Flare? Diarrhea strangeness...

Help me understand if this is a flare!

After managing a months-long flare last year, I finally got to the point where things were calm. My problem is that my flares have appeared about annually since 2017. Mucus and gas are the first signs of a flare. Most come under control with mesalamine enemas. Last year I needed a 7-day course of steroids to get me to the point where the enemas could start to work. The concern my GI and I have is, is the Humira really working if I need to be doing the enemas so frequently. My last contact with my GI before she left the practice was, “Keep monitoring the gas, call me if you get worse and we’ll get you in for a colonoscopy before I leave.” (I was still complaining of stinky and uncomfortable gas and very mild and occasional mucus, but nothing terrible.) However, I actually improved a bit in terms of gas and the mucus cleared up. My appointment with a new GI is in May.

For the past two months the gas has been bad, but no mucus. I’ve had really normal BMs (heaven!) and zero urgency. Four weeks ago I’d had enough with the gas so I changed my diet to see if I could make it better (limited dairy, no beans, cut back on some processed food, started Phasyme pills). It kinda worked - I had some days of zero symptoms. Last Sunday, boom, diarrhea out of the blue. Crazy gurgling noises after lunch. And it hasn’t stopped. I’ve had some small formed BMs but it’s most liquid. Gas still here, smell is worse. Not much urgency, weirdly? However, I’m having cramping pain but in a place I rarely have had it before. I’m a left-sided colitis-er, so cramping for me is usually towards my side. This is transverse, up high between my diaphragm and belly button, and this is also where all the gurgling noise and sensations originate. At one point during the week I felt so terrible I took my temperature to see if I had a fever (I did not).

I was convinced it was a bug or bad food until Thursday, when I finally realized I may be in a flare, although mine have never started like this. I have a history of C Diff (including pseudo colitis) and these symptoms are similar, but with quarantine I can’t think of where I might have picked that up. I’ve done two nights of enemas so far.

Since I’m in limbo with doctors, I wanted to post here and get your thoughts. Flare? Anything else I can do or try? Words of reassurance or solidarity? Thanks!

No, mesalamine enemas are my first step and I try to only escalate to steroid enemas if needed. Not sure I have a current script for steroid enemas right now...

I discontinued Florastor during my diet change just to see if that might be exacerbating things. Other than that, the diet changes were a major decrease in cheese/dairy (milk replaced with almond milk), cut wine intake in half, and a slight increase in veggies, but nothing I haven’t tolerated well in the past.

The feelings and noises are reminiscent of colonoscopy prep. That said, today is quiet post-lunch with only minor cramping this morning.

The enema regimen to date has only been when flaring. The GI who just left and I discussed maintenance but they were equivocal about it - they felt the Humira and methotrexate should control. Because it seems they might not be, we were talking about trying a new biologic, but since I wasn’t actively flaring we hadn’t gotten to that point when they left the practice.

Fiber supplements and my gut do not get along, unfortunately. I’ve tried them at various times over the past 20 years, both pre and post diagnosis, and they cause more problems than they solve. I do get a fair amount of fiber from my diet: oatmeal with raisins, whole grain cereal with raisins, or fruit smoothie for breakfast; lunch is usually vegetarian - sandwich or wrap or salad, piece of fruit or two (I try to space lunch out into smaller meals for gas-reduction purposes); dinner is meat/veg/starch or a hearty soup. Snacks are a mix of terrible-for-you (fig Newtons, crackers) and somewhat-better (dried sweetened fruit pieces, chocolate covered almonds). Pre diet experiment, there would be a decent amount of cheddar cheese sprinkled in there. ;) And I’m a very active person, so I have a set of 3-4 products to fuel workouts that have been agreeing with my gut for years.

So, probiotics: Florastor has been on my menu for years because of the C Diff. It also seems to be the favorite of the GIs in my area, as I know others who get the same recommendation. What is the advantage of a broader one, gas reduction or flare prevention?