Flares: What to Do Right Now

Flares are periods when inflammatory bowel disease symptoms worsen. Quick action can shorten a flare and prevent emergencies. This guide explains what to do today, what to watch over the next few days, and when to seek urgent care. It covers steps to rule out infection, protect hydration and nutrition, and coordinate with the care team. It also lists clear red flags for emergency visits.

Key takeaways

• Contact the gastroenterology team within 24 hours if new bleeding, pain, fever, or diarrhea appear or worsen.

• Do not stop maintenance medicines. Avoid nonsteroidal anti‑inflammatory drugs (NSAIDs) unless a clinician says they are safe.

• Arrange stool testing to check for infection, especially Clostridioides difficile, before starting steroids if possible.

• Go to the emergency department for severe bleeding, signs of blockage, high fever, or dehydration that does not improve.

• Use a simple daily log of stools, bleeding, pain, fever, and fluid intake to guide decisions.

What is a flare?

A flare means inflammation is active. Common signs are increased stool frequency, urgency, rectal bleeding, belly pain, and fatigue. Some symptoms can also come from infection or irritable bowel syndrome. The first step is to alert the care team and check for infection. Treatment often changes only after infection is excluded.

Act now: the first 24 hours

1) Check for red flags
Seek emergency care now if any of these are present:
- Severe belly pain, rigid belly, or significant swelling.
- Vomiting that prevents fluids for more than 6 hours.
- Heavy rectal bleeding, passing clots, or feeling faint.
- Fever above 101°F with shaking chills.
- Heart rate above 120 beats per minute, or severe weakness.
- No urine for 8 hours, very dark urine, or dizziness when standing.
- For those with an ostomy, output over 1.5 to 2 liters in 24 hours with signs of dehydration.

2) Call the care team
- Use the patient portal or phone. Describe the number of stools, amount of blood, pain level, fever, and recent medicine doses.
- Ask for stool tests for infection, including C. difficile. Samples guide safe treatment.
- If a written flare plan exists, follow it. If not, wait for medical advice before starting steroids.

3) Protect hydration and rest
- Sip oral rehydration solution or electrolyte drinks. Aim for small, frequent sips.
- Choose soft, lower‑fiber foods for a short time if solid food is tolerated.
- Avoid alcohol and NSAIDs such as ibuprofen or naproxen. Acetaminophen as labeled is usually preferred for pain.

4) Medicines to continue or pause
- Continue maintenance therapy, including biologics, unless the care team advises a change.
- Do not skip or delay an infusion without checking first.
- Avoid starting leftover antibiotics or anti‑diarrheals unless a clinician says they are safe.

5) Start simple tracking
- Record each bowel movement, blood in stool, pain score, temperature, and fluids.
- Note missed doses, recent travel, sick contacts, and any new medicines.

The next 48 to 72 hours

• Complete stool tests. If an infection is found, treatment targets the germ, not the immune system.

• If infection is unlikely and symptoms remain moderate or worse, the team may adjust therapy. Plans vary by disease type:

• Ulcerative colitis: add rectal mesalamine or rectal steroids for urgency and bleeding.

• Crohn’s disease: consider targeted steroids such as budesonide for certain locations, or systemic prednisone if needed.

• If already on a biologic, therapeutic drug monitoring may help check levels and antibodies. This can guide dose timing or switching.

• Keep drinking fluids. Include salty broths and oral rehydration if diarrhea continues.

• Rest, use a heating pad, and pace activity. Short walks can reduce gas and stiffness.

When to use or avoid specific treatments

• Steroids can calm inflammation fast, but they carry risks. Many teams prefer stool testing first to rule out infection. Only start steroids when a clinician confirms the plan.

• Anti‑diarrheals may worsen severe colitis. Do not use them if there is fever, blood, or severe pain unless cleared by a clinician.

• Do not take NSAIDs for pain unless a clinician confirms they are safe. These can trigger or worsen flares in some people.

Clear red flags for emergency care

Go to the emergency department now if any apply:
- More than 6 bloody stools per day with fever, fast heart rate, or significant pain.
- Severe belly pain with bloating and no gas or stool, persistent vomiting, or green bile, which may signal a blockage.
- Signs of toxic colitis, such as severe tenderness, high fever, and sudden belly swelling.
- Fainting, chest pain, confusion, or inability to keep fluids down.
- For perianal pain with fever, new swelling, or drainage, which can mean an abscess.
- During pregnancy, any of the above or reduced fetal movement.

Special situations

• Pregnancy: involve obstetrics and gastroenterology together. Many IBD medicines are continued in pregnancy. Do not stop a medicine without advice.

• Children and teens: dehydration can develop quickly. Call the pediatric gastroenterology team early and use weight‑based oral rehydration if advised.

• Ostomy or J‑pouch: very high output, new nighttime leakage, or severe cramps need prompt evaluation. Loperamide or fiber supplements are sometimes used, but only with clinician guidance.

After the flare

• Confirm a follow‑up plan. This may include calprotectin stool testing, blood work, drug levels, or a scope when stable.

• Review triggers such as missed doses, recent infections, NSAID use, or high stress.

• Ask for a written flare plan. A good plan lists when to message the team, which tests to get, how to use rectal therapies, and when steroids are appropriate.

• Update vaccinations when well, and consider nutrition and mental health supports.

Quick action guide

FAQs

Should maintenance medicines be stopped during a flare?

In most cases, no. Maintenance therapy helps control inflammation. Skipping doses can worsen a flare. Ask the care team before changing any medicine.

Is it safe to start steroids at home?

Only if there is a written plan from the gastroenterology team. Steroids can mask infection and have side effects. Testing for infection first is often preferred.

When will symptoms improve after treatment changes?

Some treatments help in days, others need 2 to 8 weeks. If symptoms are not improving within a few days for moderate disease, contact the care team to reassess.