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Ulcerative colitis (UC) is an unpredictable and chronic inflammatory bowel disease. Common symptoms include diarrhea, bloody stools, and abdominal pain. Symptoms of UC can come and go throughout your life.

Some people experience periods of remission where symptoms disappear completely. This can last for days, weeks, months, or years. However, remission isn’t always permanent.

Many people experience occasional flare-ups, which means that their UC symptoms return. The length of a flare-up varies. The severity of flare-ups can also vary from person to person.

Although symptoms can become active at any time, it’s possible to lengthen the time in between flare-ups.

Getting a handle on UC involves knowing how to manage the return of symptoms and recognizing factors that can trigger a flare-up.

The only way to 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

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

1. Keep a food journal

Write down everything you eat and drink to identify items that may trigger your flare-ups.

Once you notice a pattern, remove suspected problem foods or beverages from your diet for a few days to see if your symptoms improve. Dairy is a common culprit.

Next, slowly reintroduce these foods back into your diet. If you have another flare-up, eliminate these foods from your diet altogether.

2. Limit your fiber intake

Fiber contributes to bowel regularity and bowel health, but too much fiber can also trigger UC flare-ups.

Try to stick to foods that have no more than 2 grams of fiber per serving. Low fiber foods include:

  • refined carbohydrates such as 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.

3. Eat smaller meals

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

4. Exercise

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

Find what type of exercise works best for you. Even incorporating low-intensity exercises such as swimming, biking, yoga, and walking can help.

5. Reduce stress

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

Simple ways to relieve stress include meditation, deep breathing exercises, and setting aside time for yourself every day. It’s also helpful to set realistic goals and to learn how to say “no” when you’re feeling overwhelmed.

You should also try to get plenty of sleep, eat a balanced diet, and stay hydrated. Cutting back on alcohol, caffeine, and carbonation is also wise.

Speak with your doctor if lifestyle changes don’t improve your stress levels. They may recommend medication or seeking counseling from a mental health professional.

6. Speak with your doctor

Without treatment, people with UC tend to relapse.

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

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 can help you get into and stay in remission. Your doctor may need to add another type or increase your dosage.

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

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

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

At some point, your doctor may discuss slowly tapering off the medication. However, you should never decrease your dosage or stop taking your medication without speaking with your 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), such as aspirin and ibuprofen (Advil, Motrin), may also irritate the colon and cause a flare-up.

This doesn’t mean you should stop taking antibiotics or pain medications, but you should speak with your doctor before taking these drugs.

If you take an antibiotic, you may also need a temporary antidiarrheal medication to combat possible side effects.

If you experience stomach pain after taking an NSAID, your doctor may suggest acetaminophen (Tylenol) to reduce pain instead.

Stress

Stress doesn’t 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 increase your heart rate and boost your adrenaline. These stress hormones also stimulate an inflammatory response.

In small doses, stress hormones are harmless. Chronic stress, on the other hand, 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, such as:

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

Troublesome beverages can include milk, alcohol, carbonated drinks, and caffeinated drinks.

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.

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

Taking quick action during a flare-up can then bring your condition under control.

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