Daily Dos and Don'ts for Ulcerative Colitis
When you experience an ulcerative colitis flare, it's easy to assign blame, be it on last night's spicy dinner or on that extra-large coffee. In actuality, flares are unpredictable — there are no proven triggers or foolproof ways to prevent them.
The most important thing to do if you have ulcerative colitis? "Take your medications as prescribed and work closely with your doctor to stay well," says Richard Bloomfeld, MD, a gastroenterologist and associate professor at the Wake Forest University Baptist Medical Center in Winston-Salem, N.C.
However, when you're experiencing active ulcerative colitis symptoms, certain bad habits can make you feel worse or keep you from reaching remission. Avoiding these common mistakes is an important part of ulcerative colitis management.
Mistake No. 1: Skipping Medications
A variety of medications are used to treat ulcerative colitis, depending on the severity of your condition and your overall health. But it doesn't matter whether your doctor has you taking an anti-inflammatory drug, an immunosuppressant, or a combination of medications — none of them will work if you don't take them as your doctor prescribes.
Still, skipping medications is the biggest reason people experience flares, says Laura Yun, MD, a gastroenterologist and assistant professor at Feinberg School of Medicine at Northwestern University in Chicago. In fact, a Canadian review published in the journal Gastroenterology found that, out of 1,681 people with ulcerative colitis prescribed to mesalamine, the majority of people did not adhere to their treatment after one year.
It may be tempting to skip doses once you start feeling better. Resist the temptation, says Dr. Yun.
Mistake No. 3: Not Drinking Enough Fluids
If you're experiencing a bout of diarrhea, you run the risk of becoming dehydrated because your body may be losing more fluids than it's taking in — especially if you're not drinking enough. This can be harmful to your body's overall well-being and ability to heal.
Drink as much water as you can during an ulcerative colitis flare. However, there are some liquids that you should think twice about if you have diarrhea. These include caffeinated coffee, soda, and the ultimate no-no: prune juice.
Mistake No. 5: Drinking Caffeine
Can caffeine make diarrhea worse? You bet it can, says Yun. That's because it's a stimulant.
If you're constipated, this can work to your benefit. But while there's no evidence to show that drinking coffee specifically triggers an ulcerative colitis flare, people with active ulcerative colitis symptoms or those who are worried about having them should consider skipping coffee and caffeinated drinks.
Mistake No. 8: Not Treating Infections
Infections outside of the gut won't aggravate ulcerative colitis, but the antibiotics you take for them could. If you're taking an antibiotic for an infection, let your doctor know if you start to experience diarrhea. A switch in antibiotics might be needed. Your doctor may also suggest taking a probiotic, which may help reduce antibiotic-related diarrhea.
It's also possible to develop a gut infection with similar symptoms, so if an antibiotic medication switch doesn't help, see your doctor to make sure you don't have an additional infection that needs attention.
Mistake No. 9: Not Being on the Right Treatment Plan
Ulcerative colitis treatment plans are typically based on how mild, moderate, or severe your symptoms are and how well you respond to medications. Usually, you'll start with the least aggressive treatment and, if necessary, move on to stronger medications. Frequent flares, hospitalizations, or prescriptions for short-term corticosteroids are signs that you might need to adjust your current treatment strategy. If you aren't satisfied with the level of control you have over ulcerative colitis, talk to your doctor about other options for you.
When you experience an ulcerative colitis flare, it's easy to assign blame, be it on last night's spicy dinner or on that extra-large coffee. In actuality, flares are unpredictable — there are no proven triggers or foolproof ways to prevent them.
The most important thing to do if you have ulcerative colitis? "Take your medications as prescribed and work closely with your doctor to stay well," says Richard Bloomfeld, MD, a gastroenterologist and associate professor at the Wake Forest University Baptist Medical Center in Winston-Salem, N.C.
However, when you're experiencing active ulcerative colitis symptoms, certain bad habits can make you feel worse or keep you from reaching remission. Avoiding these common mistakes is an important part of ulcerative colitis management.
Mistake No. 1: Skipping Medications
A variety of medications are used to treat ulcerative colitis, depending on the severity of your condition and your overall health. But it doesn't matter whether your doctor has you taking an anti-inflammatory drug, an immunosuppressant, or a combination of medications — none of them will work if you don't take them as your doctor prescribes.
Still, skipping medications is the biggest reason people experience flares, says Laura Yun, MD, a gastroenterologist and assistant professor at Feinberg School of Medicine at Northwestern University in Chicago. In fact, a Canadian review published in the journal Gastroenterology found that, out of 1,681 people with ulcerative colitis prescribed to mesalamine, the majority of people did not adhere to their treatment after one year.
It may be tempting to skip doses once you start feeling better. Resist the temptation, says Dr. Yun.
Mistake No. 2: Ignoring Stress
Dr. Bloomfeld and Yun both agree: When asked, people with ulcerative colitis often report experiencing stress before a flare. A study published in the October 2013 issue of the journal Inflammatory Bowel Disease, which looked at 75 people with ulcerative colitis, found that short-term stress was a risk factor for relapse.
Stress can lead to a flare in a variety of ways, such as potentially starting an immune system response that leads to inflammation, or simply knocking you out of your usual routine, leading to poor diet, sleep, and medication habits. At Yun's clinic, a psychologist teaches relaxation exercises to people with ulcerative colitis. Learning techniques such as meditation or yoga may help manage the stress in your life.
Dr. Bloomfeld and Yun both agree: When asked, people with ulcerative colitis often report experiencing stress before a flare. A study published in the October 2013 issue of the journal Inflammatory Bowel Disease, which looked at 75 people with ulcerative colitis, found that short-term stress was a risk factor for relapse.
Stress can lead to a flare in a variety of ways, such as potentially starting an immune system response that leads to inflammation, or simply knocking you out of your usual routine, leading to poor diet, sleep, and medication habits. At Yun's clinic, a psychologist teaches relaxation exercises to people with ulcerative colitis. Learning techniques such as meditation or yoga may help manage the stress in your life.
Mistake No. 3: Not Drinking Enough Fluids
If you're experiencing a bout of diarrhea, you run the risk of becoming dehydrated because your body may be losing more fluids than it's taking in — especially if you're not drinking enough. This can be harmful to your body's overall well-being and ability to heal.
Drink as much water as you can during an ulcerative colitis flare. However, there are some liquids that you should think twice about if you have diarrhea. These include caffeinated coffee, soda, and the ultimate no-no: prune juice.
Mistake No. 4: Eating Poorly
"There's no food or food group that causes or cures ulcerative colitis," Yun explains. Likewise, no specific food has been shown to trigger a flare. But doctors do recommend an overall healthy diet, even when you're not experiencing ulcerative colitis symptoms. Sticking to nutrient-rich foods — and avoiding those that have caused digestive issues in the past — may help keep you in remission.
What you eat may also make a difference when you're having an ulcerative colitis flare. "I recommend a low-residue diet when symptoms are active," says Yun. This means eating low-fiber foods that are easy to digest and cooking your veggies before you eat them. It also means cutting out foods that put your bowels to work, such as beans, whole grains, nuts, seeds, and some raw fruits and vegetables.
"There's no food or food group that causes or cures ulcerative colitis," Yun explains. Likewise, no specific food has been shown to trigger a flare. But doctors do recommend an overall healthy diet, even when you're not experiencing ulcerative colitis symptoms. Sticking to nutrient-rich foods — and avoiding those that have caused digestive issues in the past — may help keep you in remission.
What you eat may also make a difference when you're having an ulcerative colitis flare. "I recommend a low-residue diet when symptoms are active," says Yun. This means eating low-fiber foods that are easy to digest and cooking your veggies before you eat them. It also means cutting out foods that put your bowels to work, such as beans, whole grains, nuts, seeds, and some raw fruits and vegetables.
Mistake No. 5: Drinking Caffeine
Can caffeine make diarrhea worse? You bet it can, says Yun. That's because it's a stimulant.
If you're constipated, this can work to your benefit. But while there's no evidence to show that drinking coffee specifically triggers an ulcerative colitis flare, people with active ulcerative colitis symptoms or those who are worried about having them should consider skipping coffee and caffeinated drinks.
Mistake No. 6: Drinking Carbonated Beverages
When you're in the midst of an ulcerative colitis flare, avoid sodas and other drinks with carbonation — they can be irritating to the lining of your digestive tract. Also, because many of these drinks contain caffeine and sugar, both of which can contribute to diarrhea, you might be giving yourself a double dose of irritation. Opt for plain water instead.
When you're in the midst of an ulcerative colitis flare, avoid sodas and other drinks with carbonation — they can be irritating to the lining of your digestive tract. Also, because many of these drinks contain caffeine and sugar, both of which can contribute to diarrhea, you might be giving yourself a double dose of irritation. Opt for plain water instead.
Mistake No. 7: Not Paying Attention to Trigger Foods
If you've never kept a food diary, now may be the time. Although there are no specific foods that have been found to be universal triggers of ulcerative colitis flares, many people with ulcerative colitis find certain foods seem to either bring on symptoms or make symptoms worse. It pays to avoid these foods once you know what they are. For example, dairy products can be particularly irritating for people who have both ulcerative colitis and lactose intolerance. If this is the case for you, be vigilant about cutting out all dairy products.
If you've never kept a food diary, now may be the time. Although there are no specific foods that have been found to be universal triggers of ulcerative colitis flares, many people with ulcerative colitis find certain foods seem to either bring on symptoms or make symptoms worse. It pays to avoid these foods once you know what they are. For example, dairy products can be particularly irritating for people who have both ulcerative colitis and lactose intolerance. If this is the case for you, be vigilant about cutting out all dairy products.
Mistake No. 8: Not Treating Infections
Infections outside of the gut won't aggravate ulcerative colitis, but the antibiotics you take for them could. If you're taking an antibiotic for an infection, let your doctor know if you start to experience diarrhea. A switch in antibiotics might be needed. Your doctor may also suggest taking a probiotic, which may help reduce antibiotic-related diarrhea.
It's also possible to develop a gut infection with similar symptoms, so if an antibiotic medication switch doesn't help, see your doctor to make sure you don't have an additional infection that needs attention.
Mistake No. 9: Not Being on the Right Treatment Plan
Ulcerative colitis treatment plans are typically based on how mild, moderate, or severe your symptoms are and how well you respond to medications. Usually, you'll start with the least aggressive treatment and, if necessary, move on to stronger medications. Frequent flares, hospitalizations, or prescriptions for short-term corticosteroids are signs that you might need to adjust your current treatment strategy. If you aren't satisfied with the level of control you have over ulcerative colitis, talk to your doctor about other options for you.
Mistake No. 10: Eating Large Meals
When ulcerative colitis symptoms are active, you can ease your body's burden by eating frequent yet smaller meals so the volume of food and fluid is stable and limited. Consider having five fist-sized meals every three to four hours instead of three large meals a day.
On top of helping reduce discomfort from ulcerative colitis symptoms, this strategy is also a way to cope with nausea or loss of appetite that might accompany your symptoms.
When ulcerative colitis symptoms are active, you can ease your body's burden by eating frequent yet smaller meals so the volume of food and fluid is stable and limited. Consider having five fist-sized meals every three to four hours instead of three large meals a day.
On top of helping reduce discomfort from ulcerative colitis symptoms, this strategy is also a way to cope with nausea or loss of appetite that might accompany your symptoms.
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