Ulcerative colitis (UC) is a chronic,
remitting-relapsing autoimmune disease of the lining of the colon (large
intestine) that can have symptom-free periods followed by flare-ups. This disease
course can negatively affect a person's quality of life and normal day-to-day
functioning.
Research shows that close to 70 percent
of people who have active UC in a given year will have a relapse of symptoms in
the next year. A large part of treating UC is preventing the next relapse and
keeping it in remission as much as possible. When you have a flare, management
aims to relieve symptoms and to end the flare as soon as possible.
The key to dealing with a flare is
knowing what caused it and how to fix it.
What is a UC flare?
A UC flare is an acute worsening of
the symptoms of bowel inflammation. It's marked by disabling symptoms, such as:
- moderate to severe
abdominal pain or cramps that aren't helped by ordinary pain or
antispasmodic medications
- bleeding from the rectum
or blood in the stool
- moderate to severe
diarrhea that may lead to dehydration in severe cases
- weight loss due to loss
of appetite and diarrheal symptoms
- inability to have a
satisfactory bowel movement
- nutritional issues
resulting from frequent and severe flaring
What are the common
triggers of UC flares?
Every person with UC has different
triggers. Below is a list of some of the most common triggers:
- Certain medications can
affect the natural balance of gut flora by removing the good as well as
bad. Broad-spectrum antibiotics are one such type of medication.
Nonsteroidal anti-inflammatory drugs and other painkillers are also
strongly linked with flaring episodes. It's important to identify your
triggers and to speak to your doctor about substitutes.
- Abrupt withdrawal from
medications can also lead to a flare. This is especially common when you stop
taking steroids or even maintenance therapies. Younger people have a
higher risk of flares, because they are less likely to stick with a
medication for the proposed duration.
- Changes in the level of
hormones during pregnancy can cause a relapse of symptoms or acute flares.
Anyone with UC who is thinking about getting pregnant should speak with a
doctor first.
- Any condition or
infection that alters electrolyte levels in the body can also induce a
flare. This includes diarrhea from any infectious or noninfectious cause,
like traveler's diarrhea.
Dealing with flares
Corticosteroids are among the most
helpful agents that doctors have to stop a flare. Prednisone
and budesonide are two examples. Steroids are not always effective, but they are usually the
best agents to try first during a severe flare.
There are five main categories of
medication used for treatment, some long-term and others short-term. These
include:
- Steroids: These can be given
systemically (by mouth or intravenously) or as enemas, and help to suppress
immune system inflammation.
- 5-Aminosalicylates: This medication gets
released in different parts of the gastrointestinal tract depending upon
the medicine, aiming to reduce inflammation directly in the colon wall.
- Immunomodulators: These include
medications such as azathioprine or methotrexate. They work on the immune system
by modifying its activity to reduce the inflammatory response.
- Antibiotics: These are used because
infections often contribute to flares.
- Biologics: These work on the
immune system, against the inflammatory protein TNF-alpha, and include infliximab (Remicade), adalimumab (Humira), and certolizumab (Cimzia).
Certain lifestyle changes can also help
reduce the intensity and frequency of UC flares. There's a link between
emotional stress and the severity of UC flares. Stress relief techniques such
as hypnosis and meditation may improve symptoms. Other healthy options are
yoga, aerobics, and static exercises.
While having chronic diarrhea can
be annoying, there are ways you can manage it. Apply soothing pads or diaper
rash cream to the area as needed. You should also monitor what you eat. Fiber
can be tough on people with UC, because eating it can have unintended
consequences. Normally it helps maintain regularity, but it may not be helpful
for treating diarrhea. On the other hand, an anti-diarrheal may be useful if
you're certain that you don't have a bacterial infection of the bowel.
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