What to Know (and Do) About Ulcerative Colitis Flare-Ups

A UC flare is an acute worsening of the symptoms of bowel inflammation. Flares may occur weeks, months, or even years apart, with different levels of severity.

Medication, your lifestyle, diet, and other factors may contribute to flare-ups. In the same way, taking all prescribed medications, eating balanced meals, and avoiding known triggers can often help prevent flares.

Ulcerative colitis symptoms change based on the severity of a flare-up and the location of inflammation in the intestine. Symptoms often include:

• moderate to severe abdominal pain or cramps
• persistent bowel movements
• 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
• nausea
• tiredness
• anemia (a lack of red blood cells)
• fever

In some cases, you may also experience aching joints or eye pain.

Flares occur at different times and may last for days or weeks. They can happen anywhere from weeks to years apart, depending on the person and the effectiveness of treatment.

Your doctor will work with you to treat your flare and help return your UC to a more manageable state.

The Crohn’s & Colitis Foundation recommends waiting to become pregnant until UC has been in remission for at least 3 months.

If you conceive during a flare-up, you may have more symptoms during pregnancy.

You’re likely to have a healthy pregnancy if you have UC, but you’ll still have a higher chance of complications than someone without the condition. Particularly if your UC is active, you may have a greater risk for:

• miscarriage
• premature birth
• low birth weight for the baby
• complications during labor

In general, UC medications can be taken during pregnancy.

Talk with your doctor about any possible changes to your medications while pregnant.

Ideally, having a conversation with your doctor prior to getting pregnant can allow them to prepare a UC treatment plan in advance that can be revised, if and as needed, during your pregnancy.

It’s important to see your doctor regularly to monitor your UC, even when it’s in remission.

When you first notice a flare, talk with your doctor to determine the cause. They may adjust your medication or suggest other treatment options.

During flare-ups, use wipes rather than toilet paper to reduce irritation. You can also apply a skin protectant at night and take acetaminophen to manage pain.

It’s also helpful to be aware of things that trigger or worsen your flares so that you can work to avoid them.

Know your triggers

Every person with UC has different triggers. Below is a list of some of the most common triggers:

• Medications. Certain medications, like antibiotics, can affect the natural balance of gut flora. Nonsteroidal anti-inflammatory drugs (NSAIDs) and certain other pain relievers are also strongly linked with flares. If certain medications trigger your symptoms, ask your doctor about substitutes.
• Abrupt withdrawal from medications. This can also lead to a flare. It’s especially common when you stop taking steroids or even maintenance therapies.
• Changes in hormone levels during menstruation and pregnancy. This can worsen symptoms or result in a relapse. If you’re thinking about getting pregnant, talk with a doctor first.
• Electrolyte levels. Any condition or infection that alters electrolyte levels in the body can also cause a flare. This includes diarrhea from any infectious or noninfectious cause, like traveler’s diarrhea.
• Stress. In some people, stress may contribute to flare-ups and increased inflammation.
• Diet. Certain foods may trigger flares or worsen symptoms. Try to identify any foods that affect your UC so you can avoid them.

Flares may not always be linked to a trigger. Still, being familiar with your triggers may help you reduce and manage flare-ups.

A modified diet may help you manage and reduce your UC symptoms. Depending on the person, specific foods may trigger flare-ups or worsen symptoms. As a result, it’s important to identify and limit these foods.

Your doctor and a dietitian can work with you to find a diet that best manages your symptoms while providing the nutrition you need.

Liquid diet

Severe UC flares may keep your body from effectively absorbing enough nutrients. Enteral nutrition, which generally involves a liquid diet given through a tube, can provide needed nutrients while helping your body heal.

A 2015 research review suggested that a liquid diet may benefit people with IBD, including severe UC. However, it noted that most studies focus on Crohn’s disease, another type of IBD.

More research is needed for UC.

Foods to eat

No specific foods will cure UC or completely stop flares. Still, it’s important to eat a balanced diet both for general health and to manage your symptoms.

Fruits, vegetables, and whole grains are an important part of a healthy diet. However, their high fiber content when raw may worsen a UC flare. Cooking fruits and vegetables can help you keep them in your diet without the impact on your UC.

Make sure you drink enough liquids, especially water. Eating frequent, small meals may also help you feel better.

If you have a nutritional deficiency from UC, your doctor may recommend that you take dietary supplements or vitamins.

Foods to avoid

Foods that increase UC symptoms may be different for each person. In general, though, it may help to limit or avoid:

• carbonated drinks
• dairy
• high fiber foods, like raw fruits and vegetables
• spicy food
• fried food
• alcohol
• caffeine

Keeping a food diary lets you record everything you eat and identify any foods that make your UC worse.

You can’t completely prevent flares without surgery, but you can work to manage them and reduce symptoms when they occur.

Medications and certain lifestyle changes can help reduce the intensity and frequency of UC flares. Currently, surgery to remove the colon is the only full cure for UC.

Medication

There are six main categories of medication used for treatment, some long term and others short term. These include:

• Aminosalicylates (5-ASA). There are multiple types of 5-ASA drugs that get released in different parts of the gastrointestinal tract. They aim to reduce inflammation directly in the colon wall.
• Tofacitinib (Xeljanz). This medication belongs to a class called Janus kinase inhibitors. It suppresses specific parts of your immune system to reduce inflammation.
• Corticosteroids. These also help to suppress immune system inflammation. They treat active moderate to severe UC, but they can have severe side effects.
• Immunomodulators. These work on the immune system by modifying its activity to reduce the inflammatory response. They’re typically used when other medications have been ineffective.
• Antibiotics. These are often used when infections contribute to flares.
• Biologics. These work on the immune system by inhibiting the inflammatory protein TNF-alpha. They can bring about remission quickly, but they may cause a higher risk of infections.

You can also use over-the-counter pain relievers, like acetaminophen (Tylenol), to help manage pain.

Try to avoid NSAIDs such as ibuprofen (Advil), naproxen (Aleve), and aspirin, as they may worsen UC symptoms.

Be sure to tell your doctor about any additional medications you take.

Natural relief

There may be a link between emotional stress and UC flares. Some things you can do to reduce stress include:

• practicing mindfulness
• doing yoga
• exercising regularly

According to a 2019 research review, taking probiotics along with aminosalicylates greatly raised UC remission rates. This supports the idea that gut bacteria affect UC. More research is needed on probiotics for UC.

Turmeric may be effective for treating UC, too. A 2018 research review found that curcumin, an active ingredient in turmeric, resulted in higher remission rates when used with the aminosalicylate mesalamine.

Surgery

You may need surgery if you have colon cancer, serious complications from UC, or severe side effects from medication.

In general, surgery for UC removes your colon and rectum. The procedure is called a proctocolectomy. Because you still need to pass stool, the surgeon will perform either an ileostomy or create an ileoanal reservoir.

In an ileostomy, your surgeon attaches the end of your small intestine, called the ileum, to a hole in your abdomen to make an opening. You’ll need to wear a bag connected to the opening to collect waste.

Alternatively, your surgeon may create an ileoanal reservoir. This pouch, made from your ileum, stores stool inside your body so it can pass through the anus.

Side effects of an ileoanal reservoir may include having bowel movements more often and developing irritation in the pouch.

Seek medical care immediately if you:

• see clots of blood in your stool
• have heavy, ongoing diarrhea
• have a high fever
• can’t keep down liquids due to vomiting
• have continuous pain

It’s also important to talk to your doctor if your UC symptoms change or if they flare up during a period of remission. Your doctor can work with you to adjust your medication or look for other possible causes of the flare.

Don’t stop taking or change medications on your own.

There’s currently no cure for UC. Still, treatment can often effectively manage symptoms.

Maintaining a healthy lifestyle, taking all prescribed medications, and avoiding known triggers can help prevent or reduce flare-ups.

With effective treatment, you could have minimal or no UC symptoms for months or even years at a time.

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