Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation and ulcers, or sores, in the large intestine. Ulcerative colitis symptoms include frequent bowel movements, bloody diarrhea, and abdominal cramps, which may come and go unpredictably. When ulcerative colitis symptoms are mild or absent, the condition is in remission. When the symptoms come back, patients experience an ulcerative colitis “flare.”
Can Ulcerative Colitis Symptoms Be Controlled?
Stella Y. Chow, MD, director of gastroenterology and endoscopy at Lahey Clinic, North Shore, in Peabody, Mass., says ulcerative colitis symptoms can, in fact, be controlled. “Even when ulcerative colitis symptoms flare up, we can usually get the disease back into remission with the right treatment.”
However, “There is no cure for ulcerative colitis,” says Bo Shen, MD, a gastroenterologist at the Cleveland Clinic in Ohio. “Flares are unpredictable, and although we do know some of the triggers, in most cases flares cannot be predicted or prevented — but they can be treated.”
Triggers for Ulcerative Colitis Flares
Although emotional stress may accompany a flare of ulcerative colitis symptoms, there is no evidence that stress causes a flare. Doctors don’t completely understand the cause of ulcerative colitis or why symptoms act up when they do, so flares can rarely be prevented. Here are some causes of flares that we do know:
Not sticking with prescriptions. People with ulcerative colitis may need to take a number of medications. “Sometimes when patients start to feel better, especially younger patients, they may stop taking their medications, and that can trigger a flare,” says Dr. Chow.
Infection. Diarrhea caused by a bacterial, viral, or parasitic infection, such as the type of diarrhea travelers get from drinking contaminated water, can cause a flare.
Other medications. Broad-spectrum antibiotics (antibiotics that can eliminate a wide range of bacteria) and over-the-counter pain relievers such as ibuprofen (Motrin, Advil, and others) or naproxen (Aleve, Naprosyn, and others) can trigger a flare, Dr. Shen says.
Pregnancy. About 50 percent of women in remission from ulcerative colitis will experience a symptom flare during pregnancy.
Controlling Ulcerative Colitis Flares
Although there is no way to prevent every ulcerative colitis flare, the condition can be managed through a combination of treatments and lifestyle adjustments:
Medications. Treatment with medication is the most important way to control ulcerative colitis. Anti-inflammatory drugs are the first line of treatment for mild to moderate symptoms. When flares occur, steroids may be used to get symptoms under control. A class of drugs called immunomodulators may be used along with steroids to control flares. Drugs in a class called biologicals are used to control moderate to severe symptoms. Work with your doctor to determine the best combination of medications for your symptoms.
Diet. Foods do not cause ulcerative colitis, but a healthy diet is an important part of managing flares. People with ulcerative colitis should avoid eating high-fiber foods, such as whole grains, raw fruits, and raw vegetables, and fatty, greasy, or fried foods. Consider limiting foods that produce a lot of gas, such as beans, legumes, or cabbage. Limit dairy products only if you are lactose intolerant. Alcohol, caffeine, and beverages with added sugar can make symptoms worse. During a flare, it’s best to eat five or six small meals a day instead of three large meals.
Nutritional supplements. Folic acid levels may be low in some people with ulcerative colitis. “Some studies show that folic acid supplements may reduce the risk of colon cancer in people with ulcerative colitis. Vitamin D and calcium may help prevent bone loss, especially in patients who have been on steroids,” says Shen. Some studies have suggested that probiotics and omega-3 fatty acids may also reduce colitis symptoms.
Surgery. When diet and medications are not enough to control ulcerative colitis symptoms, surgery may be recommended. Up to one-third of people with ulcerative colitis will eventually need surgery. After the entire colon and rectum are removed in a procedure called a proctocolectomy, another procedure is done to either reroute bowel movements through a small opening in the abdomen or to allow more-normal bowel movements. Since ulcerative colitis symptoms only occur in the colon and rectum, this procedure can eliminate colitis symptoms.
ulcerative colitis support group can be a source of emotional strength for many people with ulcerative colitis,” says Chow.
Alternative therapies. Several studies indicate that acupuncture can relieve some ulcerative colitis symptoms. There are a few studies that support the use of herbal medicines as an alternative therapy, but these options should not be used in place of traditional medical treatment. Psyllium seeds, boswellia, and turmeric have all been shown to have some anti-inflammatory properties. “At this point, there is not enough evidence to recommend any alternative therapies for ulcerative colitis treatment,” says Shen.
Although there is no cure for ulcerative colitis, symptoms can usually be treated with medication and diet. Work closely with your doctor and make lifestyle changes that help you cope with ulcerative colitis symptoms.