Most people with ulcerative colitis go through periods when the symptoms are active, which is known as a flare, and periods when the symptoms disappear, which is known as remission.
The most important part of treatment for ulcerative colitis is managing and easing the symptoms of flares while increasing the length of remissions.
Symptoms of ulcerative colitis may include fever, tiredness, and pain in the belly.
The exact causes of ulcerative colitis and its flares are still unknown.
Instead, researchers are focusing on the immune system's response or overreaction as the most likely cause.
A family history of the disease can also be a predictor of who will develop ulcerative colitis.
Ulcerative colitis flares have no known cause. Treatment focuses on reducing the number of flares that a person experiences.
Despite diet changes being one of the main focuses of treatment to avoid flares, researchers have found no evidence of food causing flares.
Ulcerative colitis is a type of inflammatory bowel disease and affects the lower parts of the digestive tract. It usually starts in the rectum, moves to the anus, and may eventually move to other parts of the colon.
Unlike other inflammatory bowel diseases, ulcerative colitis will stay in the lower section of the digestive tract.
Ulcerative colitis has a variety of potential symptoms, which become more severe during a flare-up. The combination of symptoms will vary. Some people may experience mild symptoms, while others experience more serious ones.
Ulcerative colitis symptoms include:
- pain in the belly
- urgent, painful bowel movements
- bloody bowel movements
- diarrhea, often including pus
Certain foods and drinks may make symptoms during an ulcerative colitis flare worse. People with ulcerative colitis should be aware of what foods make them feel worse during flares and avoid these foods both during and between flares.
Tips for reducing flares
A large part of treating ulcerative colitis is preventing and controlling flares.
Preventing flares involves a variety of steps and measures. Some of the most common steps to preventing flares are described below.
Writing a diet plan may help with preventing and managing flares.
Diet plans are a crucial part of preventing as well as managing flares when they happen.
Diets should contain foods that a person knows will not cause them to either experience the symptoms of a flare or make an active flare worse.
People can develop personal diet plans, but a doctor or dietitian can help balance the diet and recommend what foods to include or exclude.
In addition to following a diet plan, a person should keep a food journal.
Keeping track of all the foods a person eats can help them work out what foods are safe for them to eat and what foods might trigger a flare.
As with many other diseases, managing stress is an important part of any prevention plan. Stress may trigger flares in a person.
People can manage stress in different ways, including exercise, therapy, and taking the time to relax.
A doctor can prescribe a variety of different medications to treat bowel inflammation. Some of the most common ones include:
- 5-aminosalicylic acid (5-ASA): This is a standard treatment for ulcerative colitis. The main forms include mesalamine, balsalazide, and sulfasalazine. These drugs are often in pill form but may also be suppositories. Doctors can prescribe a sulfa-free form of the drug for people allergic to sulfa.
- Corticosteroids: These have an anti-inflammatory effect. A doctor may prescribe them, usually for a short period, for more advanced cases of ulcerative colitis, or if other medications are not working. These drugs may have side effects and long-term complications.
- Immunosuppressants: A doctor may recommend these if 5-ASA or corticosteroids are not effective. Immunosuppressants help stop the immune system from overreacting. However, taking these can increase the risk of other infections.
- Biologics: These include the anti-tumor necrosis factor (TNF) agents infliximab (Remicade), adalimumab (Humira), and golimumab (Simponi). They can help to bring on remission. Another biologic option is vedolizumab (Entyvio), which targets the gut mucosal immune system.
- New drug class option: Xeljanz is a Janus kinase (JAK) inhibitor. The Food and Drug Administration (FDA) have approved a dose of 5 or 10 milligrams (mg) twice a day. Adverse effects include diarrhea, high cholesterol levels, shingles, and a higher risk of an upper respiratory tract infection, among others.
The medications that a person is prescribed will depend on how the flare presents and what triggered it.
A doctor may suggest surgery if diet and medication are not working or further complications have occurred. Surgery is usually a last resort, but there are several options available.
- Surgical removal of the person's colon, rectum, and anus. After removing these organs, the surgeon makes an opening in the abdomen and passes part of the small intestine out through the opening, forming a stoma. People who undergo this surgery will have to wear an external "ostomy" bag over the stoma to collect waste products.
- The surgeon leaves part of the rectum and anus intact. This means that people can have bowel movements as before. However, those who opt for this type of surgery may still experience recurrent episodes of ulcerative colitis.
- The surgeon creates a new rectum from the small intestine, which is then attached to the anus. It works in a similar way to the removed colon and allows people to use the bathroom, rather than wearing a bag. They will need to wear a temporary bag while the new rectum heals, however. This surgical option also means the person may continue to experience ulcerative colitis.
When to see a doctor
Ulcerative colitis may be diagnosed after looking at family history, symptoms experienced, and a colonoscopy.
A person should see a doctor when they first suspect that something is wrong. Persistent diarrhea lasting longer than 48 hours signifies something worse than a typical bug.
As symptoms of ulcerative colitis often are similar to other chronic bowel diseases, such as irritable bowel disease, a doctor will need to make sure the symptoms are not due to a different problem.
Typically, a doctor will diagnose ulcerative colitis by looking at a person's family history and the symptoms experienced.
They will likely undertake a physical exam that may include a colonoscopy. A colonoscopy is a procedure where a doctor looks at the inside of the colon using a thin, flexible tube with a camera attached.
After diagnosing ulcerative colitis, a doctor should give the person a clear plan of action, outlining what they should do when a flare occurs. A doctor will also provide information on how to manage ulcerative colitis, including foods to avoid.
When a person experiences a flare, they do not necessarily need to see a doctor as long as a plan is in place. However, if the plan is not working or symptoms are worse than normal or not improving, it is a good idea to see a doctor.
Managing a flare
Managing ulcerative colitis flares is a similar process to preventing them.
When a person experiences a flare of ulcerative colitis, they should continue to take their medications as the doctor prescribes. People should also avoid any foods that are known triggers, as they will make flares feel much worse.
People who have ulcerative colitis should also have a plan in place so that they know what to do when they experience a flare.
A flare plan should include:
- a list of safe foods
- a list of foods to avoid
- safe medications to take to manage pain, nausea, and diarrhea
- when to call the doctor