IBD Symptoms & Flare Recognition

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Inflammatory bowel disease, mainly Crohn’s disease and Ulcerative colitis, can cause symptoms that change over time. Some people have mild symptoms, while others may notice more noticeable problems during a flare. Recognising a change from your usual pattern can help you know when to consult a doctor.

Common Bowel Symptoms

Bowel symptoms are often the first noticeable signs of IBD. They can vary depending on the type of IBD, the area affected, and whether the disease is active. These symptoms can become more noticeable during a flare: 

Diarrhoea

Stool may become watery or very loose and can occur several times a day. Ongoing diarrhoea is more concerning when it is accompanied by blood, pain, fever, or weight loss.

Abdominal Pain And Cramps

Cramping can occur before or during bowel movements. You may feel soreness or sharp pain in the lower abdomen. It is usually caused by inflammation. The location and intensity can vary depending on which part of the digestive tract is affected.

Blood Or Mucus In Stool

Blood may appear as bright red streaks, mixed with the stool, or on the toilet paper, and it is common when inflammation affects the rectum or the lower part of the colon. Mucus may look like a clear, white, or slightly cloudy substance in the stool. It can occur when the lining of the bowel becomes inflamed. 

Urgency And Tenesmus

Urgency means having a sudden, strong need to pass stool that can be difficult to hold. It can happen when inflammation makes the rectum more sensitive. Tenesmus is slightly different. It is the feeling that you still need to pass stool even after you have already used the toilet, and it is painful.

Constipation

Although diarrhoea is more commonly associated with IBD, some people can also experience constipation. It may occur for different reasons, including inflammation of the rectum or narrowing of the bowel.

Whole-Body Symptoms

IBD does not only affect the digestive system. Ongoing inflammation can also affect how you feel more generally, especially when the disease is active. These symptoms can occur during IBD flare-ups:

Fatigue

Feeling unusually tired or drained even after getting enough rest. It can be related to inflammation, anaemia, poor sleep, or reduced nutrition.

Fever

A rise in body temperature can occur when inflammation is active, although fever can also have other causes such as infection.

Appetite And Weight Changes

Abdominal pain, nausea, or active inflammation may make you less interested in food, and unplanned weight loss may happen when appetite decreases, nutrients are not absorbed well, or symptoms make eating difficult.

Anemia

Blood loss or low iron levels can contribute to tiredness, weakness, dizziness, headaches, or breathlessness.

Joint Pain 

Some people with IBD develop pain, stiffness, or swelling in the joints, which can occur alongside or independently of bowel movements. It usually affects large joints or the spine.

Skin & Eyes Problem 

Some people may develop skin changes like rashes, nodules, lesions, ulcers, or painful, red eyes, and sensitivity as part of inflammation. 

Night-Time Symptoms

IBD may sometimes cause symptoms that disturb sleep, such as diarrhoea, sudden bowel movements, repeated trips to the toilet, or abdominal cramps. Some people may also experience fever or night sweats when inflammation is high. Night-time bowel symptoms can be a sign of active inflammation, especially when they are new or getting worse. 

Crohn’s And Ulcerative Colitis Symptom Patterns

Crohn’s and Ulcerative Colitis share many symptoms, including diarrhoea, abdominal pain, fatigue, and weight loss, but they often follow different patterns. In Crohn’s disease, abdominal pain may occur anywhere in the abdomen; it is often felt in the lower right side of the abdomen. Diarrhea may or may not contain blood, and symptoms can vary depending upon which part of the digestive tract is affected. Some people also experience mouth sores, anal pain or drainage, and problems such as fistulas or narrowing of the bowel. In ulcerative colitis, symptoms mainly involve the colon and rectum. Frequent diarrhoea with blood or mucus, abdominal cramps, a sudden urge to pass stool, and a feeling of incomplete bowel are common symptoms and may become more noticeable during flare-ups and settle during periods of remission. Both can also cause fever, reduced appetite, and tiredness when inflammation is active, but symptoms alone cannot confirm which type of IBD a person has.

What AN IBD Flare Means

An IBD flare is a period when inflammation in the digestive tract becomes active again, and symptoms worsen. It may cause diarrhoea, abdominal pain, cramps, blood or mucus in stool, urgency, tenesmus, fatigue, low appetite, or weight loss. The symptoms can vary depending on whether the person has Crohn’s disease or Ulcerative colitis and where the inflammation is located. Flares can be followed by periods of remission, when symptoms are reduced or absent. A change in symptoms does not always mean a flare-up, so doctors may use blood tests, stool tests, and other imaging or medical tests to check whether inflammation is active or not.

Common Flare Triggers And Look-Alikes

IBD symptoms can worsen for different reasons, and not every increase in symptoms means an actual flare. Some factors trigger or worsen inflammation, while other conditions can cause similar symptoms. Common flare triggers are: 

• Infections such as stomach or intestinal infections caused by viruses and bacteria.
• Missing or stopping medicines prescribed for IBD.
• NSAIDs or non-steroidal anti-inflammatory painkillers such as aspirin and ibuprofen.
• Certain foods which may worsen symptoms when they do not directly cause inflammation.
• Stress or poor sleep, which can make symptoms harder to manage.

Conditions That Can Look Like A Flare: 

• Gut infections causing diarrhoea or abdominal pain.
• IBS, which can cause bowel changes and cramps without active inflammation.
• Food intolerance, such as lactose intolerance.
• Medication side effects.
• Small intestine bacterial overgrowth.
• Bile Acid Malabsorption, particularly in some people with Crohn’s disease.

How To Track Symptoms

A simple symptoms diary or a dedicated IBD app can make it easier to understand how your symptoms change over time. You can track:

• Bowel Movements: How often you go and whether the stool has blood or mucus.
• Discomfort or Pain: Where it hurts, how severe the pain is, and how long it lasts.
• Medicines: Track down new medicines you started or any missed doses.
• Food and Routine: Note any major food changes, stress, or sleep changes around the time symptoms change or get worse.
• General Wellbeing: Whether symptoms are affecting sleep quality, work, studies, or normal activities

When To Contact The Care Team

You need to reach doctors if your symptoms are getting worse day by day or becoming more difficult to manage. You need serious medical care when: 

• Diarrhoea or abdominal pain is becoming more frequent or severe.
• Blood in stool is increasing or keeps coming back.
• You have frequent urgency or bowel movements, especially at night.
• You are losing weight without any changes in lifestyle or workout.
• Having painful sores in your mouth.
• You have a fever over 101 degree fahrenheit, unusual tiredness, or signs of dehydration.
• Your symptoms are not improving with ongoing treatment.
• Missed several doses or are having problems with medicines.

Emergency Warning Signs

Most IBD symptoms can be managed with routine medical care, but some signs need urgent medical supervision. These include:

• Heavy or ongoing bleeding from the rectum.
• Severe or rapidly worsening abdominal pain.
• A swollen or very tender abdomen.
• Repeated vomiting or inability to keep fluids.
• Severe dehydration, dizziness, or fainting.
• Severe fever or symptoms of an infection.
• Confusion, extreme weakness, or feeling seriously unwell.

Reference

Case-control study of factors that trigger inflammatory bowel disease flares - PMC

Inflammatory Bowel Disease (IBD) Basics

Presenting symptoms in inflammatory bowel disease: descriptive analysis of a community-based inception cohort - PMC

Inflammatory bowel disease | Office on Women's Health

What Is a Flare? The Manitoba Living With IBD Study - PMC

A113 WHAT IS A FLARE OF IBD? THE MANITOBA LIVING WITH IBD STUDY - PMC