or antispasmodic 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
- nutritional issues resulting from frequent and severe flaring
What are the common triggers of UC flares?
Every person with UC has different triggers. Below is a list of some of the most common triggers:
- Certain medications can affect the natural balance of gut flora by removing the good as well as bad. Broad-spectrum antibiotics are one such type of medication. Nonsteroidal anti-inflammatory drugs and other painkillers are also strongly linked with flaring episodes. It’s important to identify your triggers and to speak to your doctor about substitutes.
- Abrupt withdrawal from medications can also lead to a flare. This is especially common when you stop taking steroids or even maintenance therapies. Younger people have a higher risk of flares, because they are less likely to stick with a medication for the proposed duration.
- Changes in the level of hormones during pregnancy can cause a relapse of symptoms or acute flares. Anyone with UC who is thinking about getting pregnant should speak with a doctor first.
- Any condition or infection that alters electrolyte levels in the body can also induce a flare. This includes diarrhea from any infectious or noninfectious cause, like traveler’s diarrhea.
Dealing with flares
Corticosteroids are among the most helpful agents that doctors have to stop a flare. Prednisone and budesonide are two examples. Steroids are not always effective, but they are usually the best agents to try first during a severe flare.
There are six main categories of medication used for treatment, some long-term and others short-term. These include:
- Steroids: These can be given systemically (by mouth or intravenously) or as enemas, and help to suppress immune system inflammation.
- Tofacitinib (Xaljanz): This is a newer medication in a class called Janus kinase inhibitors. It works in a unique way to reduce inflammation.
- 5-Aminosalicylates: This medication gets released in different parts of the gastrointestinal tract depending upon the medicine, aiming to reduce inflammation directly in the colon wall.
- Immunomodulators: These include medications such as azathioprine or methotrexate. They work on the immune system by modifying its activity to reduce the inflammatory response.
- Antibiotics: These are used because infections often contribute to flares.
- Biologics: These work on the immune system, against the inflammatory protein TNF-alpha, and include infliximab (Remicade), adalimumab (Humira), and certolizumab (Cimzia).
Certain lifestyle changes can also help reduce the intensity and frequency of UC flares. There’s a link between emotional stress and the severity of UC flares. Stress relief techniques such as hypnosis and meditation may improve symptoms. Other healthy options are yoga, aerobics, and static exercises.
While having chronic diarrhea can be annoying, there are ways you can manage it. Apply soothing pads or diaper rash cream to the area as needed. You should also monitor what you eat. Fiber can be tough on people with UC, because eating it can have unintended consequences. Normally it helps maintain regularity, but it may not be helpful for treating diarrhea. On the other hand, an anti-diarrheal may be useful if you’re certain that you don’t have a bacterial infection of the bowel.