Having Crohn’s or colitis often means living with concerns lurking just under the surface
- Will my condition flare up?
- What can I do when it does?
- How will I cope?
These concerns are very common for people with Crohn’s disease and ulcerative colitis, also known as IBD. Even with medical treatment, a person with IBD is likely to experience periods of time when symptoms become active.
When to seek urgent medical care
If your symptoms become severe, such as having heavy bleeding, severe stomach pain, ongoing vomiting, a high fever, or dehydration, contact your healthcare team right away or seek emergency medical care. Getting treatment early may help prevent complications and help you feel better sooner.
What causes IBD flares?
While there is no one cause for flare-ups of IBD symptoms, there are several factors that may impact a flare and/or make symptoms worse.
Many people with IBD take medications on a regular basis, even when the disease is in remission
Flares can occur when medications are not taken as prescribed (for example, skipping doses, weaning off medications without healthcare team guidance). If you are taking your medications as prescribed and still experiencing increased symptoms or a flare, speak with your doctor. They may suggest changing the dose, frequency or type of medication.
If you have missed doses of your medications or have stopped your medications and are now experiencing symptoms, talk with your doctor before restarting or increasing your medications on your own. It’s important to share with your healthcare team why you may have missed doses or stopped taking the medication. By sharing you and your healthcare professional can discuss how to make your treatment work for you in terms of lifestyle, frequency, and cost or medication assistance support.
Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDs, which include aspirin, naproxen (Aleve®), and ibuprofen (Motrin®, Advil®, Nupin®), may lead to inflammation of the bowel and make symptoms worse. Therefore, for mild pain or to reduce a fever, it is generally recommended that people with IBD take acetaminophen (Tylenol®) rather than an NSAID.
If you’re taking an antibiotic and experience a flare of your IBD symptoms, it is important to inform your doctor
Antibiotics are good for treating bacterial infections, but they also alter the bacteria that normally live in the intestine. Changes to the balance of intestinal bacteria may cause diarrhea (for example, antibiotic-associated diarrhea) or may lead to excessive growth of specific bacteria that can cause inflammation.
Smoking cigarettes not only raises the risk for developing Crohn’s disease, it can also trigger flares
People with Crohn’s disease who smoke tend to have more disease activity, need more surgery, and develop a greater need for medications to control their disease. Crohn’s disease patients who have quit smoking report having fewer flare-ups and a reduced need for medications to control their disease.
Surprisingly, the risk of developing ulcerative colitis is decreased in current smokers compared with people who have never smoked. The numerous potential harmful health effects of smoking (e.g., cancer, heart disease) largely out-weigh any benefits of smoking for people with ulcerative colitis.
It is important to understand that physical and emotional stress do not cause IBD
However, stressful situations of strong emotions may impact IBD symptoms. For people with IBD who know that stress can be problematic, it may be helpful to be prepared for this reaction and to learn some stress-management techniques.
No one type of food or beverage aggravates symptoms in all people with IBD
In general, it’s best to avoid greasy and fried foods during a flare. Some people find that foods high in fiber (such as fruits, vegetables and whole grains) can be problematic. Rather than eliminating these necessary foods from your diet, try eating only thoroughly-cooked fruits and vegetables. You may also want to avoid foods that cause gas, such as beans, cabbage, broccoli, caffeine, and carbonated drinks.
Although diet does not cause nor cure IBD, paying attention to your diet may help you reduce symptoms, replace lost nutrients, and promote healing. Each person with IBD will need to determine which foods impact symptoms and which do not. Keeping a food journal may help you track how your diet relates to your symptoms.
What will your doctor do to treat your flare?
Often, the first step is for your doctor to order testing to find out if your flare is due to inflammation in the intestine, or something else (such as infection, scar tissue, or medication side effects). They may also recommend blood work, stool testing, colonoscopy/upper endoscopy, or a CT scan, MRI or x-ray to find out why you have developed new symptoms.
It’s important to discuss your treatment goals, preferences, lifestyle and insurance coverage when considering a medication change. Understanding treatment goals will help you and your healthcare team decide on the best course of treatment. We have resources to help you partner with your healthcare team.
Managing the physical symptoms of IBD flares
When symptoms are flaring, you may experience a variety of uncomfortable or painful symptoms. Here are some tips to help you cope with the discomfort.
Cramping, urgency, and frequent loose stools are often the most disruptive part of a flare
- Smaller, more frequent meals instead of a few large ones give your digestive system less to process at once, which can mean less cramping and urgency after eating
- A warm compress or heating pad on the abdomen can ease cramping before or after bowel movements
- Loose, non-restrictive clothing around the waist while your abdomen is tender or bloated
Extra trips to the bathroom can leave you feeling raw. Small changes can make a difference.
- Alcohol-free, fragrance-free baby wipes or perineal wipes, or a bidet or hand-held bidet sprayer instead of dry toilet tissue is gentler on already-irritated skin
- An all-purpose skin protectant (Vitamin A&D ointment, Desitin, or even diaper rash cream) applied after cleansing in the evening to relieve irritation around the anus.
- Patting dry rather than rubbing, and letting the area air out for a few minutes when you can
- A warm sitz bath (a few inches of warm water in the tub, or a sitz bath basin that fits over the toilet) for 10–15 minutes can soothe soreness
Arthritis, or inflammation (pain with swelling) of the joints, is the most common symptom outside the gut
- Experts recommend acetaminophen (Tylenol) as the safest pain management options for IBD patients
- Consult your physician before starting medication; they will help you determine which treatments fit best with your individual treatment plan
- Warm compresses or a heating pad on stiff or aching joints, especially first thing in the morning
- Gentle range-of-motion movement rather than total bed rest, which can exacerbate feelings of stiffness
Fatigue is one of the most frequently reported concerns of IBD patients
- Pace yourself, spreading tasks across a day (or a week) instead of powering through in one burst tends to leave more in reserve for the following day
- Prioritize tasks during flares: decide what actually needs to happen versus what can wait, and let the rest go without guilt
- Taking short breaks before you're depleted are more effective than pushing until you crash. Rest proactively, not just when you hit a wall
- Ask your provider about anemia. Iron deficiency is common in IBD and is a very treatable contributor to fatigue that's easy to miss if it's never been checked
During a flare, you can lose fluids and electrolytes faster than plain water alone replaces them
- Sip steadily through the day rather than trying to catch up with a large amount at once, which the gut may not tolerate well mid-flare
- Oral rehydration solutions replace electrolytes more effectively than water alone during heavier fluid loss
- Broths and soups add fluid, sodium, and a bit of easy nutrition at the same time
- Limit caffeine and alcohol during a flares, as both can act as diuretics and may irritate the digestive system
Managing your mental health during a flare
Living with a chronic, unpredictable, and often invisible illness takes a real emotional toll, and anxiety or low mood are common companions to a flare. If low mood, anxiety, or fear about your body's unpredictability is affecting daily life, that's worth talking to your care team specifically. Mental health support during a flare is part of treating the whole condition, not a separate issue.
Tips for coping with IBD flares
Difficulties may arise in your personal relationships, work, ability to travel, or sense of independence. It’s not uncommon to feel angry, fearful, uncertain, or anxious. You may wonder how your body can betray you by making you lose control over a basic function such as a bowel movement. You may feel embarrassment, or become apprehensive about leaving home. It’s important
not to let your fears and worries overtake your life.
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