By Oshi Health
Medical professional recording patient information about ulcerative colitis flare on tablet

Oshi users have submitted more than 200 anonymous questions to our experts through the Ask section on our app. One topic that Oshi users keep asking questions about? Flares. Here are some of our most popular questions about flares.

(Have a question about flares? Go to the Ask section on the Oshi app to submit an anonymous question to our GI experts.)

Q: What can I do to monitor my condition? Also, how will I know if I’m having a flare-up?
A: IBD can cause a wide variety of symptoms. However, since these symptoms can also be caused by other GI conditions like viral infections, it is often hard to tell whether your IBD is flaring or you have another condition. Determining whether your symptoms are due to an IBD flare will require discussion with your doctor and possibly medical tests, such as a colonoscopy, stool tests, or blood tests.

With that in mind, you should contact your doctor if you experience consistently worse diarrhea, bloody stools, nausea, vomiting, or abdominal pain. Symptoms that are even more worrisome include unintentional weight loss, fevers, bowel movements that wake you from sleep, and accidents because you can’t make it to the bathroom in time.  -Jonathan Hansen, MD, PhD

Q: Can you tell me how much blood there can be in my stool before I really have to go see my doctor?
A: If you have IBD and are having persistent stools with blood, you are likely experiencing a significant flare of your IBD which your doctor will need to know about. Depending on the type of IBD, your doctor will want to know about other symptoms such as new and severe abdominal pain, bowel distension that may be associated with nausea or vomiting, and any symptoms associated with fever. The sooner you can relay these symptoms to your doctor the better to avoid complications and more serious illness.

It is also possible that your IBD may be more treatable if the symptoms are treated earlier in a flare rather than later. If you have any questions, you can always call or message the doctor’s office to relay your symptoms so that they can decide whether you need to be seen or not. -Matthew J. Hamilton, MD

Q: Does a flare mean your current medication (a biologic or otherwise) has stopped working?
A: If you have a flare while on a maintenance medication like a biologic, this could be a sign that your medication isn’t working anymore. It’s also possible that something has changed about your IBD, so the med isn’t working as well. This doesn’t mean that the med has stopped working altogether. You should definitely discuss this with your provider and determine next steps together (for example, adding another med on top of the one you’re currently taking, adjusting the dosage on your current med, or possibly switching to a different med). -Matthew J. Hamilton, MD

A doctor answers questions about an IBD flare

Q: When is the right time to go to the ER during a flare?
A: This is a difficult question to answer because there are so many potential reasons you might need medical attention in an ER. In general, it is probably best to contact your IBD doctor first if you think you are having a flare or worrisome symptoms. Many times, he/she can evaluate you in their clinic and potentially avoid an ER visit or hospitalization. Other times, he/she may talk to you on the phone and instruct you to go to the ER based on what you are telling them. If you are unable to reach your IBD doc, use your best judgement. -Jonathan Hansen, MD, PhD

Q: What medications might help to reduce inflammation when I’m having a flare?
A: Flares can take many forms, but are usually characterized by increased bowel frequency, fecal urgency, blood in stool, or abdominal pain. In the case of a flare, it is important to discuss all of your symptoms with your IBD doctor.

The key point here is that not all “flares” are the result of inflammation. Flares could instead be related to an undiagnosed infection. Your IBD doctor will recommend stool tests to rule out infections such as Clostridium difficile (C. diff) and other infections. If you do have an infection, treatment will be prescribed.

Another key point is whether or not true inflammation is present. Your doctor may recommend a flexible sigmoidoscopy (partial colonoscopy), a colonoscopy, or a scan to evaluate for active inflammation.

When symptoms are disabling and they fail to improve on other IBD medications, then steroids such as oral prednisone or budesonide may be prescribed to help improve symptoms. If the inflammation is predominantly limited to the left side, topical medications such as mesalamine or steroid enemas may be prescribed to limit systemic exposure. -Matthew J. Hamilton, MD

Oshi is a tracking tool and content resource. It does not render medical advice or services, and it is not intended to diagnose, treat, cure, or prevent any disease. You should always review this information with your healthcare professionals.