What Is an IBD Flare-Up?

Relapse of Crohn's Disease or Ulcerative Colitis

People with inflammatory bowel disease (IBD) or other chronic conditions may hear about "flare-ups" or "flaring" in connection with their disease. These terms are generally meant to refer to the active state of IBD. IBD is not curable and it is a condition that goes through periods where it is active (a flare-up) and periods where it is not active (remission). The time flaring and the time in remission can be highly variable from person to person: no two people with IBD are the same. However, a person with IBD who experiences diarrhea for a day or two which gets better on its own is not necessarily having an IBD flare-up. The diarrhea could be from some other cause. This is why it is important to get symptoms of IBD or those that are suspected to be from IBD evaluated by a doctor when they start to occur.

Bowel pain artwork

The Flare-Up and Remission Cycle of IBD

IBD is a chronic condition that is characterized by intermittent periods of active disease (flare-ups) and little or no disease activity (remission). The duration and severity of the active period vary widely from person to person. The goal of treatment with IBD is to quell the flare and get the IBD back under control and hopefully into remission.

There are different forms of remission and a physician can help a person with IBD understand if and when one or more types of remission has been achieved:

  • Clinical remission. When symptoms aren't present and a person with IBD may feel better.
  • Endoscopic remission. Testing to look at the lining of the intestine shows no inflammation.
  • Biochemical remission. Blood tests and stool tests show no sign of inflammation.
  • Surgical remission. When the IBD goes into an improved state after having surgery to treat the IBD.
  • Histologic remission. When there is both clinical and endoscopic remission and any biopsies taken from the intestines don't show any of the characteristics of IBD. 

What Is an IBD Flare-Up?

After a period of remission, IBD may flare-up, causing symptoms and/or inflammation. Symptoms that may have been gone for weeks or months become bothersome again. 

There is, unfortunately, no criteria that would define a flare-up: there's no quiz that a person can take to determine if the IBD is active. Many times, a patient will start to have symptoms and will see their gastroenterologist for an evaluation. The gastroenterologist may do a series of tests such as blood or stool tests, to start to understand why the symptoms are returning. In some cases, this might also mean having an endoscopy, such as a sigmoidoscopy, a colonoscopy, or an upper endoscopy. With these tests, a gastroenterologist can see exactly what is going on in the digestive tract, and pinpoint the area of inflammation. It's important to know where the problem is in order to treat it.

Treating a Flare-Up

A flare-up will probably not resolve by itself, and treatment will be needed. Most people with IBD take a maintenance drug to help keep symptoms in check, even when the IBD is quiescent. Maintenance drugs will be continued during a flare-up, and other drugs, diet modifications, or more treatments may be prescribed by a gastroenterologist to bring the disease back under control. How the drug regimen will change is an important point of discussion between patient and physician. What was working for a time may no longer be effective and different drugs or a change in dosage might need to be tried.


Identifying and Managing Crohn’s Disease Flare-Ups

Surgery is also considered a treatment for IBD. Surgery might be needed when there are complications of the IBD such as abscesses or strictures. With Crohn's disease, surgery might be used to remove the part of the small intestine that is showing disease. For ulcerative colitis, surgery always involves the removal of the colon, because the disease will come back if part of that organ is left in place. There are many other types of surgery that are done to treat IBD, and sometimes they are very individualized because of the variable nature of these diseases from person to person.

A Word From Verywell

People with IBD will need care from a physician and regular check-ups to keep the disease under control. It can be challenging to know if symptoms are from another illness or if they are from the IBD ramping up again. When symptoms such as diarrhea, bleeding, pain, and fever return, seeing a gastroenterologist right away is critical. Symptoms can rapidly become serious, and getting them treated right away gives the best chance of stopping the flare-up before it causes more damage. 

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Moss AC. Residual inflammation and ulcerative colitis in remissionGastroenterol Hepatol (N Y). 2014;10(3):181–183.

  2. Crohn's & Colitis Foundation. Crohn's Disease Treatment Options.

  3. Crohn's & Colitis Foundation. Ulcerative Colitis Treatment Options.

By Amber J. Tresca
Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.