What to do if you have an inflammatory bowel disease flare Inflammatory bowel disease, or IBD, primarily consists of two conditions: Crohn’s disease and ulcerative colitis. These diseases are similar but distinct. In Crohn’s disease, inflammation can affect any part of the digestive tract whereas in ulcerative colitis, inflammation affects just the inner lining of the colon. If you have IBD, your treatment goal is likely to go into remission, which occurs when the medications you take address the underlying inflammation and control your symptoms.

However, there is no guarantee that you will remain in remission. If you experience a new onset of symptoms such as diarrhea, rectal bleeding, abdominal pain, fistulae, or fever, especially if they are worse than before, it could mean that you are having a flare. Even if your IBD is well-controlled, you might find it difficult to relax because of the nagging worry that a flare could be around the corner. However, there are some steps you can take to prevent flares or to manage a flare if you do experience one.

It is extremely important that you take your medications as directed by your healthcare team, even if you feel well, as this is the best way to prevent a flare. This means you should do everything you can to avoid missing doses of your medication. However, your physician might intentionally reduce your dose of a medication to see if a lower quantity is enough to control your disease or to lessen negative side effects, which might also lead to a flare.

There are other potential triggers for flares, including illnesses or infections, stress, dietary changes, and hormonal changes, such as those that occur during pregnancy or after giving birth. Being prepared is the best way to deal with a flare. It might take time to schedule an appointment with your gastroenterologist, which can be frustrating when you are dealing with severe, untreated symptoms. You can also reach out to your primary care physician for advice in the interim.

However, by pro-actively asking your gastroenterologist what to do in case of a flare when you’re at your regular appointment, you will be ready with an action plan in case you start to experience symptoms. Your doctor might give you a lab requisition for blood or stool tests for you to complete between office visits. For example, the fecal calprotectin test measures an inflammatory substance called calprotectin in your stool.

An elevated level of this protein can signal a decrease in mucosal healing and that a flare is imminent. Testing for C. difficile in your stool is also helpful, as infection with these bacteria can mimic a flare. There are options to help self-manage a flare. Your physician might recommend that you increase the dose of your current medication. Or give you a different prescription to have on hand that will temporarily manage a flare until you can get an appointment. Or potentially prevent one from happening.

If you have ulcerative colitis or Crohn’s disease that affects your lower colon or rectum, your doctor might give you a prescription for a rectal preparation of a suppository, enema, or foam, which can start reducing inflammation quickly and improve symptoms. If all else fails, and you are unable to reach your usual healthcare team, don’t hesitate to seek help at the emergency department of your hospital. By the time you experience symptoms of a flare, it is likely that you have had untreated inflammation in your digestive tract for a few months already, so it is extremely important that you do what you can to manage a flare as soon as you feel symptoms.

Untreated inflammation can grow worse over time, leading to severe symptoms and increasing your risk of developing complications. However, if you do see different healthcare professionals, such as at a clinic or the emergency room, make sure to keep some notes on hand to share with them about your disease.

Helpful information includes your disease location and activity, which medications you are currently using, and which medications you have used in the past, either successfully or unsuccessfully. Even if these options are enough to control your flare, you should still contact your healthcare team to let them know of the change in your symptoms so they can better manage your Crohn’s disease or ulcerative colitis going forward.

I’m Dr. James Gray. On behalf of the Medical Advisory Council of the Gastrointestinal Society, thanks for watching. For more information on many aspects of inflammatory bowel disease, or to make a donation, go to badgut.org

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