Why Is My Ulcerative Colitis Getting Worse?

When you have ulcerative colitis, it can be hard to predict exactly how you'll feel over the long haul. Usually, you go back and forth between flare-ups and remission. But like any long-term disease, you're bound to see changes.

Flare-ups might take days or weeks. Remission might last for months or even years. You may go from a mild flare-up to a severe one and back again. Or, it may get more advanced and spread to other parts of your colon.  

Two main things affect how you feel: where you get inflammation and how severe it is.

There are lots of ways it might seem to be getting worse. And it's different in everyone who has it. So you should work closely with your doctor to understand what any changes mean for you.

What to Look For

The key is to pay attention to your specific symptoms. The more you're aware of them, the better able you are to spot changes.

And there are lots of ways your symptoms can change. You might get new ones. Or the ones you have may get worse, last longer, or come on more often.

Usually, a flare-up brings at least:

  • An urgent need to poop
  • Blood or mucus in your stool
  • Cramps in your lower belly

If it spreads to more areas of the colon, everything gets more intense. You have more diarrhea. Cramps get more severe. You have more mucus, pus, and blood in your stool. Pain in your belly gets worse and more widespread, especially up the left side. It can also affect your desire to eat and cause you to lose weight.

And some of those symptoms may just be signs of a stronger flare-up. You'll need to see your doctor to find out for sure.

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What Makes It Worse?

The reasons why aren't totally clear. Doctors don't know why it affects only a small section in one person, but spreads through the entire colon in another. But certain triggers sometimes play a role. These include:

Food. It's different for everyone, but certain foods can irritate your symptoms. For example:

  • Caffeine can make severe diarrhea worse
  • Dairy may lead to more diarrhea, gas, and pain
  • Fizzy drinks can be a problem if you have gas
  • Greasy and fried foods often lead to gas and diarrhea
  • High-fiber foods, such as fresh fruits and veggies, whole grains, corn, nuts, and seeds, can be hard on you
  • Spicy foods can be tough to handle

Stress. It can trigger flare-ups and make your symptoms much harder to deal with. It's especially challenging because just having ulcerative colitis can bring on more of it.

Skipping meds. Even when you're in remission, it's very important to take your meds. In the best case, they prevent flare-ups. And even if not, they can help keep things under control.

Next Steps

If you think your symptoms are getting worse, call your doctor. Even if they're the same, but they've come back after a remission, it's best to check in. To figure out what to do next, your doctor will look at your history, treatments you're on now, and what your symptoms are like.

You may need to:

Get tests done. You might have to get:

  • Blood tests to look for signs of inflammation or anemia, a condition where you don't have enough red blood cells
  • Colonoscopy to look at your entire colon
  • Sigmoidoscopy to look at just the lower part of your colon

Keep a food diary. Your doctor might suggest that for several weeks, you write down everything you eat and how you felt afterward. Then you can see if any specific foods cause you problems.

If it looks like they do, talk to your doctor about how to take them out of your diet. You want to make sure that as you remove foods, you still get all the nutrients you need.

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Learn new ways to manage stress. Your doctor may also talk to you about how you can better keep your stress in check. You have lots of choices, such as exercise, meditation, relaxation techniques, breathing exercises, and counseling. Try some to see which ones work best for you.

Change your medicine. This could mean a new dose or a change in how often you take it. You might also need a different medicine altogether. Your doctor can check on what you've tried and what else might help.

WebMD Medical Reference Reviewed by Neha Pathak, MD on October 17, 2018

Sources

SOURCES:

The Lancet: “Ulcerative Colitis.”

Crohn's and Colitis Foundation of America: “Living with Ulcerative Colitis,” “Facts About Inflammatory Bowel Diseases.”

Merck Manual, Consumer Version: “Ulcerative Colitis.”

Harvard Health Publishing, Harvard Medical School: “Ulcerative Colitis.”

Victoria State Government, Better Health Channel: “Crohn's Disease and Ulcerative Colitis.”

Crohn's and Colitis UK: “My Crohn's and Colitis Care,” “Staying Well with IBD.”

British Society of Gastroenterology: “Ulcerative Colitis.”

Mayo Clinic: “Ulcerative Colitis.”

National Health Service: “Ulcerative Colitis.”

UC San Diego Health: “Inflammatory Bowel Disease Treatment.”

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