Pepto bismol for colitis

Tackling an Ulcerative Colitis Flare

If your ulcerative colitis (UC) symptoms suddenly worsen, you could be experiencing a flare. A flare involves painful cramping, bloody diarrhea, fever, and nausea, and it can be the most stressful part of living with this unpredictable disease.

Although doctors don’t know exactly what causes a flare or how to predict one, there are some triggers that you can avoid:

  • Lapses in treatment. “One of the most common reasons for a flare is forgetting to take medications or not taking them appropriately,” says Richard Desi, MD, a gastroenterologist with the Institute for Digestive Health and Liver Disease at Mercy Medical Center in Baltimore. Another possibility is that the medication you’ve been taking has stopped working and needs to be changed.
  • Mixing medications. Antibiotics as well as over-the-counter pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) and Aleve (naproxen) have also been linked to flares.
  • Stress. Many people with ulcerative colitis associate stress with a flare. Although there is not a lot of research that proves stress causes a flare, doctors agree that stress reduction can be helpful.
  • Food. Some people associate certain foods such as raw fruits and vegetables and fried, greasy food with causing ulcerative colitis symptoms. Doctors recommend keeping a food journal to see if certain foods trigger a reaction.

“But sometimes flares just happen without any particular reason,” Desi adds. “A flare can last a few days to several months.”

When to Call Your Doctor About a Flare

Flares come with different levels of intensity. You may be able to manage a mild flare-up of symptoms on your own. But a more severe flare may be a warning sign of an ulcerative colitis complication that needs immediate attention.

Theodore J. Saclarides, MD, director of the Division of Colon and Rectal Surgery at Loyola University Health System in Chicago, suggests calling your doctor if you have any of these ulcerative colitis symptoms:

  • Severe abdominal pain that lasts more than 24 hours
  • A decrease in bowel movements along with abdominal pain
  • Abdominal pain with a high fever
  • Blood during a bowel movement that is too thick to see through

Your UC Flare Management Plan

Your doctor may help you deal with a flare by changing your medications or offering new ones. “Treatment of flares can include mesalamine products and usually a steroid, such as prednisone,” says Desi.

There are also some things you can do at home to temper a flare. These include:

  • Eating well. Pay close attention to what you’re eating during a flare. Foods that are high in fiber, like fruits and vegetables, should be cooked, not eaten raw. Drink plenty of fluids, but not alcohol and caffeine. And be careful to avoid greasy and gas-producing foods, which can worsen your ulcerative colitis symptoms.
  • Soothing the burn. Frequent diarrhea can lead to anal irritation and even infection. You can fight this by using sanitary wipes after bowel movements and by taking frequent, warm saltwater baths or sitz baths. Ask your doctor to recommend a protective or antibiotic ointment to put in the bath.
  • Taking over-the-counter medications. Medication you can get at your pharmacy like Pepto-Bismol may help control diarrhea. Many doctors recommend Tylenol (acetaminophen) as the safest medication for ulcerative colitis pain, but check with your physician before taking any medication.
  • Relaxing. Find ways to manage stress, whether it’s through meditation, mild exercise, yoga, deep breathing, or just reading a good book. A study published in March 2014 in the journal Digestion found that stress management practices can improve the quality of life for people with ulcerative colitis by reducing the negative effects of a flare.
  • Planning ahead. The last thing you want is to have ulcerative colitis symptoms while you’re far from a bathroom. Know where the restrooms are whenever you leave the house and have an emergency change of underwear with you just in case. By joining the Crohn’s & Colitis Foundation of America you’ll get a “Can’t Wait” card for access to any available bathroom.
  • Enlisting support. Make sure you have a support system to help you. Ask for help from a close friend or relative who understands what a flare is all about and can lend a hand or emotional support. Many people also benefit from joining an ulcerative colitis support group, either in person or online.

During an ulcerative colitis flare, it’s recommended to schedule regular visits to see your doctor, at least once every three months until the symptoms go away. After the flare has subsided, physicians recommend one or two checkups a year to manage the disease.

When an ulcerative colitis flare strikes, you have options for getting your life back on track. It’s important to learn what you can about maintaining your quality of health and work with your doctor to find the best ways to safely control UC. And remember to always let your doctor know when new or persistent symptoms arise.

Additional reporting by Michael H. Wilson

Ulcerative Colitis

Ulcerative Colitis Outlook

Ulcerative colitis is a chronic, systemic inflammatory disease manifesting in the colon. Intensity of this condition varies greatly from person to person and during a lifetime. Some patients may have an initial episode and then go into remission for a long period, some may have occasional flare-ups, and some others may have ongoing disease. Although there is no cure, ulcerative colitis patients require ongoing medical care, and must adhere to a proper nutrition and medication regimen, even when things appear to be going well. Your physician will work with you to create an appropriate treatment plan, and will monitor your disease regularly, even during periods of remission.

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Diagram Credit: © Jan Kowalczewski

Ulcerative Colitis: Tips for Dealing with Flares

Corticosteroids are among the most helpful agents that doctors have to stop a flare. Prednisone and budesonide are two examples. Steroids aren’t always effective, but they are usually the best agents to try first during a severe flare.


There are six main categories of medication used for treatment, some long term and others short term. These include:

  • 5-aminosalicylates (5-ASAs). There are multiple types of 5-ASA drugs, and they get released in different parts of the gastrointestinal tract. 5-ASAs aim to reduce inflammation directly in the colon wall.
  • Tofacitinib (Xaljanz). This is a newer medication in a class called Janus kinase inhibitors. It works in a unique way to reduce inflammation.
  • Steroids. These help to suppress immune system inflammation. They can be given systemically (by mouth or intravenously) or as enemas.
  • Immunomodulators. These work on the immune system by modifying its activity to reduce the inflammatory response. They include medications such as azathioprine or methotrexate.
  • Antibiotics. These are used because infections often contribute to flares.
  • Biologics. These work on the immune system by inhibiting the inflammatory protein TNF-alpha. They include infliximab (Remicade), adalimumab (Humira), and certolizumab (Cimzia).

Lifestyle changes

Certain lifestyle changes can also help reduce the intensity and frequency of UC flares.

There’s a link between emotional stress and the severity of UC flares. Stress relief techniques such as hypnosis and meditation may improve symptoms. Other healthy options are yoga, aerobics, and static exercises.

While having chronic diarrhea can be annoying, there are ways you can manage it. Apply soothing pads or diaper rash cream to the area as needed. You should also monitor what you eat.

Fiber can be tough on people with UC, because eating it can have unintended consequences. Normally, it helps maintain regularity, but it may not be helpful for treating diarrhea. On the other hand, an anti-diarrheal may be useful if you’re certain that you don’t have a bacterial infection of the bowel.

How I Got My Ulcerative Colitis Under Control

I was diagnosed with ulcerative colitis in 1999. I was in graduate school when I began feeling sick. I was losing weight, and all of a sudden food did not agree with me. I was constantly running to the bathroom—sometimes 20 to 25 times a day.

I knew I needed help so I went to see a gastroenterologist. When my gastroenterologist figured out what was going on, he wanted to admit me to the hospital as soon as possible. I explained that I wanted to finish my last semester of graduate school and that finals were less than one week away. I struggled through finals week and as soon as I finished my last one, I was admitted to the hospital the next day. I dont think I realized how sick I was.

After my initial admission, I was in and out of the hospital and was on and off prednisone for a few years. Unfortunately I had some bad reactions to the first medications that I was given, but I began to improve. Presently there is no specific cause of ulcerative colitis, but there are many things that can trigger a flare-up. Stress played a part in aggravating my symptoms while I was in graduate school.

I had to make some major lifestyle changes. I learned to have a plan and be prepared; now I always know where the bathrooms are when I go out. My doctor told me that I actually have a relatively mild version of ulcerative colitis. I had no idea how bad this disease could be. Even with a mild case, I had to use the bathroom dozens of times a day before I got the disease under control.

I take medication every day
I have been in remission for about eight years. I have a flare-up here and there, but nothing like the symptoms I had immediately before and after being diagnosed. A flare-up can occur at anytime out of the blue. I can feel fine one minute and then realize my stomach has a mind of its own and I have to run to the bathroom.

Prior to my last episode, I had my gallbladder removed. The doctors said it was so inflamed that they couldnt do the minimally invasive surgery and I had to have the more invasive type of surgery in which they open up your abdomen. The good news is that I found that my ulcerative colitis really improved after the surgery.

My ulcerative colitis is now under control with the help of 10 pills I take daily, as well as changes in my diet. I watch what I eat and go to the gastroenterologist every six months. I am active and healthy and I know much more about the things that trigger ulcerative colitis flare-ups, and how to avoid them.

Next Page: It all works together It all works together; I know how food affects me, Im really good about taking my medicine, I exercise and get a good nights sleep. It sounds healthy, but its a lifestyle thats necessary, not optional.

I have to admit though that Im not happy about having to take medication indefinitely. Every six months when I go to the doctor, I ask if I can stop taking them; he says no. He reminds me how sick I was and how the medications are helping to keep me healthy. Medications are really just part of my life now. I take them with breakfast, lunch, and dinner.

The Crohns and Colitis Foundation of America has been a rock-solid source of support for me since I was diagnosed. I have volunteered at the overnight camp for kids with Crohns disease and ulcerative colitis, as well as a number of events that occur throughout the year. Most recently I have been active in events that help raise money and awareness for Crohns disease and ulcerative colitis.

Now I raise funds for research
I am open about having ulcerative colitis and I do think that with greater awareness, people feel free to talk about this condition more than they have in the past. It is not something thats easy or fun to discuss, but I think it helps to be open and honest.

Nowadays I focus on spreading greater awareness about Crohns disease and ulcerative colitis and work on fundraising to find a cure for these two devastating conditions. In February 2008, I committed to participate in the Crohns and Colitis Foundation of Americas 16-week endurance-training program called Team Challenge.

Team Challenge allows participants to raise money and awareness, as well as train to walk or run a half-marathon. The Team Challenge half-marathon (13.1 miles) is a great way to get the word out. Each participant has a minimum fundraising goal to achieve. At first I was very nervous about the fundraising aspect of the program. I was not sure how I was going to reach my minimum goal of $3,800. However, within 3 1/2 weeks I surpassed my minimum, raising almost $8,500 for my first Team Challenge in Napa Valley, Calif.

To get started, I sent letters to everyone I knew and explained my condition. A lot of people knew I had ulcerative colitis when I was hospitalized, but a lot of others didnt.

Team Challenge was an amazing experience and I decided after successfully fundraising and walking 13.1 miles in Napa that I wanted to participate in Team Challenge–Kona Hawaii, which was in June 2009. My fundraising goal this time was $10,000. Again I solicited family and friends and this time I included businesses and restaurants. I also had a few fundraisers, including a pancake breakfast at a local restaurant and an event at a local bar. I raised more than $12,000 while successfully completing the half-marathon as a run/walk.

Now, Im a national mentor and I just returned from my third Team Challenge event in Las Vegas. I didnt want to ask my family and friends for financial support because it was so close to Team Challenge–Kona, so I decided to go to Wal-Mart.

I stood in front of the store with a can (with Wal-Marts permission). It turned out to be a wonderful experience. I met so many people who either had ulcerative colitis or shared information about the condition. One girl who had just been diagnosed with ulcerative colitis told me her whole story and cried. I got her email address and later sent her information to the CCFA. She said she was amazed that a complete stranger would reach out to her. She had been so sick; she hadnt wanted to leave her house the day we talked.

I think Im helping to make a difference. Ulcerative colitis has altered my life and I want others to know they can reach out and find great support systems like the CCFA.

Treatments for lymphocytic colitis

What is lymphocytic colitis?

Lymphocytic colitis is a type of microscopic colitis, a condition characterized by chronic non-bloody watery diarrhea. People with lymphocytic colitis have a normal appearing bowel when assessed by an endoscope (a camera used to look at the bowel) or an X-ray; but have microscopic (histological) inflammation of the bowel when assessed by a biopsy (a tissue sample taken during endoscopy). The cause of this disorder is unknown. This review is an update of a previously published Cochrane review.

What treatments have been tried for lymphocytic colitis?

Budesonide, mesalazine with or without cholestyramine, beclometasone dipropionate and bismuth subsalicylate (i.e. Pepto-Bismol®) have been tried as treatment for lymphocytic colitis. Budesonide is an immunosuppressive steroid drug that is quickly metabolized by the liver resulting in reduced steroid-related side-effects. It is taken by mouth. Beclometasone dipropionate is also a steroid drug. Steroid drugs are used to treat inflammation. Mesalazine (also known as 5-ASA) is an anti-inflammatory drug which is often taken by mouth. Cholestyramine is a drug that helps the body remove bile acids. Pepto-Bismol®, is an antacid medication used to treat temporary discomforts of the stomach and gastrointestinal tract.

What did the researchers investigate?

The researchers investigated whether these drugs improve the symptoms of lymphocytic colitis (e.g. diarrhea) or microscopic inflammation and whether any side effects result from treatment. The researchers searched the medical literature extensively up to 11 August 2016.

What did the researchers find?

Five studies including 149 participants were identified. These studies assessed budesonide versus placebo (e.g. a sugar pill), mesalazine versus mesalazine plus cholestyramine and beclometasone dipropionate versus mesalazine and Pepto-Bismol® versus placebo. The study which compared mesalazine to mesalazine plus cholestyramine and the study which compared beclometasone dipropionate to mesalazine were judged to be of low quality. The study which compared Pepto-Bismol® bismuth subsalicylate to a placebo was judged as low quality due to a very small sample size (5 participants) and limited data. The other three studies were judged to be high quality.

A pooled analysis of two studies (57 participants) showed that budesonide (9 mg/day for 6 to 8 weeks) was superior to placebo for improvement of diarrhea and improvement of microscopic inflammation of the bowel. Improvement in diarrhea was noted in 88% of budesonide participants compared to 38% of placebo participants. Improvement in microscopic inflammation was reported in 78% of budesonide participants compared to 33% of placebo participants. Forty-one participants were enrolled in the study that compared mesalazine (2.4. g/day) to mesalazine plus cholestyramine (4 g/day). Improvement in diarrhea was noted in 85% of participants in the mesalazine group compared to 86% of participants in the mesalazine plus cholestyramine group. Five patients were enrolled in the trial studying Pepto-Bismol® (nine 262 mg tablets daily for 8 weeks versus placebo). There were no differences in improvement of diarrhea or in improvement of microscopic inflammation of the bowel. Forty-six participants were enrolled in the trial studying beclometasone dipropionate (5 mg/day or 10 mg/day) versus mesalazine (2.4 g/day). Although participants receiving beclometasone dipropionate (84%) and mesalazine (86%) had improved diarrhea at 8 weeks, this improvement was not maintained at 12 months (26% and 20%, respectively). Side effects reported in the budesonide studies include nausea, vomiting, neck pain, abdominal pain, excessive sweating and headache. Side effects reported in the mesalazine plus cholestyramine study included nausea and skin rash. Side effects in the beclometasone dipropionate trial included nausea, sleepiness and change of mood. No side effects were reported in the Pepto-Bismol® study.

Low quality evidence suggests that budesonide may be an effective therapy for the treatment of lymphocytic colitis. Low quality evidence also suggests that mesalazine with or without cholestyramine and beclometasone dipropionate may be effective for treatment of lymphocytic colitis. No conclusions can be made regarding bismuth subsalicylate due to the very small number of participants in the study. In the future, researchers should consider further large placebo-controlled trials of budesonide to confirm the suggested benefit and safety of this therapy. Bismuth subsalicylate, which has less potential for toxicity than budesonide, also warrants further study. The effectiveness and safety of mesalazine with or without cholestyramine, and beclometasone dipropionate need to be investigated in a large placebo-controlled studies.

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