Ulcerative colitis (UC) is a chronic condition that mainly impacts the colon and rectum, causing inflammation and ulcers in the lining of the gastrointestinal tract.
A ‘flare-up’ refers to periods of intensified symptoms and inflammation associated with UC, including abdominal pain, diarrhea, rectal bleeding, and fatigue. Flare-ups are unpredictable and can significantly impact quality of life due to discomfort and disruption of daily activities. That said, understanding the causes and triggers of your flare-up can greatly help manage symptoms and reduce disease activity.
UC Flare-Up Symptoms
A flare-up of ulcerative colitis (UC) is a period of heightened disease activity characterized by worsening symptoms and inflammation in the colon and rectum. These flare-ups can vary in intensity and duration, ranging from mild to severe, and can significantly impact an individual’s daily life.
Several symptoms may manifest during a UC flare-up, including:
- Persistent cramps or abdominal pain
- Increased frequency of bowel movements and diarrhea
- Rectal bleeding
- Unintentional weight loss
- Urgency (sudden urge to have a bowel movement)
- Tenesmus (a feeling of incomplete evacuation)
What Causes UC Flare-Ups?
Various factors can trigger a UC flare-up. While specific triggers can vary from person to person, there are several common trends. Primarily, many foods can trigger a flare, especially dairy products, high-fiber foods, caffeine, and alcohol. It may help to keep a food diary to track your eating habits and any symptoms that may arise from a specific food.
However, it is important to note that it is not always easy to distinguish if these foods really triggered a flare by causing increased gut inflammation, or merely led to increased diarrhea incorrectly interpreted as colitis flare, which can often occur in patients with lactose intolerance.
This distinction is important because the absence of inflammation implies that limiting the offending food will result in the resolution of symptoms, whereas a genuine UC inflammatory flare will require some escalation of treatment to control the inflammation.
Periods of emotional stress and anxiety have also been confirmed in studies to exacerbate UC symptoms. Researchers have traced this to the overproduction of the stress hormone, glucocorticoid, which, when chronically released over long periods of time, literally transforms enteric glial cells into pro-inflammatory signals.
Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can also trigger flare-ups. In some cases, antibiotics can cause UC flare-ups. Broad-spectrum antibiotics reduce microbiota diversity, which can exasperate UC symptoms. Bacterial or viral infections in the gastrointestinal tract also trigger inflammation and exacerbate UC symptoms.
Lastly, hormonal fluctuations such as those occurring during menstruation, pregnancy, or menopause, can influence UC symptoms in some individuals.
Identifying personal triggers is crucial for managing UC flare-ups, as triggers can vary from person to person. By recognizing and avoiding triggers, you can reduce the frequency and severity of flare-ups, improving your overall disease management and quality of life.
How Long Does a UC Flare-Up Last?
The duration of a UC flare-up can vary widely from patient to patient and depends on factors such as the severity of the inflammation, individual response to treatment, and the effectiveness of management strategies.
Mild flare-ups may resolve within a few days to weeks with appropriate treatment and lifestyle adjustments. However, moderate to severe flare-ups may last several weeks or months, requiring intensive medical intervention and possibly hospitalization.
Early intervention and proactive management can shorten the duration of flare-ups and minimize their impact on daily life.
How to Manage a UC Flare
According to Professor Shomron Ben-Horin, Head of Gastroenterology at Sheba Hospital, it’s important to pay close attention to all symptoms when a flare starts. “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.”
Whether your symptoms are similar to your previous flares or not, it’s important to alert your physician. 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 an increase in the dose of medication or a change or addition of medications.
Managing UC Flare-Ups with the Right Foods
During a flare-up, a tailored diet is crucial for managing symptoms and promoting well-being. A suitable diet may include:
- Low-residue foods like white rice, refined pasta, and cooked vegetables without skins reduce bowel irritation and minimize symptoms such as diarrhea and abdominal pain.
- Lean proteins like skinless poultry, fish, tofu, and eggs are easier to digest and less likely to cause discomfort, providing essential nutrients for maintaining well-being during flare-ups.
- Probiotic-rich foods like yogurt with live cultures, kefir, and fermented vegetables contain beneficial bacteria that can help restore balance to the gut microbiome and alleviate symptoms during UC flare-ups.
- Hydration is essential for individuals with UC, especially during flare-ups when fluid loss from diarrhea can lead to dehydration.
- Avoiding legumes, milk and dairy products, and red meat can help alleviate the symptoms.
- Regular monitoring of symptoms and adjustments to the diet are crucial for identifying trigger foods and tracking symptom patterns. Keeping a food diary can help individuals manage UC flare-ups effectively.
Managing UC Flare-Ups with Natural Supplements
Several natural compounds show promise in managing UC flare-ups. By far the most effective in human trials is Qing Dai (Indigo Naturalis). The Chinese herbal remedy has undergone extensive research, showing its ability to quickly counter intestinal inflammation and heal mucosal tissue damage in UC patients with moderate-severe disease activity.
Please note that Qing Dai is a potent herbal formula and should be taken in a standardized dose and short duration under your doctor’s supervision to avoid side effects and improve efficacy. If you’re interested in Qing Dai for UC, please take our online assessment for a tailored treatment plan.
Comprehensive Relief from UC Flare-Ups
To effectively manage a UC flare-up, it’s important to consult with your healthcare team as soon as possible so they can make appropriate treatment adjustments and prevent potential complications.
Employing stress reduction techniques like mindfulness and therapy, and engaging in gentle exercises such as yoga or tai chi can help immensely. During a flare, low-impact exercise is recommended. Getting good quality sleep is essential for the recovery process, so it may be wise to establish a consistent bedtime routine.
A comprehensive approach, including medication adherence, stress management, and dietary adjustments, can help you regain some symptom control and improve your well-being.
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