When patients with ulcerative colitis (UC) experience a flare-up, they can endure severe pain, discomfort, and fatigue. At their worst, the symptoms of a UC flare can require immediate medical attention.

As UC is a chronic condition, patients need education on how to mitigate symptoms and keep inflammation down. There are a number of factors that can play a role in worsening a UC flare that your patients should know about for their health and quality of life. As their health care professional, what are some notable factors you can share with them?

  1. Medication

The medications a patient takes can play a role in the likelihood and severity of a UC flare. In particular, pain relievers like nonsteroidal anti-inflammatory drugs (NSAIDs) are strongly associated with flares.¹ Antibiotics may also create a flare risk, as they can change gut bacteria. Patients with UC that are getting flares triggered by NSAIDs or antibiotics should speak with their physician about potential substitutes.

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Medication withdrawal has also been shown to increase the risk of a flare, particularly withdrawal from steroids.¹ Skipping days and weeks, or generally not taking medication as prescribed, also has the potential to cause a UC flare.²

  1. Stress and Smoking

As ulcerative colitis is an autoimmune disease, stress is a major factor and can cause a UC flare to be made even worse.³ Stress can stimulate the immune system, which can lead to inflammation and increase the risk of a flare-up.

Stress may also increase the likelihood of cigarette use. Research about smoking and UC has yielded mixed results, with some studies suggesting that nicotine could have a positive effect on the disease due to it lessening inflammation.⁴ However, this has not been fully established and researchers caution that even with evidence of its anti-inflammatory effects, the harmful consequences of smoking would make it an unsuitable treatment. Other research has suggested that cigarettes actually increase the risk of UC and flare triggers.²

  1. Diet

While dietary choices can play a role in UC flare-ups, every patient is unique and can have different dietary triggers. If you have patients with ulcerative colitis, it may be a good idea to discuss foods that often give them discomfort or inflammation, to help create a more beneficial diet for them.

There are certain food and drink that these patients are generally recommended to avoid, including¹:

  • Spicy foods
  • Caffeine
  • Alcohol
  • Fried foods
  • Carbonated beverages
  • Foods high in fiber
  1. Family History

A November 2021 study published in Cureus examined ulcerative colitis flare-ups and patient characteristics to try and determine potential triggers for flares.⁵ The researchers found a number of factors that correlated with a higher probability of recurrent flares, such as depression and being underweight. A family history of UC, however, had some of the greatest risk for recurrent flares. Their research also suggested that the risk of developing UC was higher if both parents had it.

  1. Air Pollution

In a 2013 study in Current Gastroenterology Reports, researchers looked at potential environmental triggers for inflammatory bowel diseases, including UC.⁶ Of the triggers they examined, one they found that could be a contributing factor to ulcerative colitis risk was air pollution. Their research found that criteria pollutant emission correlated with an increased rate of UC hospitalizations, and that increased exposure to certain pollutants increased the risk of early UC in patients less than 25 years old.


1. Klein E. What to know (and do) about ulcerative colitis flare-ups. Healthline. https://www.healthline.com/health/ulcerative-colitis-take-control-dealing-with-flares. Updated August 20, 2021. Accessed January 25, 2022.

2. Managing UC flare-ups. Crohn’s & Colitis. https://www.crohnsandcolitis.com/living-with-crohns-uc/ulcerative-colitis/flare-ups. Accessed January 25, 2022.

3. Higuera V. Ulcerative colitis and stress: what’s the link? Healthline. https://www.healthline.com/health/ulcerative-colitis-stress. Updated July 24, 2019. Accessed January 25, 2022.

4. Whelan C. Ulcerative colitis and smoking: does it really help? Healthline. https://www.healthline.com/health/ulcerative-colitis-and-smoking. Updated May 13, 2021. Accessed January 25, 2022.

5. Malibary NH, Ezzat MA, Mogharbel AM, et al. Factors affecting ulcerative colitis flare-ups: associations with smoking habits and other patient characteristics. Cureus. 2021;13(11):e19834. Published 2021 Nov 23. doi:10.7759/cureus.19834

6. Ananthakrishnan AN. Environmental triggers for inflammatory bowel disease. Curr Gastroenterol Rep. 2013;15(1):302. doi:10.1007/s11894-012-0302-4

This article originally appeared on Gastroenterology Advisor