What Is an IBD Flare-Up?

What it Means to Have a Relapse of Crohn's Disease or Ulcerative Colitis

Bowel pain, artwork
Seeing a doctor right away when IBD symptoms come back is very important to stopping any inflammation and getting back to a state of remission.. ROGER HARRIS/SPL/Getty Images

You may read a lot about "flare-ups" or "flaring" in connection with inflammatory bowel disease (IBD) or other chronic conditions. These terms are generally meant to refer to the active state of IBD. IBD is not curable, and it tends to go through periods where it is active (a flare-up) and periods where it is not active (remission). The time flaring and the time in remission are highly variable from person to person: no two people with IBD are the same.

However, having diarrhea for a day or two that gets better on its own is not necessarily due to an IBD flare-up, and could be from some other cause. This is why it's important to get symptoms evaluated by a doctor if they crop up.

The Flare-Up/Remission Cycle of IBD

IBD is a chronic condition that is characterized by intermittent periods of active disease (flare-ups) and little or no disease activity (remission). The duration and severity of the active period vary widely from person to person. The goal of treatment with IBD is to quell the flare and get the IBD back under control and hopefully into remission.

What Is An IBD Flare-Up?

After a period of remission, or a time with few or little symptoms, IBD may flare-up, causing symptoms again. Symptoms that may have been gone for weeks or months become bothersome again. 

There is, unfortunately, no criteria that would define a flare-up: there's no quiz that a person can take to determine if the IBD is active.

Many times, a patient will start to have symptoms and will see their gastroenterologist for an evaluation. The gastroenterologist may do a series of tests such as blood test or stool tests, to start to understand why the symptoms are returning. In some cases this might also mean having an endoscopy, such as a sigmoidoscopy, a colonoscopy, or an upper endoscopy.

With these tests, a gastroenterologist can see exactly what is going on in the digestive tract, and pinpoint the area of inflammation. It's important to know where the problem is in order to treat it.

Treating A Flare-Up

A flare-up will probably not resolve by itself, and treatment will be needed. Most people with IBD take a maintenance drug to help keep symptoms in check, even when the IBD is quiescent. Maintenance drugs will be continued during a flare-up, and other drugs, diet modifications, or more treatments may be prescribed by a gastroenterologist to bring the disease back under control. How the drug regimen will change is an important point of discussion between patient and physician. What was working for a time may no longer be effective, and new drugs or new dosages might need to be tried.

Surgery is also considered a treatment for IBD, and is typically considered only after all other medical options have been exhausted. Surgery might also be needed when there are complications of the IBD such as abscesses or strictures.

With Crohn's disease, surgery might be used to remove the part of the small intestine that is showing disease. For ulcerative colitis, surgery always involves the removal of the colon, because the disease will come back if part of that organ is left in place. There are many other types of surgery that are done to treat IBD, and sometimes they are very individualized because of the variable nature of these diseases from person to person.

The Bottom Line

People with IBD will need care from a physician and regular check-ups to keep the disease under control. When symptoms such as diarrhea, bleeding, pain, and fever return, seeing a gastroenterologist right away is very important. Symptoms can rapidly become serious, and getting them treated right away gives the best chance of stopping the flare-up before it causes more damage.

Sources:

Crohn's and Colitis Foundation of America. "What is Crohn’s Disease?" CCFA.org 2013. 8 Sept 2013.

Crohn's and Colitis Foundation of America. "What is Ulcerative Colitis?" CCFA.org 2013. 8 Sept 2013.

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