Staying on top of your treatment should help lengthen the time between flares, but sometimes, ulcerative colitis symptoms appear no matter how careful you’ve been. Knowing what to do during a flare will help you start feeling better sooner. With the latest treatment options, sustained remission is a real possibility for the majority of people with ulcerative colitis, according to treatment guidelines published in 2020 in the journal Digestion. Dr. Damas emphasizes that your doctor will likely be equally focused on ensuring your treatment also leads to endoscopic remission — no findings of inflammation on a colonoscopy — and histologic/deep remission — no findings of inflammation on the biopsy specimens obtained from a colonoscopy. “Studies show that those who are in endoscopic and deep remission do best long term, as far as lower chances of hospitalizations for flare-ups and lower chances of complications, including surgery,” she says. People in endoscopic or deep remission can also have less chance of experiencing a relapse, according to a review published in October 2020 in the journal Gastroenterology. Still, a flare can occur, even if you’ve been in remission for years. Here’s what you can do if your symptoms flare up again. When you have a flare, try to follow a low-residue diet (a type of low-fiber diet) for several weeks, Damas says. The goal is to let your colon rest. That means staying away from seeds, nuts, dried fruit, most fresh fruit, raw vegetables, whole grain bread and cereal, and tough meat. “We’re learning more now about the influence that diet can have on control of inflammation,” Damas notes. “When patients are having an acute flare, it’s important in the short term to have a low-fiber diet. … We recommend what’s called a ‘low-FODMAP’ diet. However, this diet is not recommended long term, because it has no impact on inflammation itself and only on control of symptoms.” The Crohn’s & Colitis Foundation says it’s important to identify and avoid your food triggers when in a flare. But once you’re in remission, returning to a diverse and nutrient-rich diet is recommended. Damas says your doctor will likely suggest reintroducing fruits and vegetables as tolerated. It’s also a good idea to cook vegetables without the skin; limit dairy products, such as milk and cheese; and cut down on potential triggers, such as fatty, sugary, or spicy foods. “Additionally, we recommend patients avoid eating processed foods, as well as those high in fat and animal protein, as these have been associated with inflammation in some studies,” Damas says. Ask your gastroenterologist about your diet. Some hospital centers have nutritionists on staff who have experience treating people with UC and can perform individualized assessments to help you eat healthier. You can also try these symptom-specific tips for relief.
For diarrhea relief
Damas says it’s usually OK to take an over-the-counter antidiarrheal medication but recommends talking to your doctor and having your stool tested first. Having IBD puts you at higher risk of a bacterial infection called Clostridioides difficile, or C. diff, and if you’re fighting the infection, an antidiarrheal will slow down your colon and expose you to the toxin longer. In addition to following a low-residue diet, you may find diarrhea relief by avoiding carbonated drinks, prune juice, milk, and gum. Eating smaller meals may also help. Warning signs of a flare: Blood in the stool accompanied by diarrhea is cause for concern for anyone, but people with ulcerative colitis who are in a flare almost always have blood in their stool, Damas says.
To ease abdominal pain
As your doctor treats the flare, your abdominal pain should get better. Remember to avoid nonsteroidal anti-inflammatory drugs (NSAIDs), but Damas also recommends avoiding opioid analgesics (a class of prescription painkillers). Your doctor may prescribe an antispasmodic medication, which relaxes the gut muscles. Warning signs of a flare: People with ulcerative colitis often experience abdominal pain, but if the pain is worse or markedly different from your baseline, Damas recommends calling your doctor. Red flags that require medical attention include fever, fatigue, and intense abdominal pain.
To kick your fever
A temperature above 100° Fahrenheit (F) is considered a fever in an adult. Choose acetaminophen instead of NSAIDs — ibuprofen, aspirin, naproxen — to bring down your temperature, and be sure to drink plenty of fluids. Warning signs of a flare: If you have a fever of 104°F or higher, call your doctor immediately. Also call if you have a lower fever that continues to rise or lasts longer than two or three days. When you have ulcerative colitis, it’s natural to go through periods of flares and remission, even when you’re doing everything right. If you have several flares that require steroids to get symptoms under control, it may be time to reevaluate your treatment, Damas notes. Good communication with your doctor will ensure the most effective relief. “If you’re experiencing an increase in symptoms, including increased rectal bleeding, increased bloating, increased abdominal cramping or pain, feeling like you have to go to the bathroom but can’t, unintentional weight loss, or increased fatigue, this may suggest that your current treatment is losing response,” Damas says. But remember, “Always talk to your gastroenterologist about your symptoms [rather than] changing anything on your own.”
