UC Extensive/Pan-colitis – plan for managing flare

Managing a flare, a step by step plan.

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Managing a mild to moderate flare

1. Recognise your symptoms

You might be having a mild to moderate flare if:

• You are going to the toilet 2 to 5 times in 24 hours OR noticeable increase from usual.
• There are small amounts of blood in your poo.
• You feel urgency but can control it.
• You can still eat and drink normally.
• Your symptoms aren’t disturbing your sleep.

2. Start treatment at home

• Use 1g mesalazine suppositories at night.
• Use 1g mesalazine enemas at night if needed.
• Take your oral mesalazine at the highest dose prescribed (e.g. Octasa 4.8g per day, Salofalk granules 3g per day, Pentasa 4g per day).
• Contact your GP for more medication if needed.

3. Review your progress after 2 weeks

If you are getting better: Continue increased treatment until you’re feeling better, and then for a further 4 to 6 weeks. Then gradually reduce (over a few weeks) to your usual daily dose.

Continue mesalazine when well to help stay in remission.

If you are NOT getting better:

Continue increased treatment and contact the IBD helpline:

You may need a course of steroids (oral or rectal). Your IBD team will advise next steps.

Managing a severe flare

1. Recognise your symptoms

You might be having a severe flare if:

• You are going to the toilet 6 or more times in 24 hours.
• There are large amounts of blood in your poo.
• You cannot control urgency/bowels.
• You have abdominal pain.
• You are losing weight.
• Your symptoms are disturbing your sleep.
• You have a fever.

2. Get in touch

Call the IBD helpline straight away

3. Start treatment at home

• Use 1g mesalazine suppositories at night.
• Use 1g mesalazine enemas at night if needed.
• Take your oral mesalazine at the highest dose prescribed (e.g. Octasa 4.8g per day, Salofalk granules 3g per day, Pentasa 4g per day).
• Contact your GP for more medication if needed.

You may need a course of steroids, your IBD team will advise next steps.

Side effects

If you are experiencing side effects from any of this medication tell your team straight away via the IBD helpline.

Knowledge is power

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Know your flare triggers

• Certain things may worsen symptoms – avoid these if you can.
• Common triggers include alcohol, certain foods, and stress, but everyone is different.

Diet

• Try to eat a healthy and balanced diet.
• Don’t skip meals to try to control symptoms.
• Don’t make big changes to your diet or cut out whole food groups unless advised to by a healthcare professional.

During a flare

• Try eating small meals more regularly.
• Drink plenty of fluids.
• Temporarily reduce the amount of fibre you eat.
• Take a look at our ‘Diet and IBD’ section on our website.

Stress and fatigue

• Try to make time to rest, relax and move your body.
• If stress or fatigue feels overwhelming, seek help. Take a look at our ‘General info for IBD’ section on our website.

Staying safe

Medication safety

• Do not stop or change any IBD treatment without speaking to a healthcare professional. Always let your IBD team know about any changes.
• If you are prescribed steroids, let your IBD team know as soon as possible.
• Avoid NSAIDs like ibuprofen, aspirin, diclofenac and naproxen as these can worsen gut inflammation.

Infection precaution

• If you get an infection (e.g. cold, flu, COVID), take a look at our ‘Active Infections’ section on our website.

Be prepared

• Get a ‘Can’t Wait!’ card and RADAR
• key to access disabled toilets.
• Take a look at our ‘General info for IBD’ section on our website.

If you have any questions or concerns contact