Managing a flare-up of IBD symptoms
It can be difficult to live with or support someone with inflammatory bowel disease, along with getting the right help and information. From time to time, you may have a flare-up. This is when symptoms come back and you feel unwell.
Everyone experiences flare-ups differently. Your symptoms may also change over time. Flare-ups can last anywhere from a few days to several months and you may have different symptoms during a flare-up to when you were first diagnosed.
What to do if you have a flare-up between appointments
You can access the advice line during weekdays (except Bank Holidays) which is an answer-phone service for patients or their relatives/carers to leave a message. We will try and respond to your call within 72 hours. Please be aware this is not an emergency service, and it is important to remember that if you are very unwell, or need urgent medical attention, then please contact your GP, 111 or go to A&E.
Messages left on the advice line are picked up several times a day and patients who are having flares or require repeat prescriptions will be prioritised.
- York Hospital: 01904 726154
- Scarborough Hospital: 01723 236323
When leaving a message, please speak slowly and clearly and include the following information:
- Name
- Hospital number or date of birth
- A brief reason for your call
- The best time to call you back
We will try and contact you up to three times. This may not be on the same day. If we still cannot reach you after the third attempt, we will assume you no longer require any advice.
Please note that there is no email service available.
More help from Crohn's and Colitis UK: Crohn’s and Colitis UK Helpline (crohnsandcolitis.org.uk).
Managing a Crohn's or colitis flare-up
People with Crohn's disease and ulcerative colitis have times when they experience few symptoms (remission) and times when symptoms flare up (relapse). It is important to tackle a flare-up quickly to stop it getting out of control. You should follow the steps below if you are having a flare-up.
Step one: Identify if it's a flare-up
Do you have any of the following signs of a flare-up?
- Pooing more frequently than usual
- Loose poo for more than three days
- Mild abdominal pain
- Small amounts of bleeding from your bottom/blood in your poo
- Generally feeling worse, loss of energy and appetite
Step two: Get tested
These tests are useful to help decide on the best treatment for you:
- Blood tests: FBC, LFTs, U&E, CRR
- Poo samples: Poo samples to check for infection - M,C&S and C.Diff. If you are not seeing blood, a faecal calprotectin can check for gut inflammation
Contact your IBD team via the advice line and leave a message to ask for relevant forms and pots or see your GP to discuss tests.
Step three: Adjusting your medications
If you are taking the following types of medication, you may be able to control your symptoms without consulting your IBD team or GP:
5-ASA (5-aminosalicylate) or Mesalazine tablets or granules
Types of 5-ASAs differ in dose and are released in your gut in slightly different ways. You may be prescribed the following to be taken daily in divided doses:
- Salofalk (1.5g-3g per day)
- Asacol MR (1.2g-2.4g to 4.8g per day)
- Octasa (1.2g-2.4g to 4.8g per day)
- Mezavant XL (2.4g to 4.8g per day)
- Pentasa(2g to 4g per day)
If you have colitis and no history of kidney disease, it is safe for you to take the maximum does of your 5-ASAs as above. Your symptoms should improve in one to two weeks and settle in four to six weeks. You can then reduce your 5-ASAs to your usual maintenance dose
If your symptoms do not improve, please contact your IBD team or GP.
Suppositories or enemas (5-ASA or steroid)
These are medicines that are inserted or squeezed into your bottom. If you have a supply of these at home, start these and increase your 5-ASA tablets as above. It is safe to take these every day during a flare-up to help control symptoms
Steroid tablets
You should NOT begin taking steroid tablets without having a conversation with your IBD team or GP. Steroids should be reduced gradually over a few weeks and not stopped suddenly.
If your GP has prescribed you steroids (prednisolone):
- Inform your IBD team
- Starting dose is usually 40mg a day for two weeks, then reduced by 5mg each week to 0mg (i.e. over nine weeks)
- Each tablet contains 5mg of prednisolone, so you will usually take eight tablets initially
- Please discuss bone protection with your GP or IBD team whilst on steroids
- Other steroids have different dosages (e.g. budesonide (MMX) and beclomethasone (Clipper))
If steroids work for you, your symptoms should improve within a few days. If your symptoms improve, please continue to take the full course.
If you are no better after three days of starting steroids or your symptoms become worse, please contact the IBD team or your GP.
Immunosuppressants and biological medicines (self-injecting or tablet)
It is not safe to adjust the dose of immunosuppressants or biologic drugs without medical advice from your IBD team.
Immunosuppressant drugs include:
- Azathioprine
- Mercaptopurine
- Methotrexate
- Upadacitinib
- Ozanimod
- Tofacitinib
- Filgotinib
- Etrasimod
Self-injectable biologic drugs include:
- Adalimumab
- Golimumab
- Infliximab
- Vedolizumab
- Ustekinumab
- Risankizumab
Step four: Call the IBD advice line if you are still having problems
York advice line: 01904 726154
Scarborough advice line: 01723 236323
The advice line is a voicemail service and our IBD Nurse Specialists will aim to respond to your call within 72 hours.
Call the advice line and let us know the outcome of steps one to three above. This will help the IBD team make treatment decisions and/or order further investigations.
When leaving a message, please speak slowly and clearly and include the following information:
- Your name
- Your date of birth or hospital number
- A brief reason for your call
- The Best time to call you back
This is not an emergency service. If you are very unwell or need urgent medical attention, please contact your GP, 111, or go to A&E in a life-threatening situation.
