Guide to managing an IBD Flare: My Crohn’s and Ulcerative Colitis

• Opening your bowels more than normal
• Loose stool for more than 3 days
• Mild and new abdominal pain
• Small amounts of bleeding from your bottom
• Blood in your stool
• Loss of energy and/or appetite and generally feeling worse

The following tests are useful to help us decide the best treatment for you:

Blood Tests	Stool Samples
Full blood count, liver function tests, urea and electrolytes, and CRP	Ask your GP for a faecal calprotectin test to provide a sample to check for gut inflammation

If you are taking the following types of medication, you may be able to bring your symptoms under control without needing to consult your doctor.

Mesalazine tablets or granules or 5-ASA (5-aminosalicylate)

Different types of mesalazine (5-ASA) are released in your bowel differently, having slightly different effects.

You may be prescribed the following to be taken daily in divided doses (min. – max. dose range):

Octasa® (1.2g-2.4g to 4.8g per day)
Pentasa® (2g to 4g per day)
Asacol® MR (1.2g-2.4g to 4.8g per day)
Mezavant® XL (2.4g to 4.8g once daily)
Salofalk® (1.5g to 3g per day)

If you have no history of renal (kidney) problems, then increase your brand of mesalazine to the maximum dose.

Your symptoms should improve in 1–2 weeks and settle in 4–6 weeks. Then you can 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-ASAs or Steroids)

These are medicines that are inserted or squeezed into your bottom. If you have a supply of these at home, start these as well as increasing your 5-ASA tablets, as above.

It is safe to take these every night during a flare to help control symptoms 

Steroid Tablets 

You should NOT start taking steroid tablets without discussing it 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):

• Starting dose is usually 40mg a day reducing by 5mg a week to 0mg (i.e. 8 week course)
• Each tablet contains 5mg of prednisolone so you will usually take 8 tablets initially
• Please discuss bone protection with your GP or IBD team whilst on steroids. Other steroids have differing dosages e.g. budesonide (MMX®) and beclomethasone (Clipper®)

If steroids work for you, your symptoms should improve within a few days but you should continue to take the full course.

Please inform your IBD team if your GP prescribes steroids

If you are not better after 3 days of starting steroids or your symptoms become worse, please contact your IBD team or GP. If you are taking prednisolone this cannot be stopped.

Immunosuppressants and biologic subcutaneous medicines (self-injectable)

It is NOT SAFE to adjust the dose of immunosuppressants or biologic drugs without the medical advice of your IBD Team. Do not increase any of your other medication.

If you are on immunosuppressants or biologics and you have symptoms of an infection (e.g. flu, chest infection, skin infection) or have been started on antibiotics for infection, ask your IBD Team or GP for advice. Then go to step 4

020 3447 5120 
Leave your name, DOB, telephone number and MRN or NHS Number 

The advice line is a voicemail service managed by our Clinical Nurse Specialists (CNS) Monday-Friday (closed bank holidays and weekends). They aim to respond to your call within 2 working days.

You can call the advice line to let the CNS team know the outcome of steps 1–3 – this helps your IBD team make treatment decisions and/or order further investigations.

If the IBD Advice Line service is closed, contact our Gastroenterology admin team via 0203 456 2060, selecting option 1 for IBD.

Crohn's and Colitis can affect parts of the body outside the gut both during and between flare-ups. Talk to your IBD Team or your GP if you are experiencing any of the following health issues. Symptoms can include:

• Swelling, redness and/or irritation of the eyes
• Joint pain and/or swelling
• Mental health problem
• Mouth ulcers
• Skin rashes
• Fatigue

All medicines have a risk of side effects. If you develop any of these side effects while taking your medication, please contact your GP, local Urgent Care Centre, ring 111 or attend your local A&E.

• Chest pain or rapid heartbeat
• Pain in the middle of the abdomen
• Nausea or vomiting
• Yellowing of the skin (jaundice)
• Dark urine
• Sore throat
• Unexplained bleeding, bruising or skin rashes
• You feel depressed or your moods are going up and down
• You feel confused, irritable, anxious, have suicidal thoughts or difficulty sleeping

Please attend your local A&E if you have signs of an allergic reaction and inform your IBD Team once any urgent side effect or allergic reaction has been treated. These could include:

• Hives (itchy rash on the skin)
• Wheeziness or difficulty breathing
• Swelling of the face, lips, tongue or throat

More information can be found in your medicine packet page.

Support options available on the Crohn’s and Colitis UK website.

Guts UK also has support resources, including “can’t wait cards” for those with a digestive condition who need to use the toilet urgently.

You can also contact your local pharmacist for further support in managing your IBD.

See our page Inflammatory Bowel Disease Service for Adults for more information.