Managing Ulcerative Colitis Flare-Ups

Ulcerative colitis (UC) is a chronic condition that causes inflammation and sores, or ulcers, on the lining of the colon (large intestine) and the rectum. It is a type of inflammatory bowel disease (IBD). 

Symptoms of UC can vary over time. There may be periods with little or no symptoms, called remission, or other periods when symptoms worsen, called a flare.

Flare symptoms may include abdominal pain, diarrhea, fatigue, or bloody stool. If you experience a flare, appropriate medication, diet, and lifestyle changes can help manage symptoms.

Warning Signs of a Flare

Flares often are acute, meaning they come on suddenly. They can last from days to weeks. Between flare-ups, you may experience weeks, months, or years of remission.

Symptoms of a flare may be different depending on the severity and location of the inflammation in the colon and rectum. Nevertheless, common symptoms include:

• Abdominal pain or cramps
• Frequent and/or urgent bowel movements
• Diarrhea
• Bloody stool
• Unintentional weight loss
• Fatigue
• Nausea
• Loss of appetite
• Fever

What Triggers Flare-Ups

Many different factors can play a role in bringing on symptoms of a flare. Even if you have been avoiding potential triggers, you can still experience a flare.

However, being familiar with common causes and your triggers can help reduce and manage flare-ups. Common causes include:

• Medication changes: If you miss, skip, or take the wrong dose of your medication, it can trigger a flare. If you take your medication as prescribed but still experience a flare, you may need a change. Talk with your healthcare professional about possible changes in the dose, frequency, or type of medication to help improve your symptoms.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as aspirin, ibuprofen, and naproxen could worsen symptoms and should generally be avoided.
• Antibiotics: Sometimes antibiotics can trigger a flare due to changes in your gut bacteria. If you experience a flare-up while taking antibiotics, talk with your healthcare professional.
• Smoking: Smoking cigarettes can increase the risk of flares. Additionally, extended exposure to secondhand smoke may also trigger a flare. 
• Stress: Stress can worsen your symptoms during a flare-up. 
• Diet: During a flare-up, certain foods can make your symptoms worse. Which foods are triggers will vary from person to person. Keeping a food diary during times of a flare can help you identify your food and beverage triggers. 

How to Manage Ulcerative Colitis

Medications, diet, and other lifestyle changes can help decrease the severity and frequency of flare-ups.

Medication

Medication is the first line of treatment for UC. Which medication you are prescribed will depend on your overall health, the severity of your disease, and other individual circumstances.

Medications used to treat UC include:

• Aminosalicylates (5-ASAs): These work to reduce the inflammation in the lining of your colon. These medications, including Azulfidine (sulfasalazine) and Asacol HD (mesalamine), are used to treat mild-to-moderate ulcerative colitis flares and can also be used as a maintenance treatment while in remission.
• Corticosteroids: These medications, including prednisone and Entocort EC (budesonide), also help to suppress immune system inflammation. They are used only as a short-term treatment because there are many possible side effects.
• Immunomodulators: This type of medication, such as Imuran (azathioprine) or cyclosporine, is also called immune system suppressors. They help reduce inflammation in your colon by decreasing the activity of your immune system. Immunomodulators can have serious side effects, so you should see your doctor regularly while taking this medication.
• Biologics: Biologic therapies are another option if you do not respond well to other treatments. These medications, including Remicade (infliximab) or Simponi (golimumab), neutralize proteins made by the immune system to help decrease inflammation in your gastrointestinal (GI) tract. Side effects include a higher chance of developing infections.
• Janus kinase (JAK) inhibitors: This class of medication, including Xeljanz (tofacitinib) or Zeposia (ozanimod), suppresses specific parts of your immune system to help reduce inflammation. They are often prescribed if you don’t respond to other medications or have severe side effects.
• Antibiotics: If your symptoms are severe or have complications that lead to an infection, you may be prescribed an antibiotic.

Diet

While food triggers are unique to each person, the following diet changes may help relieve your symptoms during a flare-up:

• Limit dairy products.
• Avoid carbonated beverages.
• Avoid caffeinated beverages, like coffee.
• Avoid alcohol.
• Reduce high-fiber foods, like raw fruits and vegetables, nuts, and seeds.
• Avoid spicy foods.
• Drink plenty of water throughout the day.
• Eat small meals.

Lifestyle

These lifestyle measures may help:

• Exercise: Find a form of physical activity you enjoy. Whether it be yoga, walking, dancing, or playing basketball, exercise may be able to improve your symptoms.
  
• Reduce stress: It’s usually easier said than done, but finding ways to decrease stress can help reduce your symptoms.
  
• Sleep: Getting seven to nine hours of quality sleep each night won’t only help your overall health but can also help improve and manage your symptoms.

Preventing Flare-Ups

Medications, diet, stress, and other lifestyle factors can contribute to worsening symptoms during a flare-up.

It makes sense, then, that by taking your medications as prescribed, avoiding known triggers, reducing stress, and minimizing other potential triggers, you may be able to help prevent flare-ups.

However, sometimes flare-ups still happen, even when avoiding your potential triggers and taking your medication as prescribed. By seeing your doctor regularly, you can make any necessary changes in your treatment plan to best avoid having a flare-up.

When to See a Doctor

Contact your doctor if:

• Your symptoms change.
• You have new or worsening symptoms.

Get medical care right away if you experience any of the following:

• Clots of blood in your stool
• Severe, continuous diarrhea
• High fever
• Recurrent vomiting
• Constant, severe abdominal pain

Summary

Ulcerative colitis can have periods of few to no symptoms and flare-ups with symptoms. What triggers a flare can vary for each person. During a flare, symptoms may include abdominal pain, diarrhea, fatigue, or bloody stool. You can use medication, diet, and lifestyle changes to help manage symptoms during a flare.

A Word From Verywell

While you can’t always prevent UC flare-ups, there is much you can do to decrease the chances of them occurring. Taking your medications as prescribed, maintaining a healthy lifestyle, and avoiding your triggers can help prevent or reduce symptoms during flare-ups.

With regular checkups and the right treatment plan, you can have a great quality of life with weeks, months, or even years of remission from your UC.