What Are Ulcerative Colitis Flare
Ulcerative colitis is a condition which affects thousands of people across the UK. Luckily, many people with ulcerative colitis flare-ups receive advice and treatment, meaning the condition has minimal impact on their quality of life.
This doesnt mean flare-ups are completely avoidable though. Depending on whether you have proctitis, distal or total colitis, a flare-up may have different effects on the individual. Knowing how to recognise and manage these effects is very important.
In this short blog post, we will discuss what happens during a flare-up and how best to alleviate problems when it does.
Talk With Onewelbeck Today
No one should have to think of flare-ups as something that become part of daily life. The team at OneWelbeck Digestive Health work with patients looking to get treatments for a number of gastrointestinal conditions.
You can see the main conditions we help with here, but if you want to speak with someone about ulcerative colitis, we are here to help. Please get in touch by leaving a message on our contact page, or by calling us directly on .
Many Disease Activity Indices Exist For Ulcerative Colitis But None Have Been Developed With Formal Patient Input
There is no consensus gold standard for the evaluation of disease activity in ulcerative colitis. This is illustrated in numerous recent clinical trials, in which investigators measured several different indices of disease activity, as no one index is considered sufficient. There are many indices for the measurement of ulcerative colitis disease activity, including Truelove and Witts classification of mild, moderate, and severe disease the St Marks Index, which empirically added endoscopy in 1978 simplified versions of the St Marks Index, including the Ulcerative Colitis Disease Activity Index and the Mayo Score and noninvasive versions, including the Seo Index and the Simple Clinical Colitis Activity Index .
The diversity of indices suggests that none of these has proven satisfactory, and none was developed with patient input. In addition, it has never been established that any of these indices actually measures all of the important symptoms of ulcerative colitis.
Ulcerative colitis lacks a validated measurement instrument such as the Crohns Disease Activity Index in Crohns disease . Furthermore, the indices that do exist for ulcerative colitis were not constructed in a patient-centered manner to attempt to capture the symptoms experienced by patients. Therefore, our study group aimed to investigate through focus groups that what symptoms does patients with ulcerative colitis experience during their disease process.
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What Should I Eat During An Ulcerative Colitis Flare
There is no specific type of diet that has been proven to relieve symptoms in people with ulcerative colitis. However, you may find that particular foods make symptoms worse.
It is important to identify and limit any foods that lead to worsening of your symptoms. Keeping a food journal may help you track how your diet relates to your symptoms.
Some suggestions that may help during a flare-up include:
- Limit fiber
- Reduce dairy products containing lactose
- Avoid high-fat foods
- What remedies help during an ulcerative colitis flare-up?
In addition to taking medication as prescribed and eating a well balanced diet, maintaining a healthy lifestyle can be beneficial for managing ulcerative colitis. Regular exercise and mindfulness strategies have been shown to improve overall health and quality of life.
Arastéh, K., Baenkler, H. W., Bieber, C., Brandt, R., & Chatterjee, T. T. . Duale Reihe Innere Medizin. Georg Thieme Verlag.
Dignass, A., Preiß, J. C., Aust, D. E., Autschbach, F., Ballauff, A., Barretton, G., … & Jantschek, G. . Aktualisierte Leitlinie zur Diagnostik und Therapie der Colitis ulcerosa 2011Ergebnisse einer Evidenzbasierten Konsensuskonferenz. Zeitschrift für Gastroenterologie, 49, 1276-1341.
Elizabeth Oliver, PhD
Will Ulcerative Colitis Affect Me Over Time
The effects of ulcerative colitis vary considerably from person to person, based on the nature and severity of their disease. In many cases, the condition does not have much impact on daily life, the ability to work or to enjoy an active social life but does take some getting used to. When it is at an active stage, symptoms such as diarrhoea and abdominal pain often require time away from work, college etc. and can make it difficult to cope going out or even being at home. However, treatment usually makes the symptoms better within days or weeks so normal quality of life can be restored quite quickly. Some severe cases of ulcerative colitis, however, can have a significant impact on peoples lives. This can be due to a weak response to treatment which makes symptom-free remission difficult to achieve and can involve frequent flare ups.
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Foods To Eat With Ulcerative Colitis
My long-term nutrition goal for my clients with ulcerative colitis is always to move towards an anti-inflammatory diet where they eat as many whole plant foods as possible. It is thought that a more Mediterranean or anti-inflammatory diet pattern contributes to an healthier community of gut bacteria, a stronger gut barrier and a better immune balance between tolerance and inflammation. In one clinical trial, a plant-based diet improved relapse rates in ulcerative colitis. Other lab research suggests that a Mediterranean-style diet decreases risk of colitis. However, because of the nature of inflammation and irritation, it can often take very slow and sustained change over time to increase intake of plant-based foods comfortably.
- Fruits and Vegetables
Fruits and vegetables have been associated with a decreased risk of ulcerative colitis. They are high in anti-inflammatory phytochemicals and fibre, which is critical for production of short chain fatty acids by our gut bacteria that help to ease inflammation and support gut barrier function.
- Omega 3 rich seeds
We all need omega 3 rich foods in our daily diet ulcerative colitis is no exception. Data suggests that increased intake of omega 3 rich foods decreases risk of ulcerative colitis but clinical trials on fish oils have not offered conclusive benefits to disease outcomes.
- Calcium- and magnesium-rich foods
- High Fibre Foods, as tolerated
- Turmeric
- Psyllium
How Ulcerative Colitis Is Treated
Treatment for ulcerative colitis aims to relieve symptoms during a flare-up and prevent symptoms from returning .
In most people, this is achieved by taking medicine, such as:
- aminosalicylates
- corticosteroids
- immunosuppressants
Mild to moderate flare-ups can usually be treated at home. But more severe flare-ups need to be treated in hospital.
If medicines are not effective at controlling your symptoms or your quality of life is significantly affected by your condition, surgery to remove your colon may be an option.
During surgery, your small intestine will either be diverted out of an opening in your abdomen or be used to create an internal pouch that’s connected to your anus called an ileoanal pouch.
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Your Uc Flare Management Plan
Your doctor may help you deal with a flare by changing your medications or offering new ones. Treatment of flares can include mesalamine products and usually a steroid, such as prednisone,” says Desi.
There are also some things you can do at home to temper a flare. These include:
During an ulcerative colitis flare, its recommended that you schedule regular visits to see your doctor, at least once every three months until the symptoms go away. After the flare has subsided, physicians recommend one or two checkups a year to manage the disease.
When an ulcerative colitis flare strikes, you have options for getting your life back on track. Its important to learn what you can about maintaining your health and work with your doctor to find the best ways to safely control UC. And remember to always let your doctor know when new or persistent symptoms arise.
How Can I Identify Patients With Ulcerative Colitis
A combination of history, assessment of endoscopic and radiological appearances, histology, and microbiology is needed to diagnose colitis . The cardinal symptoms of ulcerative colitis are:
-
Bloody diarrhoea
-
Urgency
-
Tenesmus .
Mild distal colitis, in which rectal bleeding may be absent, can mimic irritable bowel syndrome. Colicky lower abdominal pain may occur, but severe pain is usually limited to severe colitis.
Stool cultures should be performed even in patients with a relapse of known ulcerative colitis. The presence of bloody diarrhoea for more than three weeks should alert the doctor to the possibility of inflammatory bowel disease, and endoscopy should be performed.
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When You’re In The Hospital
You were in the hospital because you have ulcerative colitis. This is a swelling of the inner lining of your colon and rectum . It damages the lining, causing it to bleed or ooze mucus or pus.
You probably received fluids through an intravenous tube in your vein. You may have received a blood transfusion, nutrition through a feeding tube or IV, and medicines to help stop diarrhea. You may have been given medicines to reduce swelling, prevent or fight infection, or help your immune system.
You may have undergone a colonoscopy. You also may have had surgery. If so, you may have had either an ileostomy or colon resection .
Continuous Signs And Symptoms
Ulcerative colitis can cause signs and symptoms such as diarrhea, blood in the stool, nausea, fatigue, and abdominal pain. One of the goals of treatment is to stay on top of the inflammation that may contribute to these symptoms.
The symptoms of ulcerative colitis can lower a persons quality of life significantly, as well as affect personal relationships and the ability to have a rewarding and successful career. While it does take time and effort to develop a treatment plan, the result can be the cessation of the symptoms and an improvement in quality of life.
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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 , such as aspirin and ibuprofen , may also irritate the colon and cause a flare-up.
This doesnt 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 to reduce pain instead.
What To Eat During An Ulcerative Colitis Flare Up
When youre in a flare, the most important thing to do is follow your doctors advice and avoid high fibre, irritating foods. For my clients who are already plant-based, this can take some work to lessen fibre while maintaining your nutrient intake. You may need doctor-supervised bowel rest, where nutrition is provided via other means. Or, you may need a low residue diet until the flare subsides.
However, you may also be advised to simply eat whatever you can if this is the case, I find is that so often, the foods chosen are not very healthy and may further the inflammatory response. So here, I recommend juicing small amounts of fruits and vegetables, and enjoying a lot of blended foods like smoothies, blended soups and easy to digest foods like noodles, nut butters, plant-based yogurts and rice.
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What Does Ulcerative Colitis Look Like
With UC there is a wide variation in the amount of inflammation from person to person, so that in mild cases the bowel can look almost normal but, when the inflammation is bad, the bowel can look very red and ulcerated. Ulcerative colitis usually affects the rectum, but occasionally there is no inflammation . Sometimes the inflammation is limited just to the rectum . However, the inflammation can involve varying lengths of the colon. When the whole large bowel is affected, this is called pan-colitis .
When To Get Medical Advice
You should see a GP as soon as possible if you have symptoms of ulcerative colitis and you have not been diagnosed with the condition.
They can arrange blood or stool sample tests to help determine what may be causing your symptoms.
If necessary, they can refer you to hospital for further tests.
If you have been diagnosed with ulcerative colitis and think you may be having a severe flare-up, contact a GP or your care team for advice.
You may need to be admitted to hospital.
If you cannot contact your GP or care team, call NHS 111 or contact your local out-of-hours service.
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Causes Of Ulcerative Colitis
We dont yet know the cause of this condition although most doctors now think it relates to how patients react to the apparently harmless friendly bacteria that everyone has in their colon. In most people, the bacteria that live in the colon do not cause any damage and indeed can be quite useful. However, patients with ulcerative colitis dont see them as being at all friendly and when the lining of the large intestine goes into battle with these bacteria, the result is that the inflammation starts. An enormous research effort is currently under way to find out why patients with ulcerative colitis appear to react badly to bacteria that dont normally cause any harm in others. There may be other causes which we have yet to discover.
How Long Does An Ulcerative Colitis Flare
Ulcerative colitis is a chronic disease that causes inflammation and ulcers in the inner lining of the large intestine and rectum. If you have UC, you may experience repeated cycles of flare-ups and remissions .
A flare-up can last a few days or a few weeks and then be followed by a remission that lasts for months or even years. How long a flare-up lasts depends on factors such as:
While there is no cure for UC, several treatment options and lifestyle modifications can help reduce symptoms or prevent flare-ups.
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Active Left Sided Disease And Extensive Disease
Doses of oral mesalazine > 3 g a day are associated with greater clinical improvement than lower doses. Combined topical and oral treatment can help induce remission in left sided colitis and extensive colitis., Oral corticosteroids are indicated in mild disease that fails to respond to topical treatment and in moderate disease .
Delays in treatment may increase the risk of colectomy. Patients should be treated promptly with an optimal dose of corticosteroids .
Natural Remedies For Uc Flares
Natural remedies are being studied, but none have been proven yet. The National Center for Complementary and Integrative Health notes that supplementing your standard treatments with meditation may be beneficial during a UC flare-up to help reduce symptoms, and that prebiotics and probiotics have shown promise in bringing about remission and helping people stay in remission when added to usual care.
Still, ulcerative colitis is a chronic, incurable condition, and symptoms may reappear unpredictably.
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How Is Ulcerative Colitis Diagnosed
The first steps to diagnosis will include a complete medical history and a thorough visual examination to look for signs of anaemia. The doctors will also examine the abdomen for tenderness . If UC is suspected then further tests will be carried out. These will include:
Blood tests: These are to check for anaemia and the level of protein which can measure inflammation known as ESR and CRP tests. In general, the greater the degree of anaemia and the lower the protein level in the blood, the more severe the inflammation is likely to be.
Faecal Calprotectin test: This test examines stools for signs of inflammation and to exclude infection. The most important investigation is to look directly at the lining of the large intestine. This is done using a tube fitting with a camera which passed into the colon via the anus. There are two types of investigations commonly used for ulcerative colitis.
Sigmoidoscopy: This investigation only views the rectum and left hand side of the colon. Patients receive an enema to clear the bowel before the procedure.
For sigmoidoscopy, tiny samples of the bowel lining may be taken, with colonoscopy biopsies are likely to be taken. Biopsies will be analysed under a microscope after the procedure has finished and used to confirm the diagnosis.
Are Your Ulcerative Colitis Symptoms Under Control
She emphasizes that your doctor will likely be just as focused on ensuring your treatment also leads to endoscopic remission and histologic/deep remission .
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.
Still, your doctor will also recommend that when you do feel your digestion is off that you recognize it and react as quickly as possible.
Pay extra attention if you are exposed to any potential ulcerative colitis triggers. For example, some common medications may prompt flares. The two biggest culprits are antibiotics and nonsteroidal anti-inflammatory drugs , such as ibuprofen, aspirin, and naproxen. Other triggers may include stress and foods that aggravated your symptoms in the past.
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What Triggers An Ulcerative Colitis Flare
Triggers of ulcerative colitis flare-ups vary from person to person. It is helpful to identify factors that trigger or worsen your symptoms in order to try and avoid them. You may want to use a symptom diary or tracking app. Some of the most common include:
- **Diet. **Certain foods may trigger flares or worsen symptoms. Try to identify any foods that impact your ulcerative colitis.
- Medications. Pain relieving medications such as non-steroidal anti-inflammatories or antibiotics can worsen symptoms of ulcerative colitis
- Not taking medication as prescribed. Missing ulcerative colitis medications or taking an incorrect dose can lead to a flare-up.
- Stress. In some people, stress may impact ulcerative colitis symptoms.