Take Control of Ulcerative Colitis Flares

From the WebMD Archives

An important part of your ulcerative colitis (UC) treatment is to beat back flares when they happen. The right diet and keeping up with your medicine are key ways you can calm your symptoms down.

Stay on Your Meds

Many people with UC take low doses of drugs such as 5-ASA, which eases inflammation in the intestines. Others may use medications such as azathioprine, 6-MP, and methotrexate, which turn down an overactive immune system -- your body's defense against germs.

It can be easy to forget to take these medicines when you feel good. But doctors say don't miss a dose. That can cause a flare.

Watch for Triggers

If you've figured out what foods make you feel bad, you should stay away from those, says Roberta Muldoon, MD, an assistant professor of surgery in the Division of General/Colorectal Surgery at Vanderbilt University Medical Center in Nashville.

Other UC triggers include stress, an infection, and antibiotics. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen, can set a flare off, too.

Be Ready, Let Your Doctor Know

For some people, flares mean mild diarrhea and bloating from time to time. For others, they can be very uncomfortable, with urgent bowel movements, bloody diarrhea, belly pain, and even nausea and fever.

If the problem doesn't clear up in 48 hours, call your doctor, says Thomas Cataldo, MD, staff surgeon in colon and rectal surgery at Beth Israel Deaconess Medical Center in Boston.

"Many gastroenterologists try to establish a collaborative plan with their patients who have UC, so that when flares start, the patient knows exactly what to do," he says. "That said, though, every flare is unique, and doctor and patient should talk, if not have a visit."

Once you've zeroed in on the cause, your doctor can adjust your medicines. You might need a larger dose or a new drug. Corticosteroids such as prednisone control inflammation. But because they have some unpleasant side effects and can cause long-term health issues, you shouldn't take them for very long, he says. They're just to get you through a flare.

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Don't Self-Medicate

Unless your doctor has OK'd it ahead of time, don't pick and choose your own treatment, Cataldo says.

"People with UC may have leftover prednisone from a previous flare, or they may have steroid enemas still in the closet," he says. "Maybe they helped last time. But by now, all of this could have expired, or maybe those therapies wouldn't be appropriate for this particular flare. Wait to talk to your doctor."

Keep Eating

Don't stop eating altogether when your symptoms get worse, Cataldo says.

"A lot of patients do this, thinking it will stop the flare," he says. "But instead, it can lead to malnourishment and dehydration -- and people in the middle of a flare are already at risk for dehydration."

Instead, avoid a possible trigger food for a short time to see if you feel better. Dairy, for example, is a common troublemaker. Muldoon also suggests staying away from items like salad, vegetables, brown rice, bran, popcorn, beans, seeds, nuts, and fruits.

Surgery Is an Option

Doctors suggest it for some people with UC, because long-term inflammatory bowel disease can raise your odds of having colon cancer. It can also be an option, though, if you've had the disease a long time and your flares are so severe that drugs no longer control them.

Surgery for UC usually means doctors remove most of the large intestine (the colon and rectum). Once those parts are gone, so are the pain, inflammation, cancer risk, and constant urges to go to the bathroom that are part of a UC flare. You'll still need to go eight to 10 times a day, Muldoon says, but that's an improvement on 20 to 30 times.

"People who get this surgery are so happy to get their life back," she says.

But not everyone needs an operation to keep UC in check. Talk to your doctor about whether it's right for you.

WebMD Feature Reviewed by Jennifer Robinson, MD on November 10, 2014

Sources

SOURCES:

CDC: "Inflammatory Bowel Disease."

Leyla J. Ghazi, assistant professor of medicine, and gastroenterologist specializing in inflammatory bowel disease, University of Maryland School of Medicine, Baltimore.

Thomas Cataldo, MD, visiting assistant professor of surgery, Harvard Medical School; staff surgeon in colon and rectal surgery, Beth Israel Deaconess Medical Center, Boston.

Roberta Muldoon, assistant professor of surgery in the Division of General/Colorectal Surgery, Vanderbilt University Medical Center, Nashville.

American Society of Colon and Rectal Surgeons: "Ulcerative Colitis."

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