Symptom Diary in IBD: Improve Your Ulcerative Colitis or Crohn’s Care

What is a symptom diary?

So-called symptom diaries are daily records that the patient himself/ herself fills in to record the evolution of their illness, including aspects such as the presence or absence of symptoms, their intensity, and his/her response to various interventions.

There are various ways of keeping a symptom diary, from simple physical supports such as a notebook or calendar, to digital supports, such as easy and intuitive mobile applications¹ designed specifically for chronic disease monitoring that simplify disease tracking conveniently from a smartphone.

It is important to keep a daily record, so the patient can use different resources or methods that are easier for him/her to carry out, for example, if a notebook is used, try to always leave it in the same room.

And above all, it should be remembered that a symptom diary in no way replaces the close relationship that should exist between doctor and patient.

Usefulness of a symptom diary

Keeping a symptom diary is very useful for managing chronic conditions, especially those with flare-ups . This record allows:

1. Improve communication with your doctor. A diary provides detailed and objective information on the evolution of the disease. This helps your doctor make a more accurate diagnosis and assess your response to treatment and thus adjust it effectively. If new symptoms, worsening or significant changes are detected, it is essential to report them to your doctor as soon as possible.
   
2.  Minimize flares . Although most flare-ups are unrelated to anything the patient has done, some factors have been identified that can trigger a reactivation of the disease such as²: stressful life events, infections, interruption or incorrect dosing of medications, or recent use of certain medications such as nonsteroidal anti-inflammatory drugs or antibiotics. Recording this information in a diary allows preventive measures to be taken to reduce the likelihood of flare-ups.
   
3. Identify triggers and patterns. Keeping a diary allows you to recognize which factors that can provoke or aggravate symptoms, such as specific foods, emotional disturbances, lack of sleep or changes in routine and smoking or alcohol use.
   Identifying these factors helps to avoid them and, consequently, to reduce the frequency and intensity of symptoms, leading to remission or reduction of the disease. It also helps determine whether lifestyle changes are having a positive impact on the disease.

4. Self-awareness and empowerment. Keeping a symptom diary is an exercise in honesty. This helps people better understand themselves and their bodies better. It allows them to take a more active role in their treatment, improve their emotional well-being, and cope with their illness with greater confidence.

How to keep a symptom diary?

Keeping a symptom diary doesn’t need to be overly complicated. But the more details you record about the onset, intensity, and duration of symptoms, the easier it is to adjust treatment effectively. Further enquiry into habits, lifestyles, how patients react to their environment and stimuli provides invaluable information for fine-tunning and optimizing IBD treatment, as any information, no matter how small, can be relevant.

Below are some of the key elements suggested for consideration in a symptom diary ³:

1. Symptoms and their evolution

• Type of symptom: Abdominal pain, bleeding, diarrhoea, fatigue, among others.
• Intensity: Use a scale of 1 to 10 to indicate severity.
• Frequency: Number of daily bowel movements, frequency of outbreaks and episodes of rectal bleeding.
• Duration: Record how long symptoms persist and at what time of day they are most intense.
• Whether the symptom is constant or fluctuates.

For greater accuracy, it is helpful to note the date and time of onset of symptoms, as well as describe in detail how they affect you emotionally and physically.

2. Triggers and relief generators

• Situations or foods that worsen or improve symptoms .
• Consumption of alcohol, tobacco, beverages and types of food eaten.
• Physical exercise, medication and stress levels.
  

3. Impact on daily life

• Daily challenges: Sleep problems, refusal of social engagements, avoidance of pleasurable activities, loss of sexual desire, absences from work or school.
• Mood: Anxiety, irritation, helplessness, embarrasement, among others.
  

4. Other symptoms and complications

• Changes in appetite, nausea, or weight changes.
• Additional complications: Problems with skin, joints, liver, eyes, etc.
  

5. Treatment and evolution

• Use of medication and its effect on symptoms.
• Improvement, worsening or no change in the disease.
• Main concerns about treatment or symptoms.

For example^4, the next time a patient suffers a flare-up, they can review their diary and perhaps discover that their stress levels have been increasing each time their symptoms have flared up, which will help them consider whether to incorporate stress-reducing techniques into their daily routine.

Ultimately, keeping a detailed symptom record helps optimize treatment and improve patients’ quality of life. But remember, it is not a replacement for a medical consultation.

• Hamilton MJ. The Use of Mobile Applications in the Management of Patients With Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2018 Sep;14(9):529-531. PMID: 30364254; PMCID: PMC6194659.
• Singh S, Graff LA, Bernstein CN. Do NSAIDs, antibiotics, infections, or stress trigger flares in IBD? Am J Gastroenterol. 2009 May;104(5):1298-313; quiz 1314. doi: 10.1038/ajg.2009.15. Epub 2009 Mar 31. PMID: 19337242.
• CROHN’S & COLITIS FOUNDATION
  https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/ibd-symptom-tracker.pdf
• https://www.healthline.com/health/ibd/ibd-journal#benefits