Digestive Disorders > IBD > Ulcerative Colitis

Ulcerative Colitis Flare-Ups: 7 Essential Questions

Elizabeth Oliver, PhD

Elizabeth Oliver, PhD

Ulcerative colitis is a chronic inflammatory bowel disease (IBD). It causes inflammation and ulcers in the large intestine (colon).

For most people ulcerative colitis follows a relapsing and remitting course. This means there will be periods of active symptoms (flare-ups) followed by times of fewer symptoms or even no symptoms at all (remission).

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

Unfortunately, yes. Ulcerative colitis is a chronic condition. Medications and lifestyle changes can help reduce the intensity and frequency of ulcerative colitis flare-ups, but not stop them completely.

Regular flare-ups may indicate a problem with your current treatment. If you are taking your medications as prescribed and still experiencing flare-ups, you should contact your physician who may adjust your medication or suggest other treatment options.

Ulcerative colitis flare-ups during pregnancy

Generally, women are recommended to wait until their ulcerative colitis has been in remission for at least 3 months before becoming pregnant.

The risk of a flare-up during pregnancy depends on the symptoms you are experiencing when you conceive. Around two-thirds of women who conceive during remission will stay in remission, while women who conceive with active symptoms are likely to have continued or worsening symptoms during pregnancy.

Women with ulcerative colitis may have a higher chance of complications during pregnancy than those without the condition. This depends on how active the ulcerative symptoms are and how the symptoms are managed during pregnancy.

It is important to talk to your doctor about any possible changes that may need to be made to your treatment plan while pregnant.

2. How do I know if I’m having an ulcerative colitis flare-up?

Ulcerative colitis symptoms vary depending on the severity of the flare-up and the location of the inflammation in the intestine. Common symptoms can include:

  • Diarrhea containing blood and mucus
  • Frequent and/or urgent bowel movements
  • Abdominal pain
  • Weight loss
  • Fever

3. How long does an ulcerative colitis flare-up last?

The length of a flare-up can vary, lasting for days or weeks at a time. Flare-ups can occur weeks, months, or even years apart.

Your physician will work with you to treat your flare-up and help bring your ulcerative colitis back under control.

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4. How severe can an ulcerative colitis flare-up be?

The severity of flare-ups vary from person to person. Flare-ups can be categorised according to the following criteria:

Mild Moderate Severe
Bloody diarrhea < 4 per day 4-6 per day > 6 per day
Temperature < 37° C / 98.6° F up to 38° C / 100.4° F > 38° C / 100.4° F
Pulse < 100 / min < 100 / min > 100 / min
Anemia no mild yes

Fig. _1. Classification of the severity of ulcerative colitis flare-ups_

5. What triggers an ulcerative colitis flare-up?

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. (We produce a tracking app for this purpose called Cara Care.) 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 (NSAIDs) 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.

6. What should I eat during an ulcerative colitis flare-up?

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 (sugar found in milk, yogurt, and cheese)
  • 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. (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

Elizabeth Oliver, PhD

Elizabeth Oliver, PhD

Elizabeth Oliver is a researcher and freelance writer with a passion for health sciences. She completed her degree in pharmacology at the University of Edinburgh and PhD in reproductive health at Imperial College London. She currently works as a researcher at the Karolinska Institutet Stockholm.

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