No 2 Flares Are the Same: The Variability of Ulcerative Colitis

"Variability is the law of life, and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease." — William Osler

When considering the ulcerative colitis flares I've experienced over the years, I thought of this quote by Sir William Osler. As one of the founding professors of Johns Hopkins Hospital, medical experts often refer to Osler as the "Father of Modern Medicine." Who better to look to during times of physical struggle like IBD flares?

From long to short, mild to severe

At age 19, doctors diagnosed me with UC. Now, at age 52, I can attest that "variability is the law of life," with my colitis flares. As with much in life, flares can be short-lived, such as a few days. But they can also create a variety of symptoms that last for many months, or worse – years.

Why does this happen? And how can a person deal with the flares of life that most often arrive unexpectedly?

Signs a flare is beginning with UC

Although doctors can't explain why flares occur, they agree that listening to your body is the key to navigating them. As for my body, flares usually begin with painful intestinal cramping. That's the first sign that I'm heading toward a flare. When it feels like a sledgehammer is pounding my abdominal region, I do my best to stop and question my recent behavior.

Did I eat food that I know my body can't handle? For example, gluten most often lashes out as painful cramping. Another question I consider: Am I overly stressed? I know that stress doesn't cause a flare, but it also doesn't help my body stay in remission.

Have I taken certain medications that might elicit UC pain? I know with my body I must watch the antibiotics I take as well as ibuprofen. Also, do I need to increase my water intake? Reduce caffeine? The first step of a flare communicates that it's time to reflect.

Treating a mild flare vs. a severe flare

Once the cramping begins, I know that I'm on the path to more pain. Then, the next symptom I'm usually hit with manifests as bloody stool. If I've ignored the intestinal pain, the blood in my bowel movements always signals my brain, "You better turn this flare-train around."

Recently, I've received these signs of a mild flare. So, I'm watching my diet and choosing to analyze my stress levels. I'll ramp up ways of relaxing with walking more than usual each day, doing deep breathing exercises, and by taking more naps. When the flare signs arrive, I know it's time to offer more kindness to my body. By knowing my body, I realize I'm not at the level of needing medical attention.

I need a doctor for my bad UC flares

For the bad flares, though, I call my doctor and schedule an appointment. I do this when the blood in my bowel movements becomes excessive, the intestinal cramping lingers for multiple days, when nausea kicks in, and over-the-counter (OTC) anti-diarrheal treatments don't work.

At this stage, I know I will need stronger medication to stop the flare. Prednisone is most often the first choice because it's the cheapest approach for my health insurance coverage and is the shortest route to recovery.

With the worst flares, my world shrinks to confinement. Constant pain and bloody diarrhea usually restrict me to the bathroom. I don't travel far from it. I can't. The risk and anxiety of not making it to a restroom makes the most horrific flare even worse. So, I stay home and spend many hours in the bathroom. It's exhausting.

Anemia, fainting, and the worst of UC

Experience over the years has taught me much about this disease. I now understand that the worst flares can lead to anemia. When I once came ever-so-close to fainting in a retail business, I learned I can't allow myself to get anemic. Therefore, I communicate as soon as my flare gets to this point. But I must admit, I was slow in learning this about my UC.

When do I need stronger treatments to tamp down flares? Experience has taught me this lesson, too.

Increased doctor visits throughout flare

If symptoms continue after a short stint on prednisone, then my doctor knows I will need stronger treatments to get back into remission. At this point, my GI schedules appointments 3 months at a time until the flare subsides and prescribes new medication. When in remission, I only visit my physician once or twice a year. I revel in those once-a-year visits.

After living with UC for over 30 years, I now understand how no 2 people experience IBD or a flare the same. Dr. Osler was correct in his assessment that no disease behaves alike in individuals.

Listen to your body

This explains why I believe it's best to know and to listen to your body. It has taken me years to learn my UC's way of behaving. But what I didn't realize in my younger years, the best way of knowing the messages of a flare is by listening to your body.

When a flare begins, tap into ways that soothe your body. Whether that means changing your diet, taking OTC treatments, scheduling an appointment with your physician, or taking time to relax, it's important for you to incorporate slight changes as you navigate the flare. Above all, be kind to yourself. The flares communicate that it's time to adjust your behavior and find more ways to relax.

What do you do during a UC flare?

In the end, those with ulcertive colitis can't stop the flares from occurring. But each of us can make choices to hopefully shorten them.

What measures do you take to avoid or reduce your flares? Please leave us a comment and let us know your flare advice. We're all in this to help one another navigate the rocky road of Crohn's and UC. Your method of dealing with a flare just might help someone else.