Managing UC Flares: Here’s What Works
Oh, that familiar feeling … It’s your ulcerative colitis (UC) acting up. The symptoms are numerous—frequent and/or urgent bowel movement, diarrhea, blood in your stool, abdominal pain, nausea and vomiting, weight loss—and while they can vary, they amount to the same thing: You’re in a flare. Maybe you’ve been in remission for a while, (or not), but UC symptoms are never fun no matter when they happen. We asked the experts what you can do to manage (or even help prevent) a flare with UC. Here’s what they said.
Take Your UC Meds!
The best way to help a flare is to never have one. How can you prevent them—or help ease the symptoms of one already in progress? “Do not stop your medication or [withhold] it for extended time,” says Ashkan Farhadi, M.D., a gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, CA. Even if you’re not having symptoms, you still need to take it to keep the condition at bay. Life happens, though, so if you miss a dose or, say, you’re on vacation and forget it, take it as soon as you can, Dr. Farhadi says.
Make Less Stress a Priority
Another way to help prevent a flare or intercept one that’s already begun? Destress. “There’s a lot of research on the role of stress in this condition,” Dr. Farhadi says. Like a recent study in Frontiers in Pediatrics where researchers found that stress might promote relapses in inflammatory bowel disease (IBD). “In a stressful moment, have in mind that all measures to manage stress are very important,” he says. He recommends finding your own best way to manage stress. The next slides offer a few options to try.
Do Gentle Exercise
“Exercise is the best stress diffuser. So for all my patients, I advise that you have a regular schedule for exercise,” Dr. Farhadi says. Low-impact exercise gets your heart pumping without stressing your joints or risking injury, says the Crohn’s & Colitis Foundation. Swimming, yoga, elliptical, and rowing, are solid gym options. Dr. Farhadi recommends a brisk walk for at least 30 minutes without distractions (this is not the time to pull out your phone). Walk as fast as you can. “That’s the walk that calms your system and improves … blood flow. So basically, you reboot your mind,” he says.
Getting good shuteye is another way to help your body prevent or soothe a UC flare, according to Dr. Farhadi. “A lot of studies show that sleep is really important in this condition,” he explains. One of those, recently published in Scientific Reports, says that sleep quality in IBD patients is associated with mood, disability, and quality of life. It’s also been investigated as a possible marker of subclinical inflammation, which might be contributing to UC. Learn to practice good sleep hygiene: Get up/go to bed the same time each day. “Have a regular schedule and stick to it,” he says. You can deviate from it occasionally, but try not to, too often.
Understand That Flares Happen
UC flare prevention didn’t work? That happens, says Rudolph A. Bedford, M.D., a gastroenterologist at Providence Saint John’s Health Center in Santa Monica, CA. “Sometimes, quite frankly, you’re going to flare no matter what we do, and no matter what’s happening,” he points out. UC is an autoimmune disease, meaning the body’s immune system is attacking the large intestine. We don’t know all the reasons why this happens, so sometimes flares can surprise us at any time, for seemingly no cause. Making peace with this can be helpful, as well as being proactive about seeking treatment to relieve symptoms.
Talk to Your Doctor ASAP
Here’s the thing—UC treatment for mild disease is typically oral medication and for moderate to severe disease, often biologics. But medications can stop working for many reasons, says Andrew Boxer, M.D., a gastroenterologist at Jersey City Medical Center - RWJBarnabas Health Medical Group, Jersey City, NJ. Or you might have an infection. Both scenarios can cause a UC flare. So it’s key that you tell your doctor as soon as you experience symptoms, he says. “If a flare is caught early, treatment may help stop the flare,” Dr. Boxer explains.
Know What Comes Next
Once you tell your doctor about symptoms, they might have you do blood work, stool testing, colonoscopy/upper endoscopy, computerized tomography (CT) scan, magnetic resonance image (MRI), or X-ray, all to determine what is happening. Flares are typically managed, short-term, with steroids, says Dr. Bedford. If the flare is severe, you might need a hospital stay with biologic treatment. And/or it might be time to consider medication(s) for long-term treatment, according to Dr. Boxer. “Often for moderate or severe disease, if a patient is having a flare, we think about changing biologic medicines and often the class of biologic medicine the patient takes.”
Eat What Works for You
Avoiding dairy products and fiber during a flare just might bring relief, Dr. Bedford says. In addition, a low-residue diet can sometimes assist. This means eating more refined grain products like white breads, cereals, and some pastas; mashed potatoes; and apple sauce while avoiding foods like whole grain breads, whole grain cereals, and whole grain pastas. It also means no fresh fruits or vegetables (especially broccoli, cauliflower, and Brussels sprouts), Dr. Boxer points out. “I always tell patients, if you would normally see a portion of this food in your stool, stay away from it during a flare.”
Consider a Probiotic
Some research indicates that probiotics may help mitigate a flare—or help prevent one. An analysis of published studies in Medicine (Baltimore) found that the probiotic types Escherichia coli Nissle 1917 and VSL#3 could be used as alternative therapy for IBD. VSL#3 can be effective in people who've had a pouch surgery, or for those with mild to moderate disease. The jury’s still out on how much probiotics can help, but it doesn’t appear that taking them hurts, Dr. Bedford says. Dr. Boxer recommends probiotics to his patients. “I usually advise patients to use an over-the-counter, big brand probiotic. Don’t use an odd expensive one from the internet,” he says.
Do Downward Dog (or Other Yoga Poses)
Yoga can also be a helpful tool during a UC flare, says Dr. Bedford. Low-impact yoga styles combine the stress relief of meditation and healing power of exercise with gentle movement. And the calming energy can help relax you. One recent study even found that UC patients who did 12 weeks of traditional Hatha yoga had significantly higher health-related quality of life scores and lower disease activity at 24 weeks than those in an inactive control group. All the more reason to roll out the mat and do a sun salutation.
- Stress and UC: Frontiers in Pediatrics. (2019.) “Stress Triggers Flare of Inflammatory Bowel Disease in Children and Adults.” ncbi.nlm.nih.gov/pmc/articles/PMC6821654/
- Exercise and UC: BioMed Research International. (2014.) “The Role of Physical Exercise in Inflammatory Bowel Disease.” ncbi.nlm.nih.gov/pmc/articles/PMC4022156/
- Sleep and UC: Scientific Reports. (2020.) “Sleep disturbance in Inflammatory Bowel Disease: prevalence and risk factors – A cross-sectional study.” ncbi.nlm.nih.gov/pmc/articles/PMC6965196/
- Managing UC: Crohn’s & Colitis Foundation. (2019.) “Managing Flares and IBD Symptoms.” crohnscolitisfoundation.org/sites/default/files/2019-07/managing-flares-brochure-final-online.pdf
- Food and UC: Gastrointestinal Society/Canadian Society of Intestinal Research. (2020.) “Low Residue Diet.” badgut.org/information-centre/health-nutrition/low-residue-diet/
- Probiotics and UC: Medicine (Baltimore). (2018.) “The clinical effects of probiotics for inflammatory bowel disease: A meta-analysis.” ncbi.nlm.nih.gov/pmc/articles/PMC6319782/
- Yoga and UC: Nutrition and Metabolic Insights. (2019.) “The Synergistic Role of Diet and Exercise in the Prevention, Pathogenesis, and Management of Ulcerative Colitis: An Underlying Metabolic Mechanism.” ncbi.nlm.nih.gov/pmc/articles/PMC6425530/