Symptoms and Causes of Ulcerative Colitis Flares

Stephanie Eckelkamp
Medically Reviewed
January 31, 2021

We’re not going to sugarcoat it: Ulcerative colitis (UC) can be erratic and hard to manage. This inflammatory bowel disease (which is also an autoimmune disease , in which the immune system mistakenly attacks your own body) causes inflammation and ulcers to develop on the inner lining of the colon, or large intestine, which can cause diarrhea, abdominal pain and cramping, bloody stools, and other debilitating symptoms.

UC is characterized by periods of symptoms (known as flare-ups) followed by periods of remission in which you’re symptom-free for anywhere from a few days to a few years. Technically, there’s no cure for ulcerative colitis, but medication can help manage it, and you can significantly minimize flare-ups and extend remission with strategic diet and lifestyle tweaks. Read on for more information on ulcerative colitis and the natural remedies that may combat these painful symptoms.

What are the symptoms of an ulcerative colitis flare-up?

An ulcerative colitis flare-up refers to the return of symptoms after a period of remission. During this time, there is significantly increased inflammation in the colon, which can lead to the formation of ulcers and aggravate existing ulcers. According to the Crohn’s & Colitis Foundation , symptoms of ulcerative colitis flare-ups may include:

  • Loose and urgent bowel movements
  • Bloody stool
  • Mucous in stool
  • Abdominal cramps and pain
  • Loss of appetite
  • Nausea
  • Fever
  • Low energy and fatigue

What causes ulcerative colitis flares?

It’s not always super clear what brings on a flare—and it can be different for everyone—but your diet, stress levels, and certain medications may all contribute. Here are some common triggers:

  • Certain foods and beverages: While research doesn’t suggest that specific foods cause ulcerative colitis in the first place, certain foods can exacerbate UC and contribute to flare-ups—particularly those that are pro-inflammatory or promote permeability of the gut lining such as highly processed carbohydrates, added sugars, and alcohol, says Cori Cohen, a health coach and registered dietitian formerly with Parsley Health. It’s good to scale back on these foods, but keep in mind, food triggers can also be unique to the individual. This is why keeping a food/symptom journal is so helpful.
  • Stress: Like food, stress is not believed to cause UC, but it can exacerbate it. High-stress levels can stimulate the immune system and contribute to chronic inflammation, both of which may contribute to an ulcerative colitis flare. In one study of ulcerative colitis and Crohn’s disease patients, 45 percent of those who experienced a relapse said they’d been exposed to “quite a lot of stress” the day prior.
  • NSAID pain relievers: Non-steroidal anti-inflammatories (NSAIDs) such as aspirin, ibuprofen, and naproxen may also contribute to flares. These drugs can be irritating to the gastrointestinal tract and should be avoided with UC, according to the Crohn’s & Colitis Foundation . Tylenol is generally considered a more GI-friendly OTC pain reliever.
  • Missing your meds: Medication is often needed to keep UC symptoms in check, and missing a dose, even when symptoms are in remission, may result in a flare-up. This is why it’s so important to have a team—like the docs and health coaches at Parsley Health —managing your care plan and guiding you on if/when it’s ever appropriate to wean off medication (and yes, it is possible in some cases, says Cohen).
Stephanie Eckelkamp

Stephanie Eckelkamp is a writer and certified health coach based in Allentown, PA. She received her B.S. in journalism from Syracuse University with a minor in nutrition. Her work has appeared in Martha Stewart Living, mindbodygreen, Greatist, Women's Health, Men's Health, Prevention, and Good Housekeeping. When she's not writing or nerding out on the latest health news, she's most likely on a walk with her pup Lucy Goose or trying to convince her boyfriend to eat more broccoli.

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