6 Tips to Help Manage Ulcerative Colitis Flare-Ups

Managing flare-ups

Learning to manage UC flare-ups can help you feel better and improve your quality of life. Here are a few tips to help you cope and limit their severity:

1. Keep a food journal

Writing down everything you eat and drink can help identify items that may trigger your flare-ups.

If you notice a pattern with particular foods triggering flare-ups, try removing suspected problem foods or beverages from your diet for a few days to see if your symptoms improve. Dairy is a common culprit, as many people with UC have lactose intolerance.

Next, slowly reintroduce these foods back into your diet. If you have another flare-up, you may want to eliminate these foods from your diet altogether. Still, it’s best to seek support from a doctor or nutritionist when using an elimination diet to ensure you still receive the nutrients you need.

Eating foods you tolerate well may help avoid symptoms. While researchers have not yet found that specific foods cause or worsen UC, health-promoting diets appear to reduce the risk of developing the disease. They also have other benefits, such as supporting your gut microbiome and helping you get the nutrients you need.

2. Limit your fiber intake

Fiber contributes to bowel regularity and bowel health, but too much fiber can also be hard to digest and may worsen UC flare-ups.

During a flare-up, try to stick to foods that have no more than 2 grams of fiber per serving. Low fiber foods can include:

• refined carbohydrates like white rice, white pasta, and white bread
• fish
• cooked meats
• eggs
• tofu
• butter
• some cooked fruits (no skin or seeds)
• juice with no pulp

Instead of eating raw vegetables, steam, bake, or roast your vegetables. Cooking vegetables results in some fiber loss.

Note that during periods of remission, the Crohn’s & Colitis Foundation recommends eating a diet with fiber to support general health and nutrition unless advised by a doctor not to do so.

3. Eat smaller meals

If you have abdominal pain or diarrhea after eating three large meals daily, scale back to five or six smaller meals a day to see if your symptoms improve.

When eating smaller meals, guidelines suggest choosing nutrient-dense items that provide higher energy.

4. Exercise regularly

Exercise can boost your mood, ease stress, and improve anxiety and depression associated with UC. Physical activity can also suppress inflammation and help you feel better.

Find what type of exercise works best for you. Incorporating low to moderate intensity exercises like swimming, biking, yoga, and walking can help.

Make it part of your routine to get the best health benefit from exercise. The anti-inflammatory effect of exercise depends on the FITT principle, which includes:

• Frequency. Aim to exercise 3 to 5 times per week.
• Intensity. Choose moderate intensity exercise that increases your energy expenditure.
• Time. Exercise for at least 30 minutes per day.
• Type. Work up to a mix of endurance and resistance exercises to use all big muscle groups.

5. Reduce stress

Stress can worsen a flare-up. Managing your stress can lower your body’s inflammatory response and help you overcome a flare-up sooner.

Simple ways to relieve stress can include:

• journaling
• meditation
• deep breathing exercises
• yoga
• mindfulness meditation

Setting realistic goals and learning how to say “no” when feeling overwhelmed can be helpful.

You can also try to get plenty of quality sleep, eat a balanced diet, and stay hydrated. Reducing or eliminating alcohol, caffeine, sugar, and carbonated drinks from your diet may also help you feel better.

Speak with your doctor if lifestyle changes do not improve your stress levels. They may recommend medication or seeking counseling from a mental health professional. A mental health professional can help you learn to recognize negative thought patterns and teach you strategies that can help you manage your stress.

6. Speak with a doctor

Without treatment, people with UC tend to experience a relapse.

For many people with mild or moderate symptoms, things can improve somewhat after diagnosis. This is thanks to medication, along with identifying and avoiding triggers.

Treatment options can include:

• anti-inflammatory medication, given orally or via the rectum (rectally)
• steroid hormones, such as glucocorticoids
• immunosuppressant medications
• biological drugs
• fecal microbiota transplantation to establish a healthy gut microbiota
• surgery

More aggressive cases are less common, and only a small number of severe cases will require hospitalization.

Repeated flare-ups can indicate problems with your current treatment, so speak with your doctor and discuss adjusting your medication.

Several classes of medication now exist that are designed to help you get into and stay in remission. Your doctor may need to add another type or increase your dosage.

How to stop a flare-up

The only way to definitively prevent UC flare-ups is to have surgery. The most common type of UC surgery is the proctocolectomy, which involves the removal of the rectum and colon.

Candidates for UC surgery include people who:

• have sudden or severe disease
• have a perforated colon
• are at risk for colorectal cancer
• are unable to tolerate their UC medications due to side effects
• have stopped responding to their UC medications

Triggers and causes of flare-ups

In addition to knowing how to manage flare-ups, it’s also helpful to recognize factors that can trigger your flare-ups.

Skipping or forgetting to take your UC medication

UC causes inflammation and ulcers in the colon. If left untreated, this condition can lead to life threatening complications, such as:

• bowel perforation
• colorectal cancer
• toxic megacolon

A doctor will likely prescribe medication, such as an anti-inflammatory or immunosuppressant drug, to help reduce inflammation.

These medications can help ease symptoms of UC and also function as maintenance therapy to keep you in remission. Symptoms could return if you do not take your medication as directed.

At some point, the doctor may discuss slowly tapering off the medication. However, you should never decrease your dosage or stop taking your medication without speaking with your prescribing doctor first.

Medications for other conditions

A medication you take for another condition can also trigger a flare-up.

This might happen if you take an antibiotic to treat a bacterial infection. Antibiotics can sometimes disrupt the balance of intestinal bacteria in the gut and cause diarrhea.

Certain over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen (Motrin, Advil), may also irritate the colon and cause a flare-up.

This does not mean you should stop taking antibiotics or pain medications, but you should speak with a doctor before taking these drugs.

If you take an antibiotic, you may also need a temporary antidiarrheal medication to address possible side effects or a probiotic to help regrow your gut bacteria.

If you have pain that requires an over-the-counter pain reliever, the doctor may suggest using acetaminophen (Tylenol) to reduce pain instead of an NSAID.

Stress

Stress does not cause UC, but it can worsen symptoms and trigger a flare-up.

When you’re under stress, your body goes into fight-or-flight mode. It releases hormones that can increase your heart rate and boost your adrenaline. These stress hormones also stimulate an inflammatory response.

Stress hormones can even affect your digestive tract, according to a 2017 literature review on the impact of stress on the body. They may cause GI inflammation, prevent stomach emptying, accelerate colon movement, and affect the way your body digests nutrients.

In small doses, stress hormones can be harmless. But chronic stress can keep your body in an inflamed state and worsen UC symptoms.

Diet

The foods you eat can also worsen symptoms of UC. You may have a flare-up or notice that your symptoms get worse after consuming certain types of foods, which may include:

• dairy
• raw fruits and vegetables
• beans
• artificial sweeteners
• popcorn
• meat
• nuts and seeds
• fatty foods
• spicy foods

Beverages that can trigger flare-ups may include milk, alcohol, sugary drinks, carbonated drinks, and caffeinated drinks.

However, the foods and drinks that trigger UC flare-ups vary from person to person. The way your body responds to certain items can also change over time. A doctor or nutritionist can help you make any necessary changes to your diet to help encourage longer periods of remission in between flare-ups.

Takeaway

It’s possible to improve symptoms of UC and achieve periods of remission through diet and lifestyle changes. The key is taking your medication as directed and identifying and avoiding any factors that may trigger your flare-ups.

Taking quick action during a flare-up may help return your condition to a more manageable state.

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