This topic is about understanding what a Crohn’s flare feels like after having an ileostomy. The person who started the discussion has had an ileostomy since 2009 and is curious about how others recognize a flare now that their colon is no longer present. They are interested in learning about the sensations, changes in stoma output, pain patterns, and other signs that indicate a return of disease activity.

Here are some insights and advice shared by others:

1. Common early signals of a flare with an ostomy include:
- A sudden increase in stoma output or activity without any dietary changes.
- The return of sharp cramps, loud bowel noises, and extreme fatigue that feels like all energy is drained.
- Doctors often confirm a flare through blood tests.

2. Pain descriptions and patterns:
- Pain can feel like labor contractions or stabbing sensations, coming and going in waves.
- It may start in the center and spread outward, with knee pain occurring at the same time.
- Pain from fibrotic strictures (scar tissue) appears in the same spot about an hour after eating, is constant, and may cause a visible bulge. Flare pain is sharper, migratory, and intermittent. A combination of both usually requires emergency room care and treatment with IV steroids and Flagyl.

3. Output changes during a flare:
- The output may become very foamy and fill the pouch quickly, increasing the risk of multiple "blow-outs."
- Loud, gurgling sounds from the stoma are common.

4. Distinguishing between a flare and post-surgical scar-tissue obstruction:
- Stricture or obstruction pain is localized and triggered by meals, while flare pain is more diffuse and wave-like.
- Imaging and surgical history can help differentiate between the two; persistent obstruction signs should be evaluated in a hospital.

5. Fatigue and general malaise:
- Feeling overwhelmingly tired, as if "hit by a truck," or extremely unwell is common.
- Maintaining a positive outlook can help, as flares, although difficult, are temporary.

6. Medication experiences:
- The person who started the discussion is using weekly Humira (adalimumab).
- Others have reported needing increased opioid pain-patch dosing during severe flares.
- One member has found that Pentasa (mesalamine) has prevented flares.
- Hospital treatment for severe episodes often includes IV steroids and Flagyl (metronidazole).

7. When to seek medical care:
- Immediate ER attention is advised for signs of obstruction, such as severe pain, no output, and pronounced bulging, or when experiencing combined flare and stricture symptoms.