Getting Out of a UC Flare: 13 Tips to Get Ready and Get Through It

If you're newly diagnosed with ulcerative colitis (UC), you may be worried about a flare that could be lurking around the corner. Flares – periods that last from a few days to a few months when symptoms return after a remission – will come, but with preparation and swift action, you can ease your symptoms. 

Here’s what you need to know to be ready.

The most common signs of a UC flare happen in your gut and include:

• Diarrhea
• Frequent or urgent bowel movements (poop)
• Loose, bloody, or mucus-containing stool (poop)
• Nausea, vomiting, loss of appetite
• Rectal/anal bleeding
• Stomach pain or cramping
• Weight loss

You may also notice sounds outside the gut, such as:

• Fatigue
• Fever
• Muscle and joint pain

A UC action plan is a color-coded form you fill out with your doctor that reminds you what to do when you're doing well (green), showing signs of a flare (yellow), or in a severe flare (red). The Gastrointestinal Society offers an action plan form that you can print and bring to your next doctor's appointment. 

When you're brand new to UC, it can be hard to predict a flare. It's a good idea to be prepared for one at any time. Stash a bag in your car or office that contains a change of clothes and underwear, toilet paper, wet wipes, a large sealable bag for packing away soiled clothes, and anything else you may need in case of emergency.

Make sure you always have these items on hand:

• Your medications
• Over-the-counter pain medications approved by your doctor
• Medicinal mouthwash for mouth sores that can develop in a flare
• Wet wipes
• Anal cleanser
• Bland foods, either frozen or non-perishable
• Oral rehydration drinks

You may still be learning which foods trigger your symptoms. They are different for everyone. You'll certainly want to avoid those foods during a flare, but you should be even more careful. Go for bland, low-fiber foods. They'll be easiest on your colon. These include:

• Canned or soft fruits, like banana, melon, and applesauce
• Well-cooked vegetables without skins or seeds
• Simple carbs like white rice, bread, pasta, and saltines
• Tender, lean protein like fish, chicken, eggs, and tofu
• Broth

More frequent, small meals will also be easier on your gut than three larger ones. But don't skip meals completely. Your body needs fuel during this time. Plan to eat four to six small meals throughout the day, even if you don't feel like eating.

Diarrhea and frequent bowel movements can dehydrate the body fast, causing you to lose water and critical electrolytes. Water alone won’t replace the sugar, salt, and electrolytes you lose. Consider oral rehydration beverages, such as Pedialyte or DripDrop, a powder that you mix with water. 

If you have an action plan created with your health care provider, take your medication as instructed. If you don't have a plan yet, call your doctor to find out whether you should increase your dose or try something else. 

Diarrhea, frequent bowel movements, and anal fissures or fistulas can cause pain, soreness, and irritation. Take these steps to keep discomfort at bay:

• Shower with a hand shower, so you can clean the anal area well, or use a perianal cleanser.
• Use wet wipes rather than toilet paper.
• Apply a skin protectant to the anus, such as vitamin A&D ointment or diaper rash cream, at night.
• Bathe in warm salt water or use a sitz bath if you have anal fissures or a fistula.

Some UC flares come with joint pain. You can manage it with:

• Moist heat
• Resting the affected joint
• Gentle range-of-motion exercises 
• Acetaminophen (Tylenol) is usually a safer choice for pain during a flare-up than nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, which can worsen bowel inflammation. Always check with your doctor before taking any medication.

Some people get small mouth ulcers, also called canker sores, during a flare because of nutrient deficiencies. You might help make them better with:

• Medicinal mouthwash recommended by your doctor
• A well-balanced diet
• A multivitamin supplement

Most IBD experts say that acetaminophen is the safest, most effective over-the-counter painkiller to use during a flare. Make sure your doctor agrees, or get other recommendations for flare-related pain. 

Stay in touch with your care team throughout a flare to make sure it's OK to keep managing yourself at home. They may recommend that you go to the emergency room if you have:

• Heavy, persistent diarrhea
• Rectal bleeding with blood clots
• Constant pain and a high fever

UC flares can be unpredictable – both in terms of when they'll happen and what symptoms they'll bring – especially when you're new to this condition. With time, you'll get better at predicting, preventing, and managing them – while continuing to live a full life.