Ulcerative colitis (UC) is a disease that can be managed, but there isn’t a cure. Symptoms come and go, change, and can get worse over time. Your doctor will work with you to find a treatment that controls your symptoms and helps managing ulcerative colitis.
When you go a while without symptoms, that’s called remission. When they quickly get worse again, that’s called a flare-up. For most people with UC, flare-ups are a fact of life. But you can do things to make them easier to deal with.
Some people experience periods of remission where symptoms disappear completely. This can last for days, weeks, months, or years. However, remission isn’t always permanent.
Many people experience occasional flare-ups, which means that their UC symptoms return. The length of a flare-up varies. The severity of flare-ups can also vary from person to person.
Although symptoms can become active at any time, it’s possible to lengthen the time in between flare-ups.
Managing Ulcerative Colitis
How To Stop A Flare-Up
What is a Flare?
When you have ulcerative colitis, your physician will try to find the right medications to control your symptoms. However, since there is no cure, the systemic disease is always there. When the symptoms aren’t present, you are in remission. If the symptoms return, especially if they are worse than before, it is a flare. This is why it is important to continue taking any medications your doctor prescribes, even if you feel better. If you stop taking your medication, then you can increase your chance of experiencing a flare and progression of the disease. Infections, stress, and taking antibiotics or NSAIDs (including aspirin and ibuprofen) can also make you more susceptible to a flare.
The only way to prevent UC flare-ups is to have surgery. The most common type of UC surgery is the proctocolectomy, which involves the removal of the rectum and colon.
Candidates for UC surgery include people who:
- have sudden or severe disease
- have a perforated colon
- are at risk for colorectal cancer
- are unable to tolerate their UC medications due to side effects
- have stopped responding to their UC medications
Keep a food journal
Write down everything you eat and drink to identify items that may trigger your flare-ups.
Once you notice a pattern, remove suspected problem foods or beverages from your diet for a few days to see if your symptoms improve. Dairy is a common culprit.
Next, slowly reintroduce these foods back into your diet. If you have another flare-up, eliminate these foods from your diet altogether.
Limit your fiber intake
Fiber contributes to bowel regularity and bowel health, but too much fiber can also trigger UC flare-ups.
Try to stick to foods that have no more than 2 grams of fiber per serving. Low fiber foods include:
- refined carbohydrates such as white rice, white pasta, and white bread
- fish
- cooked meats
- eggs
- tofu
- butter
- some cooked fruits (no skin or seeds)
- juice with no pulp
Instead of eating raw vegetables, steam, bake, or roast your vegetables. Cooking vegetables results in some fiber loss.
Eat smaller meals
If you have abdominal pain or diarrhea after eating three large meals a day, scale back to five or six small meals a day to see if your symptoms improve.
Exercise
Exercise can boost your mood, ease stress, and improve anxiety and depression associated with UC. Physical activity can also suppress inflammation in the body and help you feel better.
Find what type of exercise works best for you. Even incorporating low-intensity exercises such as swimming, biking, yoga, and walking can help.
Work With Your Doctor
You’ll need to see your doctor regularly. It may be every 6 months while you’re in remission. You’ll have routine procedures like colonoscopies and bloodwork to check on your UC.
If you’re having a flare-up, make sure to check in with your doctor. UC isn’t the only thing that causes digestive symptoms. They may need tests to rule out something else, like an infection. Or you may need your prescriptions adjusted.
Dietary and Lifestyle Modifications
As most nutrients are absorbed higher up in the digestive tract, those with ulcerative colitis generally do not have nutrient deficiencies; however, other factors might influence your nutritional state. Disease symptoms may cause food avoidance, leading to food choices that might not provide a balanced diet. If bleeding is excessive, problems such as anemia may occur, and modifications to the diet will be necessary to compensate for this.
Generally, better overall nutrition provides the body with the means to heal itself, but research and clinical experience show that diet changes alone cannot manage this disease. Depending on the extent and location of inflammation, you may have to follow a special diet, including supplementation. It is important to follow Canada’s Food Guide, but this is not always easy for individuals with ulcerative colitis. We encourage you to consult a registered dietitian, who can help set up an effective, personalized nutrition plan by addressing disease-specific deficiencies and your sensitive digestive tract. Some foods may irritate the bowel and increase symptoms even though they do not worsen the disease.
In more severe cases, it might be necessary to allow the bowel time to rest and heal. Specialized diets, easy to digest meal substitutes (elemental formulations), and fasting with intravenous feeding (total parenteral nutrition) can achieve incremental degrees of bowel rest.
Manage Your Stress
It’s stressful to live with a disease like UC. Stress may not bring on a flare, but it does make digestive symptoms worse. Along with exercise, some things you can do to lower your stress include:
- Meditation
- Biofeedback
- Yoga or tai chi
- Relaxation and breathing exercises
What Can I Do to Prevent Ulcerative Colitis?
Experts don’t know what causes ulcerative colitis. They also don’t know how to prevent the disease.
But good nutrition can play an important role in managing the disease. Changes in diet can help reduce symptoms. Some of the dietary changes that may be advised include:
- Not drinking carbonated drinks
- Not eating high-fiber foods such as popcorn, vegetable skins, and nuts while you have symptoms
- Drinking more liquids
- Eating more frequent, smaller meals
- Keeping a food diary that identifies foods that cause symptoms
Nutritional supplements and vitamins may be advised if nutrients are not being absorbed. If you use complementary or alternative therapies, including dietary supplements and probiotics, it is important to let your healthcare provider know. This is important for ensuring safe care.
Ulcerative colitis requires long-term management. It can cause great physical, financial, and emotional stress to both the person and his or her family. If you or your family members are having trouble coping with this disease, ask your provider for resources. Resources can include mental health counselors or local and online support groups.
Prevention Through Medication
Medication as a prevention method to the effects of ulcerative colitis includes using anti-inflammatories, steroids and immunosuppressants. Anti-inflammatory drugs reduce the inflammation caused by several bowel diseases, and are therefore the first drug that doctors tend to prescribe to patients with ulcerative colitis. Sulfasalazine, mesalamine, balsalazide, and olsalazine are just some of the most common anti-inflammatory drugs people with ulcerative colitis could be given. These can be taken orally, as an enema, or as a suppository to help relieve pain caused by mild ulcerative colitis.
There is no sure way of preventing ulcerative colitis since its cause is still unknown. You can, however, decrease both the frequency and intensity of ulcerative colitis through various methods.
If these anti-inflammatory drugs do not help, or if your case of ulcerative colitis is more severe, steroids may be the next best medication to use. Corticosteroids decrease inflammation in a patient’s large intestine as well, but are much stronger and should therefore be taken with caution.
Immunosuppressants are prescribed to patients who are still not responding to previously mentioned medication. These drugs work by suppressing the patient’s immune system, which in turn cease inflammation caused by ulcerative colitis. Azathioprine is a commonly used immunosuppressants because it causes minimal or next to no side-effects in patients.
Prevention by Lifestyle Adjustments
Ulcerative colitis can also be prevented by medication-free ways. Following a strict ulcerative colitis diet plan, for example, can reduce the frequency of painful experiences dealing with this disease.
Proper hydration also helps prevent ulcerative colitis. You should try to drink a lot of water every day, and avoid drinks such as coffee, alcohol and carbonated beverages, which may make your diarrhea worse.
Individuals with ulcerative colitis, or any inflammatory bowel disease for that matter, tend to stray from exercising, but this shouldn’t be the case. Exercising can help control your ulcerative colitis symptoms and avoid diarrhea. Tai chi, yoga, breathing exercises and other simple activities should be done regularly to stay healthy.
Learning how to manage your stress may also help alleviate the signs and symptoms ulcerative colitis may bring about. A lot of stress may cause your regular digestive process to change, causing the stomach to produce more acids and empty at a slower pace. Some ways to reduce or control stress may be through exercises, relaxation and simple activities you could do any day, like listening to soothing music or reading a good book.
Prevention Through Probiotics
You may have already heard the term probiotics in finding out about methods of prevention of ulcerative colitis. This refers to the live bacteria you can easily find in yogurt, miso soup, tempeh and sauerkraut that may provide health benefits to the consumer. The theory behind the use of probiotics in treating ulcerative colitis is that the ‘good bacteria’ found in the stated food products prevent the ‘bad bacteria’ from sticking to the walls of the large intestine and affecting the quality of life of the patient.
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