7 Key Facts About Colds and Flu if You Have Ulcerative Colitis
People with ulcerative colitis are more susceptible to the common cold and flu for several reasons, including having to take medication that suppresses the immune system.
Anyone can catch a common cold or flu, but when you have ulcerative colitis (UC), you may be more susceptible to both. Inflammatory bowel diseases (IBD) like Crohn’s disease and UC can disrupt your immune system’s ability to protect you, which can lead to an increased risk of infections like colds or flu, says Asad Rahman, MD, a gastroenterologist with Cleveland Clinic in Florida.
Many people with UC get the flu each year. In one study of more than 1.6 million people with IBD, the flu was the most common vaccine-preventable disease that caused a serious infection.
Beyond the effects of UC itself, the medications you take for this condition can also increase your infection risk. “Some UC medicines, like steroids or biologics, calm the immune system down so it doesn’t overreact, [which] can also make it harder for your body to fight germs like cold or flu viruses,” says Andrew Dam, DO, a gastroenterologist at Pomona Valley Hospital Medical Center in Pomona, California.
The good news is, you have plenty of options for preventing and treating a nasty cold or flu when you have UC. Here are seven key facts to know.
1. You Can Prevent Colds and Flu With Frequent Handwashing
Most people get a cold or flu virus by breathing in droplets from someone else’s cough or sneeze, or by touching an object that has the virus on it and then touching their mouth, eyes, or nose. But, when you wash your hands with soap and water for at least 20 seconds, you scrub away any germs lingering there.
“I always recommend regular handwashing, avoiding touching your eyes or nose, and avoiding biting fingernails or putting fingers in your mouth,” says Jill Gaidos, MD, a gastroenterologist at Yale Medicine in New Haven, Connecticut, who also suggests staying away from others who are sick to protect yourself.
You can use hand sanitizer in a pinch, but it doesn’t work on all germs and isn’t as effective on greasy or visibly soiled hands. Dr. Dam recommends wearing a mask in crowded places, cleaning surfaces like phones and keyboards often, and supporting your immune system with good nutrition and sleep.
2. If You Have Cold or Flu Symptoms, Tell Your Gastroenterologist Immediately
If you notice the common symptoms of a flu or cold, let your gastroenterologist know right away. “Because your immune system isn’t as strong, an ordinary flu could turn into a bigger problem,” says Dam. The flu can cause symptoms including:
Fever
Chills
Sore throat
Cough
Stuffy or runny nose
Body aches
Headaches
Feeling exhausted
Colds can cause similar symptoms, but symptoms are typically milder and have a lower risk of complications than the flu.
“I advise my patients to keep me informed if they develop a viral infection,” says Dr. Rahman. With either illness, by getting help early, you can prevent complications and sometimes treat the virus itself.
3. Your Gastroenterologist May Tell You to Pause Your Medications
If you have a mild cold, your gastroenterologist probably won’t adjust your UC treatment. But for more serious infections, your immune system may need a break from suppressing UC medications.
“In some cases, we may need to temporarily hold their immunosuppressive medications, particularly during active infection, hospitalization, or complications from bacterial superinfection,” says Rahman.
4. You May Have a Higher Risk of Cold and Flu Complications
Because UC causes the immune system to malfunction, and its treatment involves lowering your ability to fight infections, a virus can do more damage to your body if you have the condition. “Patients with UC are at increased risk of hospitalization from influenza because of their immunocompromised and immune-dysregulated state,” says Rahman.
Common flu complications can include sinus and ear infections, pneumonia, and inflammation of the heart, brain, or muscles. In extreme cases, flu can lead to organ failure and a life-threatening reaction called sepsis. It can also worsen other conditions like asthma and heart disease.
Adults with UC ages 65 and older have an even higher complication risk because of their age, especially from the flu, says Dr. Gaidos.
5. You Need a Flu Shot Every Year — but Not the Nasal Spray
The best way to protect yourself against the flu is by getting a flu shot every year. Gaidos recommends older adults in particular get a high-dose flu vaccine during flu season. “[But] anybody with UC should get an annual flu shot,” she says.
Some flu vaccines, like the nasal spray, contain live influenza virus and aren’t the best choice for people with UC. “UC patients, particularly those who are immune-suppressed, should receive the flu shot, which contains portions of a combination of flu viruses that are not alive,” says Gaidos.
You need a flu shot every year because it loses its effectiveness over time. The influenza viruses floating around your community also change every year, and infectious disease experts constantly update the vaccine to fight the flu as it mutates. So, by getting vaccinated each year (ideally in September), you’ll have the best chance of preventing flu and its complications.
6. Cold and Flu May Not Cause UC Flares, but You Should Still Take Extra Care
Some research suggests that viruses, especially chicken pox, hepatitis C, and human papillomavirus (HPV), could trigger a UC flare for some people. “[But] infections with the cold or flu do not cause a UC flare,” says Gaidos.
Some people stop taking their UC medications while they are sick with a cold or flu, but it’s vital to check with your provider before doing this, says Gaidos. “[Stopping your medications] is usually unnecessary and can result in an exacerbation of [UC] symptoms.”
If you have a cold or flu, Dam recommends taking it easy and getting plenty of rest. “Stay hydrated with water, broth, or tea, and eat easy-to-digest foods so your gut isn’t stressed,” says Dam.
7. Both Antiviral Meds and Home Remedies Can Improve Cold and Flu Symptoms
Most cold and flu infections go away on their own, but you may be offered antiviral medications like oseltamivir (Tamiflu) to treat influenza.
“I recommend drinking plenty of liquids, getting rest, and then addressing other symptoms (cough, congestion, sore throat) with over-the-counter cold and flu therapies,” says Gaidos. She also suggests hot tea with honey to help relieve a sore throat.
Dam’s go-to home remedies for cold and flu with UC are to drink warm fluids for comfort, use a humidifier for easier breathing, and eat foods gentle on the stomach, like rice, bananas, applesauce, and toast. Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen unless your doctor says it’s okay, because they can irritate the gut, says Dam. “Let your body rest — healing takes energy,” he says.
The Takeaway
When you have ulcerative colitis, you carry a higher risk of catching a cold or the flu and developing complications from them.
You can help prevent cold and flu by washing your hands often, wearing a mask in crowds, avoiding people who you know are sick, and getting a flu vaccine every year.
If you have a cold or the flu, you may be treated with antiviral medication, but you can also ease symptoms with home remedies like a humidifier, warm fluids, and plenty of rest.
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Resources
Craviotto V et al. Viral Infections in Inflammatory Bowel Disease: Tips and Tricks for Correct Management. World Journal of Gastroenterology. 2021.
Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.
Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.
She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.
Abby McCoy is an experienced registered nurse who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She is a married mother of four and loves the circus — that is her home! She has family all over the world, and loves to travel as much as possible.
McCoy has written for publications like Remedy Health Media, Sleepopolis, and Expectful. She is passionate about health education and loves using her experience and knowledge in her writing.
