Most people who have inflammatory bowel diseases (IBD) like Crohn’s disease and ulcerative colitis don’t have symptoms all the time. Usually, there are periods when there is no sign of illness. This is called remission. At some point the symptoms usually return. Doctors call this a relapse or flare.

No-one knows for sure what causes IBD in the first place, or what causes flares in patients who have IBD, but are in remission. Recent research at the University of Manitoba has found that most of the things that were suspected causes don’t seem to cause flares at all. These include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs). There are many of these. They are used to treat pain and inflammatory diseases like arthritis. Some of them need a prescription, but others can be bought over the counter. Common NSAIDs include aspirin, ibuprofen, Aleve and Celebrex. Although this study doesn’t support this association, there are other studies that do suggest indeed NSAID use can lead to a flare. Most physicians feel that a few NSAIDs used intermittently is ok, but a patient with IBD would want to avoid regular use of these drugs if possible.
  • Antibiotics. These drugs are prescribed for many different kinds of infection.
  • Infections. Many kinds of infections, especially gut infections, were thought to cause flares, but this does not seem to be the case. More research is needed to be sure about how infections affect people with IBD as other studies suggests an infection can lead to a flare.

Stress causes flares

Stress can have a negative effect on health. It can make inflammation worse. Anxiety and stress can cause a lack of sleep which can stop the immune system from working properly. IBD is a condition caused by immune system problems and inflammation, so stress can make the problems that lead to IBD even worse.

It is not easy to measure stress, because we all react differently to stressful situations. For instance, losing your job can be very stressful, but it will probably cause more stress to someone who has a family to support than to a young person who still lives at home. Some people have a more positive attitude than others, and may feel less stress in a difficult situation than a pessimist.

  • We now know that people who feel very stressed about big events in their lives have almost 2 ½ times more chance of having a flare than people who do not feel stressed.

What does it mean to me?

If you suffer from IBD, you certainly want to avoid flares. This means taking the right medication and avoiding anything that is likely to make your disease active. At the same time, you don’t want to make changes that don’t help to keep you healthy. If you can reduce your chance of having flares by avoiding stressful situations in your life. If you can’t avoid them, you can still help yourself by taking stress management training, and learning how to deal with difficult events without getting badly stressed.

Bernstein CN, Singh SS, Graff LA et al. A Prospective Population-Based Study of Triggers of Symptomatic Flares in IBD. Am J Gastroenterol 2010; 05:1994-2002