Preventing a ‘Flare-up’ of Ulcerative Colitis

Listed below are a few points to help you prevent a flare-up of your disease. Some flare-ups are unavoidable, but if advice is followed they will occur less often.

1. Take medications as directed by the doctor or IBD nurse. Do not stop because you feel well. The doctor will advise you when it is safe to tail off treatment.

2. Seek prompt treatment or advice as soon as symptoms begin in order to prevent a more severe relapse.

• Always ensure that you have an adequate supply of medications, particularly when you are travelling away from home.
• Keeping a small stock of enemas may be useful so that treatment can commence as soon as symptoms such as blood & mucus recur. 5-ASA enemas, such as Pentasa or Asacol, are usually better than steroid enemas (providing you are not allergic to mesalazine). These will only be effective for colitis affecting the left colon; oral steroids may be necessary for more extensive colitis but should only be taken on instruction from the doctor.

3. Avoid situations which you know trigger attacks, such as:

• Diet: There is no clear evidence that food causes colitis but if you find that certain foods upset you, then you should avoid them to stay well. Do not exclude multiple foods from your normal diet without seeking the help of a registered dietitian.
• Stress: Take time to practice relaxation at certain periods throughout the day. Make time to follow pursuits that you enjoy. Do not bottle up worries or concerns; speak to someone who may be able to help.

4. Avoid constipation. Flare-ups of left-sided colitis are frequently triggered by proximal constipation, that is to say accumulation of faeces in the right hand side of the large intestine.

5. Gastrointestinal infections may trigger a flare-up and you should therefore avoid situations, which may lead to this such as:

• Travelling to countries with poor sanitation.
• Poor personal hygiene when preparing and cooking food.
• Restaurants and cafés should be selected with care.

6. Avoid taking non-steroidal anti-inflammatory drugs such as, diclofenac (Voltarol), or ibuprofen(Brufen), and naproxen, as these have been associated with flare-ups of the disease. If you need to take painkillers, try paracetamol or co-proxamol instead. A list of NSAIDs can be found here)(make a link to NSAID list in About IBD section).

7. Keep yourself fit. Ensure that a healthy, balanced diet is taken, with vitamin and mineral supplements is necessary. Take regular exercise in order to build up bone strength, thus reducing the risk of osteoporosis. Exercise promotes good gut function.

8. Ensure that you get adequate rest and sleep. This does not mean no to partying, but it is important to balance late nights with several early nights.