Factors that Trigger the Inflammatory Bowel Disease Flare-up

October 28, 2021by Health Desk

Inflammatory Bowel Disease (IBD) is a lifelong condition. As seen with any autoimmune condition, in IBD there is a repeating cycle of flares or active disease that can last for days, weeks or even months, followed by periods of remission (when inflammation is controlled, and symptoms are absent).

The two main types of inflammatory bowel disease are Ulcerative Colitis and Crohn’s Disease. The exact causes of Crohn’s and colitis are not known but both are believed to be caused by immune dysfunction in genetically susceptible people.

A disease flare is a period of symptom activity and can include abdominal pain, stool changes, urgency, and loss of appetite, among other symptoms that are attributable to Inflammatory bowel disease (IBD)

Because of the nature of the disease, inflammatory bowel disease can have a profound effect on the lives of people affected and their families. Much of the day and night may be spent making trips to the restroom during a flare-up. The symptoms may cause pain, exhaustion, fatigue, and disturbed sleep.

There are several factors that can trigger a flare-up: medications [nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics], infections, travel, emotional stress, tobacco use, and poor adherence to prescribed medications.

Medicine Adherence

Poor adherence with prescribed medications

The best way to control IBD is by taking medications as recommended by your doctor. Missing doses or taking the medication incorrectly can worsen the inflammation. It is important to take prescribed medications, even when you are on remission, to keep your inflammation under control and prevent future flare-ups.

No Aspirin

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory medications such as aspirin, naproxen, and Ibuprofen are not recommended if you have inflammatory bowel disease (IBD). These medications can worsen your symptoms. NSAIDs can cause erosion, ulcer, and perforation of the gastrointestinal tract as side effects. NSAIDs can also cause colitis similar to IBD. If you need to take a pain reliever, acetaminophen (brand name, “Tylenol”) should not affect inflammatory bowel symptoms. Talk to your doctor about this.


In some circumstances, antibiotics can trigger a flare. Antibiotics influence the risk of disease development due to their effect on the microbiome. Please notify all your healthcare providers that you have inflammatory bowel disease before being prescribed any medications.



Anxiety and depression can worsen symptoms, such as abdominal pain and diarrhea, through activation of the gut-brain axis. When the brain receives stress input, multiple pathways are activated. This causes alterations in gut microbiota, the release of inflammatory mediators, and disruption of the intestinal barrier.

Infections of the gastrointestinal tract

C. Difficile Infection and Cytomegalovirus Infection can cause symptom flares due to inflammation and immunosuppression. Your doctor may check for these in your stool if you experience symptom flares. 


For some people with IBD, certain foods can make symptoms worse.  If this happens to you, your doctor might suggest avoiding those foods for a while to see if you improve. If you do avoid certain foods, your doctor may suggest taking supplements.

No smoking

Cigarette smoking

It is particularly important to avoid (or quit) smoking if you have IBD, especially Crohn’s disease. Smoking can lead to more severe symptoms, more frequent flares, and an increase in the risk of needing surgery. More recent studies suggest flare due to smoking is mediated through oxidative stress. Oxidative stress is a disturbance in the balance between free radicals causing damage to cells and antioxidant defenses. There may also be lower amounts of interleukin-8 (IL-8), IL-10, and IL-23. Interleukins are proteins that play an important role in inflammation.

Reasons why flare-up occurs due to various factors

Flare-Up Factors Infographic

Most of these risk factors are modifiable. You can address them to reduce the occurrence of future flare-ups.

Some of the ways to modify the risk factors include:

  • Adherence to all your medications. Even if you feel better, do not stop taking your prescribed medications. If the medications are not working for you, talk to your healthcare provider as they may change the medication or adjust the dose.
  • Do not smoke. If you do smoke, stop smoking. Ask your doctor for assistance in stopping this habit.
  • Reduce stress. Take frequent breaks from work or adopt flexible working hours. Surround yourself with people and belongings that make you feel better. You can also join support groups. Additional ways of combating stress are deep breathing, yoga, meditation, talk therapy and cognitive-behavioral therapy.
  • Before being prescribed any medications, make sure you notify all healthcare providers, including your dentist, about your condition. Check with your doctor before taking any counter medications.
  • To identify foods that may be causing symptoms, keep a log or diary of all food and beverages you consume. Over several weeks, record exactly what you eat, including ingredients and quantities. During this same time period and for a time after, record the occurrence and duration of any health symptoms. Look for information and patterns.

The first thing you must do when you experience a flare is contacting your doctor. Your doctor will assess you, and look for a cause and way to treat the flare. His goal is to help you alleviate your symptoms and improve your health.