When does an ulcerative colitis flare need emergency care?

Question

Hello doctor,

I am a 40-year-old woman currently experiencing severe abdominal pain, frequent bloody stools, and significant weakness due to ulcerative colitis. I would appreciate your guidance on a few concerns.

Could you please explain, in simple terms, how to recognize when a flare becomes an emergency and when hospitalization might be necessary? I would also like to understand whether treatments such as IV steroids or stronger medications are considered safe in such situations. Additionally, could surgery ever become necessary, and if so, what might that mean for my day-to-day life?

Thank you for your time and guidance.

Please help.

Answer 1

Hi,

Welcome to iCliniq,

I am sorry to hear that you are experiencing these symptoms. Ulcerative colitis can sometimes flare severely, and recognizing when medical attention is urgently needed is very important.

A flare may require hospitalization when inflammation becomes very intense, and the body begins to struggle to cope. Some warning signs to watch for include:

Very frequent bloody diarrhea (typically more than six to eight times per day).
Severe abdominal pain or noticeable abdominal swelling.
High fever, dizziness, or signs of dehydration.
Extreme weakness or a sudden drop in energy levels.
Difficulty eating or drinking adequately.

In such situations, doctors may recommend hospital admission so they can monitor you closely, treat dehydration, check blood counts, and quickly control the inflammation.

In the hospital, one commonly used treatment is intravenous steroids such as Hydrocortisone. These medications work faster than oral tablets to calm the immune system and reduce inflammation. If steroids are not sufficient to control the flare, stronger treatments such as biologic medications, for example, Infliximab, may be recommended. When used under medical supervision, these treatments are widely used and generally considered safe.

In some cases, if the inflammation cannot be controlled with medication or complications develop, surgery may be advised. This procedure typically involves removing the diseased colon (a colectomy). Many patients are candidates for a procedure called a J-pouch, where a small internal pouch is created from the small intestine so that bowel movements can still pass through the normal route. In other situations, a temporary or permanent stoma may be needed.

Although the idea of surgery can feel overwhelming, many patients experience significant relief from ulcerative colitis symptoms afterward and can return to active, fulfilling daily lives.

If you are experiencing severe pain, heavy bleeding, or profound weakness, it is important to contact your gastroenterologist or seek urgent medical care so appropriate treatment can begin as soon as possible.

I hope this helps.

Thank you.