You’re feeling well, taking your medications, and minding your own business. Suddenly, out of the blue, the colitis starts to flare up again.
So, how best to handle a flare of colitis? Here are the most important initial steps.
1. Discern any new or altered symptoms
First, you know your colitis best. So it’s crucial to pay attention to your body and determine whether the symptoms are similar to those from your previous flare-ups, or if they are new or slightly different symptoms that may hint at a different illness. Another illness, either related or unrelated to colitis, may be the current culprit.
For instance, let’s say your previous flares caused bloody diarrhea and some left abdominal discomfort, but this current flare involves mild diarrhea without blood and severe pain in your right upper abdomen. These new or altered symptoms may indicate inflammation or stones in the gallbladder, not an actual flare of colitis.
2. Alert your physician
Whether your symptoms are similar to your previous flares or not, it’s important to alert your physicians. Even if your symptoms are similar to previous flares, there may be other causes at work. The most common cause mimicking a colitis flare is an infection, such as dysentery and the like. Therefore it is often advised to obtain stool cultures or stool PCR tests in order to rule out bacterial infections that will require antibiotics rather than intensification of your colitis treatment.
A sigmoidoscopy is often also performed, especially if you are taking immunosuppressive medication. This helps rule out CMV (Cytomegalovirus) colitis – an infection of the colon by the CMV virus. A sigmoidoscopy will also help you and your doctor understand how severe the colon inflammation is, and to what extent it spreads. For instance, if you’re mostly suffering from urgency and feeling of incomplete evacuation (known as tenesmus), a sigmoidoscopy may reveal that only a few inches of the rectum mucosa near the anus are inflamed.
In these cases suppositories are often the best next move, whereas if inflammation extends to the longer internal segments of the colon, more systemic therapy (with/without enemas) may be required. A stool test for calprotectin is also commonly performed, especially if the sigmoidoscopy was not performed, to help ascertain whether active inflammation was the cause of your symptoms.
Once the situation and its severity are clarified, your doctor will choose the appropriate therapy for your flare, depending on its severity and extent, but also based on your current and past medications. Treatment usually includes either increase in the dose of medication or a change or addition of medications. We will break down the different medications in a forthcoming article.
3. Explore complementary medicine & dietary support
Your physician may also consider a trial of herbal compounds such as Qing Dai (QD) or gut-directed curcumin. These combines can be combined with most medications.
Although the inflammation is not directly influenced by diet, if diarrhea is one of your symptoms, it is usually recommended to reduce lactose and fiber intake during flares. It’s also vitally important to maintain adequate protein and calorie intake to help your body cope with inflammation and recover fully.
If you are suffering a severe exacerbation of symptoms, a more restricted diet may be required, along with nutritional support. If so, this should be under the strict guidance of an experienced IBD dietician.
Overall, the best rule of thumb for colitis flares is to identify the cause accurately, treat it promptly, and feel better!