I've had Inflammatory Bowel Disease (IBD) for 15 years, i've had many flare ups over the years and these are my tried and tested ways for getting through them!
From my own experience of living with Crohn’s, and as a Health Coach supporting lots of clients with IBD, I’ve pulled together some of the best ways that my clients and I deal with a flare.
I will remind you that I am not a doctor, I have Crohn’s myself and this is based on my own research and the evidence I have gathered from the clients I work with and through my own experience.
What is a flare up?
A flare is a period of time when symptoms and inflammation from ulcerative colitis or Crohn's disease become active. These symptoms can include diarrhoea, abdominal pain, and blood in stools to name a few.
Why does this happen?
Several factors can worsen inflammation in inflammatory bowel disease and cause symptoms, which can result in you experiencing a flare up of those symptoms.
These factors can include:
Missing medication doses: Even when symptoms are in remission, people with inflammatory bowel disease need to continue to take their medications. Missing doses or taking the medication incorrectly can result in flares of symptoms
Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs include aspirin, naproxen, and ibuprofen. These medications can cause flares and should generally be avoided. For pain, paracetamol is recommended, or if you need something stronger then discuss with your IBD team.
Antibiotics: In some circumstances, antibiotics can cause flares of symptoms. If you are prescribed antibiotics, confirm that this is for a bacterial infection and make your gastroenterologist aware before using the therapy.
Smoking: Smoking can increase the possibility of a flare in Crohn's disease. Keep in mind that this could include prolonged exposure to second-hand smoke.
Infections: Sometimes, infection of the gastrointestinal tract (such as c. difficile, or food poisoning) can cause flares of symptoms. Your doctor can check for this in your stool if you have flares of symptoms.
Stress can worsen symptoms in people with inflammatory bowel disease.
Certain foods can cause symptoms in patients with inflammatory bowel disease.
The evidence around food causing symptoms currently isn’t sound. More work needs to be done in this area. But when we consider the huge number of people with IBD who show an increase in symptoms when eating certain foods, it cannot be ignored or dismissed as it so often it.
One of the things that has always annoyed me, is that I have been told on so many occasions that food and diet has nothing to do with IBD. I mean, how is that even possible when it’s your DIGESTIVE TRACT!! Of course, the food you eat will impact your symptoms, because the food we eat impacts our whole body.
Conditions linked to inflammation are soaring in the UK, with as many as 6 in 10 of us living with a chronic disease. Our gut microbiome (gut health) is linked to all lifestyle diseases we face today. This is amongst the greatest area of research in nutrition and medical science of the past century. Improving gut health has been shown to improve general health. (Dr Rossi 2021)
“Symptoms are not the start of the problem, they are the last straw. It is a sign your body is already overwhelmed”
Tip 1 – Gut rest
My flares usually consist of urgency, diarrhoea and blood loss. During a flare I can go to the toilet more than 30 times a day. One of the things I do on the first signs of a flare is that I try to rest my bowel as much as possible, because whatever I put in – comes straight back out… almost immediately!
I try to stick to water and bone broth for at least a day. For me this gives my system a chance to settle, and not be continuously aggravated by food being digested. I imagine my bowel filled with ulcers, if you think how sore one mouth ulcer is – and how much that is aggravated by certain foods, imagine the ulcers inside you.
Tip 2 - Get Rest
I know this can sometimes feel impossible. I have young children and a business and resting isn’t always an option. But whenever I have tried to push through, it always makes my flare worse. If you can rest, it will undoubtedly help your body to recover faster. Resting for people with invisible illnesses can be difficult, because we are constantly reminded that “we don’t look ill”, it can lead to feelings of guilt and that you must justify yourself constantly. I struggle so much with this personally. If I had a broken leg – I’d rest up. People would see my broken leg and not expect me to do all the stuff, but when it’s on the inside, and no one can see it – it can be very difficult to justify to yourself and others as to why you can’t do all the things you usually do.
You must be selfish and put yourself first. You must think of the impact on your body. Yes, this may be a bit of an inconvenience for people around you for a day or so, but if your flare worsens it can lead to far greater consequences, and longer periods of Ill health and even hospitalisation.
Speak to the people who matter and help them understand why you need that rest. It’s not because you are lazy or selfish – it’s because you want to get well as soon as you can.
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Tip 3 - You are what you eat…
If IBD is caused by inflammation, then eating inflammatory foods will increase that inflammation.
Foods that have been shown to cause inflammation.
Sugar – refined and added sugar, which is highly addictive.
Wheat & Gluten – can cause issues due to a lack of enzymes to break it down. It has been shown to link to Leaky Gut Syndrome. More and more people are becoming sensitive to gluten.
Dairy – research on this one is inconsistent
Processed foods – filled with chemicals, sugar and other inflammatory ingredients.
Alcohol – alcohol can impair gut and liver function as well as induce intestinal inflammation
Food and health are huge topics of discussion, and as with everything else with IBD it will affect people differently. For example, I don’t ever seem to react to gluten or dairy, I seem to tolerate foods with either quite well.
For others, food containing dairy, or gluten could be real trigger foods. You must trial what works for you.
However, I think everyone can agree that SUGAR, PROCESSED FOODS and ALCOHOL offer no health benefits to anyone and will only ever cause issues within your body.
When you are in a flare avoiding these foods will help you come out of the flare faster. Putting extra stress, and inflammation into your gut will only exacerbate the symptoms you are experiencing.
Tip 4 - Talk to you IBD team
Depending on where you are, this can be easier said than done. The NHS is under resourced and overstretched and it’s not easy to get the help and support you need, when you need it. But it is important to keep them in the loop – even if that means leaving a message with a secretary. You want there to be a log that you have called and are in a flare. Hopefully someone will get back to you asap and will be able to advise on any medical treatments such as steroids or alternative medications. It is also possible to talk to your GP and they may be able to prescribe steroids if needed. (We alllll hate them – but sometimes you’ve got to go with the Devil’s tic tacs!)
Tip 5 - You are not alone
One of the things that strikes me the most from personal experience and working with clients is how isolating having IBD can be. If people don’t have it, they simply don’t understand what you are going through. IBD is personal to each of us experiencing it, and we all have different combinations of symptoms. This can make it even harder to feel that people understand what you are going through.
One thing that always stays with me, is in the fifteen years that I have had this disease not one medical practitioner I have ever met with in relation to my condition has ever asked if I am OK, and if I am coping mentally with my condition. Not once. And for me, I know that the impact that I have felt mentally has on occasion been far worse than any of the physical symptoms that I have experienced.
But there are lots more groups available for people struggling with the same issues, find a group that suits you and don’t be afraid to ask questions. We are all in this together and we can support each other through it.
I only wish that I had more places where I could have asked all the questions, I wanted answered when I was diagnosed.
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