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Beginner questions - what is a flare? What is remission?

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Ulcerative Colitis
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Posted 5/2/2016 2:50 AM (GMT 0)
Hello,
I am new to colitis and new to the board. I have been reading for a few months with interest and finally joined.

I will ask my question and then give a bit of a background.

How do I know if I am in a flare? I have the sense that I have been in a mild flare, off and on, since October 2015. Some blood, some mucus, urgency in the morning. Semi-formed bm. Usually 3/4 times a day. Does that sound like a flare?

Then, I will go for a week or two feeling mostly normal. No urgency, only 1 bm a day, formed, no blood. Is that remission? Wouldn't it last a bit longer?

I had a sigmoidoscopy last month and have follow up next week, but in the meantime, what does this all mean?

Will it just take me longer to know what a flare is for me and what remission is.

Thanks so much, I look forward to your expertise.

Background: Diagnosed with UC just before my second pregnancy in 2012. Have had a few mild (I think) flares since. Never been on anything stronger than salofalk suppositories and enemas. Attempting a modified paleo diet. Have also tried: mutaflor, other probiotics, etc. Am very interested in alternative therapies (worms, FMT) and terrified of steroids. Currently breastfeeding.
Posted 5/2/2016 8:22 AM (GMT 0)
Hi there, like you this is all very new to me...diagnosed less than a year ago. Initially I was just so grateful it was not bowel cancer, and now trying to learn and understand what this UC actually is.

Everyone seems to understand it but like you I am quite confused.

At worst, was bleeding up to 12 times per day, quickly sorted with enemas and medication. Lost over a stone yet never eaten so much in my life!

My confusion is around flares and remission. How do we know if we are in remission or if it is being controlled by meds?

Thank you

UC newbie and confused...
Posted 5/2/2016 10:47 AM (GMT 0)
Clinical remission would be absence of inflammation and ulcers in the colon as seen by a scope. Symptomatic remission is a little more individual. In Remission you will not see blood or urgency or large amounts of mucous (small amounts of mucous can be normal)

You mentioned going 3-4 times a day...how is this compared to prior diagnosis? When I'm in remission, I have 1 solid bm a day no urgency, no blood.

For me 1-2 solid bms with no pains, normal smelling gas, no cramping and living a normal life without fear of an accident tell me I'm in remission. Over the past 2 years I've had chunks ranging from 6-11 months of symptomatic remission but we've yet to get me to full clinical remission, though we've been close.

Feel free to reach out with lots of questions. This board is great for newly diagnosed people.

I understand your fear of steroids, they aren't great. For me, they often give me a sense of a normal life while waiting for maintenance meds to work. Have you considered uceris? It's a far less agressive steroid.
Posted 5/2/2016 11:45 AM (GMT 0)
Ulcerative colitis is a chronic illness characterized by periods of remission (where there are no uc symptoms) and periods of flares (where symptoms return in full force). If your uc is well controlled then your remissions should be long and your flares should be infrequent, short, and mild.

What are flares? Flares can vary from severe enough to warrant hospitalization, to very mild simmering states, to anywhere in between. I've been simmering (4-6 semi-formed bms a day with a lot of urgency) which means untreated inflammation remains and it impacts your quality of life (you can limp by but uc causes accidents and much anxiety). I've been flaring with 20 plus bms within a 24 hour period where I was essentially house bound and miserable. Every flare is different.

I'm currently in histological remission (also known as complete/deep remission), as confirmed by biopsies, and I have one normal, solid bm per day without blood, urgency or mucus. Uc has no impact on my daily life, I can forget about uc. I'm 1.5 years into this remission, some have been in it 8 years or more. Remission should last over a year and be steroid free.

If you're still struggling then get aggressive in treating your uc. Ask your gastroenterologist about increasing your doses, adding new medications. All we have is quality of life with chronic illness. You don't want to miss out on everything due to suffering from horrible uc symptoms.
Posted 5/2/2016 3:02 PM (GMT 0)
I would say any period defined by on again off-again symptoms while there was underlying inflammation was a flare.

I would say the short intermissions some people get where symptoms clear up for a few days to a few weeks are not remission. Likely the underlying inflammation has not changed greatly.

IF you get absence of symptoms for an extended period, and the absence of inflammation is confirmed by a scope, then this is true medical remission, and other uses of "remission" might have been better described as a period of relief.
Posted 5/4/2016 2:03 PM (GMT 0)
Thank you all. Great information and helping me tell the difference.

I think part of it (for me) also might be denial. I have a few days of bad smelling gas and chalk it up to something I ate, rather than UC again. And usually it is uc again.

I get so down on the idea of being on medication for life (though I already am on synthroid for life due to being thyroid-less), so I guess I had better just suck it up.
Posted 5/4/2016 2:15 PM (GMT 0)
Has your doctor suggested oral mesalamines? I think they're allowed while breastfeeding and might help as well.

As for diet, some of us do find it helps, but requires a lot of tinkering and can be difficult to find the right balance.
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