How to recognize and manage an IBD flare

What is IBD?

Inflammatory bowel disease (IBD) is a term used to describe chronic inflammatory conditions of the gastrointestinal tract. The two main types of IBD are Crohn's disease and ulcerative colitis.

Crohn's disease:

• Affected area: Any part of the digestive tract, from the mouth to the anus, but most commonly involves the end of the small intestine (ileum) and the beginning of the colon.
• Characteristics: Inflammation can occur in patches, with healthy tissue between affected areas. It can involve all layers of the bowel wall.

Ulcerative colitis:

• Affected area: Primarily affects the colon (large intestine) and the rectum.
• Characteristics: Inflammation is continuous and usually starts at the rectum, extending proximally through the colon in a continuous manner.

While Crohn's disease and ulcerative colitis share some common symptoms, there are also differences in the location and nature of inflammation. Both conditions can cause abdominal pain, diarrhea, weight loss, and fatigue, among other symptoms.

"IBD is a chronic condition, and its cause is an imbalance between one's genetics, microbiome, and environment. However, it is hard to know the exact cause in each case. It is a lifelong disease characterized by periods of remission and flare-ups," says Sujaata R. Dwadasi, MD, Gastroenterology at ARC Northwest Hills Specialty. "Medical treatment is aimed at bringing the conditions into a state of remission and keeping it that way for as long as possible."

What are the symptoms of an IBD flare-up?

The term "flare-up" or "flare" is used to describe a period during which the symptoms of IBD become more pronounced or active. Symptoms of an IBD flare-up can vary depending on the specific type of IBD and the location and severity of inflammation. Here are common symptoms associated with an IBD flare-up:

• Abdominal pain: Intense and crampy abdominal pain is a common symptom. The location and severity may vary based on the type and location of the inflammation.
• Diarrhea: Increased frequency of bowel movements and loose stools can occur during a flare-up.
• Blood in stool: Rectal bleeding, or the presence of blood in the stool, is a significant sign of inflammation in the gastrointestinal tract.
• Weight loss: Ongoing inflammation can lead to a reduced appetite and weight loss.
• Fatigue: Chronic inflammation and the body's response to it can lead to fatigue and a general feeling of weakness.
• Fever: Some individuals may experience a fever during a flare-up, especially if there is a systemic response to inflammation.
• Joint pain: Inflammation associated with IBD can sometimes affect joints, leading to joint pain and stiffness.
• Mouth sores: Some people with IBD may develop sores in the mouth.
• Nausea and vomiting: In severe cases, nausea and vomiting may occur.

"It's important to know that IBD symptoms can be unpredictable and may vary from person to person," says Dr. Dwadasi. "But, if someone with IBD experiences a flare-up or a change in symptoms, it's important to consult with your physician for evaluation and management."

Managing symptoms during an IBD flare

• Put extra emphasis on your gut health: In general, when experiencing a flare, it is best to avoid greasy and fried foods, which can cause gas and diarrhea. Some people find that foods high in fiber, such as fruits, vegetables, and whole grains, can be problematic. Rather than eliminating these necessary foods from your diet, it may be helpful to eat only thoroughly cooked fruits and vegetables. You may also want to avoid foods likely to cause gas, such as beans, cabbage, broccoli, caffeine, and carbonated drinks. Eating smaller, more frequent meals may be helpful.
• Stay hydrated: Adequate hydration is essential during an IBD flare as it helps prevent dehydration, a common concern due to increased fluid loss through diarrhea. Opt for water, herbal teas, and electrolyte-rich beverages to maintain proper hydration. Monitoring urine color and frequency can be a simple guide to ensure sufficient fluid intake.
• Reduce stress: Implement stress-management techniques to minimize the impact of emotional factors on IBD symptoms. Engage in activities such as meditation, deep breathing exercises, or yoga to promote relaxation. Establishing a routine and setting aside time for self-care can contribute to a more balanced emotional state, positively influencing the course of IBD symptoms.
• Reduce alcohol: Alcohol intake, whether moderate or in excess, may also make symptoms worse. Alcohol abstinence may not be required, but moderation is advised.

"No one type of food or beverage triggers or aggravates symptoms for all people with Crohn's disease or ulcerative colitis," says Dr. Dwadasi. "But one diet that has been seen in research to help with just symptoms in IBD patients is the Mediterranean diet."

Track your symptoms

Tracking your symptoms with IBD is helpful for several reasons:

• Disease management: Regular symptom tracking allows you to monitor the course of your disease over time. This includes changes in the frequency and severity of symptoms, such as abdominal pain, diarrhea, fatigue, and weight loss.
• Treatment evaluation: Tracking symptoms provides valuable data for assessing the effectiveness of your current treatment plan. If you are on medication, dietary changes, or other interventions, monitoring your symptoms helps determine whether these strategies are working or if adjustments are needed.
• Early detection of flares: Tracking can help identify early signs of a flare before it becomes severe. Early intervention may prevent complications and reduce the duration and intensity of flare-ups.
• Communication: Sharing detailed information about your symptoms with your healthcare team facilitates more productive discussions during medical appointments. It enables your doctor to make informed decisions about your care, such as adjusting medications or ordering additional tests.
• Quality of life: IBD can significantly impact your quality of life. Tracking symptoms allows you to identify specific aspects that affect your daily activities, emotional well-being, and social interactions. This information helps in addressing not only the physical but also the psychosocial aspects of living with IBD.
• Personal empowerment: Actively participating in the management of your condition empowers you to take control of your health.
• Data-driven decision-making: The data collected through symptom tracking can be used to make evidence-based decisions about treatment plans. It provides a basis for discussions with your healthcare team, promoting a collaborative approach to managing your IBD.

Make an appointment

Treatment for IBD usually involves medications to control inflammation, lifestyle changes, and, in some cases, surgery. If you would like to learn more about treatment options, visit us at ARC Inflammatory Bowel Disease (IBD) Program.

Dr. Dwadasi accepts new patients, ages 18 and older. To schedule an appointment with Dr. Dwadasi, call ARC Northwest Hills Specialty at 512-344-0450.