Is a severe UC flare with diarrhea and bleeding an emergency?

Question

Hi doctor,

I am a 42-year-old woman. I have been living with extensive ulcerative colitis for the past seven years. Last week, my diarrhea suddenly increased to almost ten times a day, accompanied by bright red blood. In a panic, I started taking Prednisolone 40 mg based on a previous prescription I had at home, although I realized I probably should not have self-started the medication. It is now day four, and the frequency of diarrhea has not improved. Additionally, I have a low-grade fever.

At what point does this situation become an emergency? Should I go to the hospital for IV steroids? I am also worried about the possibility of toxic megacolon, and I find myself overthinking everything. How quickly should I expect to see improvement from the steroids?

Please help me.

Answer 1

Hi,

Welcome to icliniq.com.

I am deeply concerned about your worries.

Your symptoms indicate a moderate to severe flare-up of ulcerative colitis. Experiencing ten bowel movements a day with bright red blood, persistent diarrhea, and a low-grade fever shows that there is significant inflammation. Prednisolone at a dose of 40 mg is a common treatment for such flares, but it is essential to have this done under medical supervision.

With oral steroids, patients typically see some improvement within three to five days, including decreased stool frequency, less bleeding, and increased energy. However, since you are on day four without any improvement and still have a fever, this raises concern and requires urgent

You should seek immediate assistance either by going to the hospital or contacting your gastroenterologist if you notice any of the following:

Stool frequency remains more than six to eight times a day with blood.
Fever continues.
You experience weakness, dehydration, or dizziness.
There is an increase in abdominal pain or distension.

In a hospital setting, doctors may conduct blood tests, stool infection tests, and imaging, and they may initiate treatment with intravenous steroids like Hydrocortisone if your condition is deemed severe. Timely intervention is crucial to prevent complications.

Toxic megacolon is a rare condition, but it is considered when there are signs such as severe abdominal pain, marked swelling, high fever, and generally feeling unwell. Your current symptoms do not definitively indicate this condition, but a persistent, severe flare warrants a thorough evaluation to rule it out.

For now, seek urgent medical assistance, ensure you are staying well-hydrated, and do not alter your steroid dosage without professional guidance. Prompt escalation of treatment generally helps to manage the flare safely.

I hope this helps address your query. Kindly revert with the answers.

Thank you.