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How do you know the difference between a stomach bug and a flare

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Ulcerative Colitis
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Posted 7/24/2021 10:41 AM (GMT 0)
Woke last Sunday feeling very bloated, was due my period so didn't think too much about it.
Monday was uneventful.
On Tuesday I had a normal bm in the morning but after lunch got some stomach pain and ended up having some diarrhoea.
No bms at all on Wednesday but my stomach wasn't really great, still bloated etc.
On Thursday I was actually a bit constipated when I tried to go in the morning, I had a second bm at lunch that was formed but after dinner everything seemed to go down hill, stomach cramps followed by watery diarrhoea throughout the rest of the day and into the early morning.
Friday no bms though I haven't eaten much as my stomach feels sore.
Had a small breakfast this morning and a formed bm with maybe a little mucus when I wiped. My stomach is still very tender and noisy.
I have inserted 2 Pentasa suppositories this morning just in case it is a flare but I'm not sure how you tell the difference, should I just treat it as a flare until things settle? I'm just not too sure how to proceed.
Any feedback would be appreciated.
Posted 7/24/2021 2:39 PM (GMT 0)
Ms2011--- Look up the most common side effects of Pentasa (Mesalamine). I've had many of these side effects until I finally stopped taking it and won't ever take it again.--- Try Imodium (loperamide HCL) for common diarrhea. But check with your doctor first.
Posted 7/24/2021 3:43 PM (GMT 0)
Do not take imodium.
Call your GI for a stool testing kit.

q
Posted 7/24/2021 3:45 PM (GMT 0)
Personally I'd ask for a faecal calprotectin test to get an idea of how much (if any) inflammation there is, if I had early symptoms of a flare. A hard, bloated stomach can be a warning sign of an imminent flare up for me.

Faecal calprotectin isn't specific for IBD though, so can be raised with gastroenteritis, so if you have a bug it might not help you differentiate.

I recently had a nasty bout of viral gastroenteritis while I was also flaring with UC, but because many people around me also had gastroenteritis and exactly the same set of quite specific symptoms I knew I had it.

If no-one else around you has stomach bug symptoms I'd assume it's more likely to be UC and get a faecal calprotectin test done.
Posted 7/24/2021 3:50 PM (GMT 0)
MS2011 - PS interesting that you have an isolated caecal patch of UC. I have a patch at my caecum as well as patchy UC in general.

I find that my symptoms can vary widely depending on which areas of my colon are inflamed at the time.
Posted 7/24/2021 3:57 PM (GMT 0)
I'll add the usual...ask for rectal meds as well add probiotics and try fibre supplements.

Anything different in the food or supplement choices since it started?

q
Posted 7/24/2021 4:33 PM (GMT 0)
Thanks for the replies.
My son (9) wasn't feeling great on Thursday, sore tummy and multiple formed bms but is fine now. My husband says he feels 'off' and has no appetite but is able to go about his day, my daughter (6) is fine.
I can ask for a CPR test but I won't get through to anyone over the weekend.
I take 6 Psyllium Husk capsules a day. I have 1g suppositories and steroid foam here, should I use these while waiting, I tried to use the foam on Thursday but my colon was so upset it wasn't keeping it in but I retained the suppositories this morning fine.
My stomach is so tender at the moment I can't even tell if I'm hungry or not.
Posted 7/24/2021 5:24 PM (GMT 0)
I would definitely ask for a stool test but also a COVID test. One of my neighbors had COVID but only had GI symptoms and felt tired.
Posted 7/24/2021 5:39 PM (GMT 0)

Ms2011 said...
Thanks for the replies.
My son (9) wasn't feeling great on Thursday, sore tummy and multiple formed bms but is fine now. My husband says he feels 'off' and has no appetite but is able to go about his day, my daughter (6) is fine.
I can ask for a CPR test but I won't get through to anyone over the weekend.
I take 6 Psyllium Husk capsules a day. I have 1g suppositories and steroid foam here, should I use these while waiting, I tried to use the foam on Thursday but my colon was so upset it wasn't keeping it in but I retained the suppositories this morning fine.
My stomach is so tender at the moment I can't even tell if I'm hungry or not.

Hmmm well the gastroenteritis that's been doing the rounds in London had the following symptoms:
- Not much vomiting or diarrhoea
- Loss of appetite and nausea
- Stomach pain / soreness (we had to use Gaviscon for this, and I still feel a bit wary of acidic foods about 8 weeks later)
- Initial phase lasts for about 10 days
- It comes in waves so you think you're getting better, then get another wave of nausea
- Then comes the post infectious IBS that can last for about 3 weeks

Loads of people I know have had it and we were independently starting to worry about what was wrong with us, till I spoke to my IBD team and they confirmed this nasty bug is going round. The symptoms feel quite different to the usual 24 to 48 hour gastroenteritis.
Posted 7/24/2021 5:52 PM (GMT 0)

momto2boys said...
I would definitely ask for a stool test but also a COVID test. One of my neighbors had COVID but only had GI symptoms and felt tired.

I did wonder myself if the gastro I had might be Covid related because the symptoms were so odd but I didn't get a PCR test done, and people I know who had the bug had negative lateral flow tests at the time.

I also wondered if the virus causing the gastroenteritis evolved to become stronger as its spread was limited due to lockdown, ie the reverse of how viruses tend to evolve. They tend to sacrifice strength for the ability to spread.

https://www.smithsonianmag.com/science-nature/how-viruses-evolve-180975343/

Whatever happened it was a nasty bug. Everyone I know who's had it has been ill for a lot longer than you'd usually expect with gastroenteritis.
Posted 7/24/2021 6:22 PM (GMT 0)

UCyousee said...

Ms2011 said...
Thanks for the replies.
My son (9) wasn't feeling great on Thursday, sore tummy and multiple formed bms but is fine now. My husband says he feels 'off' and has no appetite but is able to go about his day, my daughter (6) is fine.
I can ask for a CPR test but I won't get through to anyone over the weekend.
I take 6 Psyllium Husk capsules a day. I have 1g suppositories and steroid foam here, should I use these while waiting, I tried to use the foam on Thursday but my colon was so upset it wasn't keeping it in but I retained the suppositories this morning fine.
My stomach is so tender at the moment I can't even tell if I'm hungry or not.

Hmmm well the gastroenteritis that's been doing the rounds in London had the following symptoms:
- Not much vomiting or diarrhoea
- Loss of appetite and nausea
- Stomach pain / soreness (we had to use Gaviscon for this, and I still feel a bit wary of acidic foods about 8 weeks later)
- Initial phase lasts for about 10 days
- It comes in waves so you think you're getting better, then get another wave of nausea
- Then comes the post infectious IBS that can last for about 3 weeks

Loads of people I know have had it and we were independently starting to worry about what was wrong with us, till I spoke to my IBD team and they confirmed this nasty bug is going round. The symptoms feel quite different to the usual 24 to 48 hour gastroenteritis.

I'm just across the pond in Ireland.
I had no vomiting, the diarrhoea I had was unlike UC diarrhoea I've had in the past which tends to involve urgency and then explosion (sorry tmi), this was more like when you take the prep for a scope where it comes out like turning on a tap!!!
Definitely no appetite though I've just had some pasta and chicken and my stomach feels a little better, the sore stomach is definitely the worst of it, I'm walking hunched over because it hurts so much.
Ugh, why is nothing ever straightforward with this disease!!!
Posted 7/24/2021 7:40 PM (GMT 0)
That definitely sounds like it could be the bug to me! I only vomited once at the start, and the nausea, loss of appetite, and gnawing stomach pain were the worst symptoms. As I'm in an active flare up I had to rely on the symptoms of others regarding the diarrhoea side, and as I mentioned, many of them have had post infectious IBS for weeks.

Yes, definitely tough having UC, let alone having UC plus gastroenteritis!!
Posted 7/24/2021 7:52 PM (GMT 0)
If I were you I'd probably treat it as though I probably have the nasty bug, but it could be the start of a UC flare, or both together, by making sure I'm taking my UC medication regularly, including rectal meds perhaps, as well as the following:

- Taking a probiotic due to the possible bug
- Avoiding or limiting lactose as it's harder to digest when you have a bug or UC flare up (or taking lactase enzyme)
- Avoiding or limiting caffeine as it stimulates the bowel
- Avoiding chilli as it irritates - but I doubt your stomach can take chilli atm!
- Eating bland food due to the bug (all of the people I know who had it had the gnawing stomach pain)

Maybe give it 10 days to see if your stomach improves before you get a faecal cal. My IBD team said there was little point doing it while I had the bug as it would show inflammation.

Trust your instincts, and if in doubt get checked!
Posted 7/24/2021 9:40 PM (GMT 0)

UCyousee said...
If I were you I'd probably treat it as though I probably have the nasty bug, but it could be the start of a UC flare, or both together, by making sure I'm taking my UC medication regularly, including rectal meds perhaps, as well as the following:

- Taking a probiotic due to the possible bug
- Avoiding or limiting lactose as it's harder to digest when you have a bug or UC flare up (or taking lactase enzyme)
- Avoiding or limiting caffeine as it stimulates the bowel
- Avoiding chilli as it irritates - but I doubt your stomach can take chilli atm!
- Eating bland food due to the bug (all of the people I know who had it had the gnawing stomach pain)

Maybe give it 10 days to see if your stomach improves before you get a faecal cal. My IBD team said there was little point doing it while I had the bug as it would show inflammation.

Trust your instincts, and if in doubt get checked!

Thank you, I appreciate your input.
Stomach is feeling alot better since eating something but is still grumbly.
I used the steroid foam I have here before bed just to err on the side of caution, my thinking is it can't do any harm.
Fingers crossed things will continue improving.
Posted 7/25/2021 10:48 AM (GMT 0)
MS2011, personally I'd take Mesalazine enemas and suppositories before I'd take rectal steroids because despite foam enemas being non-systemic I do find I get some steroid side effects from them. We're all different though.

Also if you do only have a caecal patch I guess there's no rectal inflammation to treat!

Do you have an IBD nurse you can contact for advice? I contact my IBD nurses whenever I'm not sure about something as they're good at giving advice when they can and involving my consultant when they need to.
Posted 7/25/2021 4:58 PM (GMT 0)

UCyousee said...
MS2011, personally I'd take Mesalazine enemas and suppositories before I'd take rectal steroids because despite foam enemas being non-systemic I do find I get some steroid side effects from them. We're all different though.

Also if you do only have a caecal patch I guess there's no rectal inflammation to treat!

Do you have an IBD nurse you can contact for advice? I contact my IBD nurses whenever I'm not sure about something as they're good at giving advice when they can and involving my consultant when they need to.


I've done the suppositories in the morning and foam before bed so far, I don't have any enemas to hand at the moment.
Little bit better today, stomach a little less tender and actually felt hungry this morning but still very swollen and bloated.
I do have an IBD nurse who will be back in work tomorrow so I might contact her if I'm not seeing any improvement especially after Tuesday when I'm due my next Humira injection.
Posted 7/26/2021 1:17 AM (GMT 0)
It's hard to know the difference but I suppose tests are the best way to differentiate. Calprotectin, stool, or scope. I always hoped for a bug personally but it was always inflammation in my case. I agree with the others about the mesalamine rectals but a short course if steroids rectals isn't terrible if it works. Best of luck!
Posted 7/26/2021 8:57 AM (GMT 0)
Formed bm this morning so either the bug is passing or the meds are working.
Stomach still tender but eating small amounts helps, hopefully things are improving.
Posted 8/1/2021 1:04 AM (GMT 0)
Good to hear you're starting to feel better!

My guess, based on the stomach tenderness is that you either had the bug, or the bug + the start of a UC flare.

My stomach is just about getting back to normal 2 months after I caught the bug. As I said before, it was much stronger than any gastroenteritis I've had before.
Posted 8/8/2021 7:19 PM (GMT 0)
Yes feeling back to normal, just back from a week long family holiday and all was good.
Still not 100% sure if it was a bug or not but either way I'm feeling better, glad you are feeling better too.
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