Digestive Disorders > IBD > Ulcerative Colitis

Ulcerative colitis flare-ups: 7 essential questions

Dr. med. Andre Sommer

Dr. med. Andre Sommer

Ulcerative colitis is a relapsing inflammatory disease of the colon that will accompany you throughout life. However, the inflammation is not always equally active. There are phases in which you hardly notice the disease (remission). Unfortunately, the inflammation can flare-up again and again and cause severe discomfort. This relapsing course is typical of the disease.

1. I take medication regularly. Can a flare-up still occur?

Unfortunately, yes. Regular medication should ensure you stay in the symptom-free phase (remission). A long flare-up-free period is often achieved through medication. Nevertheless, the disease can still flare-up again. In this case, the dosage of the medication must be adjusted for the duration of the flare-up and other active ingredients may have to be used.

Flare-ups during pregnancy

The risk of a flare-up occurring during pregnancy is 30 percent. It is important that you see your doctor quickly to treat the flare-up. The high inflammatory activity can otherwise harm the fetus. In consultation with a gynecologist, optimal therapy can then be initiated.

2. What symptoms will I experience in a flare-up?

Inflammation occurs again in your colon during the episode. This inflammatory reaction damages the mucous membrane and can cause the following symptoms:

  • Bloody diarrhea
  • Acute stomach pain
  • Increased bowel movements (more than five per day)
  • Painful urgency (tenesmen)
  • Difficulty retaining stool
  • Fever

Depending on how strong the inflammatory reaction is and how far it has spread in the intestine, the severity of your symptoms will also vary. It is important to contact your treating doctor in an acute flare-up to discuss therapy with them. The goal of ulcerative colitis therapy is to keep the inflammatory reaction at bay and thus to minimize your symptoms. Ulcerative colitis patients are also more prone to gastrointestinal infections. The doctor must diagnose whether there is an infection or a flare-up. There is usually no bloody diarrhea in the case of an infection, although there are exceptions.

3. How long will the flare-up last?

Unfortunately, it is impossible to predict how long the flare-up will last. Medications that curb the inflammatory response or suppress the immune system attempt to end the flare-up and bring you back into remission. How well the medication works is individual and also depends on how severe the inflammation is. Sometimes a complete remission cannot be achieved. This is referred to as a chronic-continuous course. However, the intensity of the disease also varies during this course.

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4. How severe is the flare-up?

There are several ways to determine the severity of your flare-up. You can find a simplified classification in the table. Your doctor may also use a blood test to determine if you have anemia. In severe cases, blood loss leads to anemia.

Severity Low Middle High
Bloody diarrhea < 4 per day 4-6 per day > 6 per day
Temperature < 37° C up to 38° C > 38° C
Feeling of sickness Low Significant High
Pulse < 100 / min < 100 / min > 100 / min

Fig. _1. Classification of the severity of episodes of ulcerative colitis_

5. What triggers a flare-up?

So far, no trigger factors for a flare-up are known. Some sufferers report that a stressful life event occurred before the relapse. However, it has not been proven that psychological stress and stress can generally trigger a surge. However, too much stress affects general well-being and can therefore be an additional strain.

6. What should I eat during a flare-up?

Generally, there is no specific nutritional recommendation for ulcerative colitis patients. The intestine is very sensitive due to the inflammation of the large intestine during the flare-up. Diarrhea also causes the loss of important nutrients and fluids.

It is therefore particularly important to ensure that there is enough water intake during the flare-up. If there is a lack of nutrients, these should be substituted. A low-fiber, gentle diet can do you good during a flare-up. That means eating food that is not too greasy and spicy.

Because drug therapy weakens your immune system, you should take special care not to ingest any bacteria. Always wash vegetables and fruits thoroughly, avoid spoiled foods and avoid raw fish, meat and raw milk products.

By monitoring your diet and symptoms over a period of time via a digestive health diary, you can find out which foods are not good for you personally. You are also welcome to take advantage of our nutritional consultation, which specializes in ulcerative colitis.

7. What remedies help during a flare-up?

See our article on treatment for ulcerative colitis for detailed information. But what other options are there? Since the discomfort during flare-ups is very stressful, it is important to minimize this stress. Do something for yourself and your wellbeing. There are indications that moderate exercise and mindfulness exercises have a positive effect on the course of the disease and increase your quality of life.

Arastéh, K., Baenkler, H. W., Bieber, C., Brandt, R., & Chatterjee, T. T. (2012). Duale Reihe Innere Medizin. Georg Thieme Verlag.

Dignass, A., Preiß, J. C., Aust, D. E., Autschbach, F., Ballauff, A., Barretton, G., ... & Jantschek, G. (2011). Aktualisierte Leitlinie zur Diagnostik und Therapie der Colitis ulcerosa 2011–Ergebnisse einer Evidenzbasierten Konsensuskonferenz. Zeitschrift für Gastroenterologie, 49(09), 1276-1341. https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0031-1281666

Taylor, K., Scruggs, P. W., Balemba, O. B., Wiest, M. M., & Vella, C. A. (2018). Associations between physical activity, resilience, and quality of life in people with inflammatory bowel disease. European journal of applied physiology, 118(4), 829-836. https://link.springer.com/article/10.1007%2Fs00421-018-3817-z

Dr. med. Andre Sommer

Dr. med. Andre Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara.

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