Recognizing Ulcerative Colitis Emergency Symptoms: A Caregiver's Guide
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Caregiver Tips: Knowing the Warning Signs of a Colitis Emergency

Caregiver Tips: Knowing the Warning Signs of a Colitis Emergency
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Updated on April 3, 2025
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The symptoms of ulcerative colitis (UC) — stomach cramps, abdominal pain, and bloody diarrhea — come and go.

 While serious complications from ulcerative colitis are rare, they can occur. Severe symptoms like excessive rectal bleeding or intense abdominal pain can indicate a serious complication that could become life-threatening without immediate treatment.

Here’s how to recognize symptoms that warrant immediate medical attention.

Ulcerative Colitis Emergency Symptoms

Call a healthcare provider immediately if you notice that your loved one is experiencing any of the following symptoms.

  • Rectal Bleeding Rectal bleeding can occur in people with UC when widespread ulcers develop along the gastrointestinal (GI) tract.

     Severe bleeding anywhere in the GI tract can lead to anemia, shock, or death.

     A sudden attack of massive bleeding might also indicate fulminant colitis, a particularly severe form of colitis that affects the entire colon.

     Severe, bloody diarrhea can also indicate toxic megacolon, a life-threatening condition.

  • Dehydration Sudden, severe diarrhea and bleeding can cause rapid fluid loss, leading to dehydration. Dehydration can lead to kidney failure, seizures, urinary tract infections, and low blood pressure, so urgent medical treatment with intravenous (IV) fluids and electrolytes is necessary.

     Symptoms of dehydration include extreme thirst, tiredness, dizziness, confusion, and urinating less often than usual.
  • Symptoms of Anemia UC can lead to low levels of red blood cells, or anemia, due to excessive bleeding. Anemia symptoms might include ongoing fatigue, headaches, dizziness, pale skin, and fainting.

  • Rapid Heartbeat A heart rate of more than 90 beats per minute, along with rectal bleeding, suggests that you have severe UC.

     This may be a sign that your blood doesn’t have enough oxygen,

     which can be an effect of anemia.

     A rapid heartbeat can also be a symptom of toxic megacolon.

  • Fever Consult your provider if you have a body temperature of more than 100.4 degrees F or a lower fever that continues for several days. This may suggest an emergency escalation of UC or other infections that need ruling out.

  • Ongoing Belly Pain Belly pain and cramping generally occur during UC flares.

     But continuous belly pain with UC is a sign that emergency care may be necessary.

     Severe stomach pain can be a sign of both toxic megacolon (along with nausea, vomiting and inability of pass gas)

     and a perforated bowel.

5 Complications of Ulcerative Colitis

Ulcerative colitis is an autoimmune disease and a form of IBD. Complications from UC affect more than just the digestive track. Here are some things to watch out for.
5 Complications of Ulcerative Colitis

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Potential Complications of Ulcerative Colitis

The following complications might be behind your loved one’s UC emergency. These result from serious tissue damage in the colon and rectum.

Acute Severe Ulcerative Colitis

Sometimes called fulminant colitis, this complication affects less than 10 percent of people with ulcerative colitis and involves damage to the entire thickness of the intestinal wall.

 Unless urgent treatment can bring the inflammation under control, people with fulminant colitis risk developing toxic megacolon, the most severe colitis complication.
Recognizing acute severe ulcerative colitis early and closely monitoring a person’s condition while they receive intravenous corticosteroids are essential for treating fulminant colitis.

 They’ll also need to stay in the hospital and receive IV fluids until they are sufficiently rehydrated.

Toxic Megacolon

Considered the most serious complication of ulcerative colitis, toxic megacolon is the most extreme (and potentially life-threatening) form of fulminant colitis. It’s rare, occurring in around 5 percent of severe ulcerative colitis flares, but it’s important to look out for as a caregiver.

In toxic megacolon, a portion of the large intestine becomes paralyzed, stops working, and swells to many times its standard size. Without treatment, a portion of the intestine can become so severely damaged that it perforates.

Signs of toxic megacolon include:

  • Worsening abdominal pain
  • A visibly distended or bloated abdomen
  • Abdominal tenderness
  • Rapid heart rate
  • High fever
  • Dehydration
  • Vomiting
  • Frequent and bloody diarrhea
  • Shock symptoms, including cool or clammy skin, confusion, breathlessness, and a weak pulse

To minimize the likelihood of toxic megacolon, avoid the following during a flare:

Perforated Bowel and Hemorrhaging

A perforated bowel is a hole in the wall of the intestine that can occur due to toxic megacolon, surgical injuries, or severe ulcerative colitis.

If the bowel is perforated, the gut's contents can spill into the rest of the abdomen, leading to an infection called peritonitis. In turn, this can lead to a life-threatening infection response called sepsis.

A colonoscopy during periods of severe inflammation is more likely to result in perforation.

If you suspect perforation, call 911 or go to the emergency room. Massive hemorrhaging in a person with ulcerative colitis is an emergency that requires immediate medical attention and possibly surgery to repair the hole in the colon wall.

Ways to Reduce the Risk of an Ulcerative Colitis Emergency

Emergency symptoms can develop suddenly in people newly diagnosed with ulcerative colitis as well as in people who have had the disease for a long time. The duration of flare-ups can be unpredictable and remissions can vary in length.

The best way to prevent flares and potential emergencies is to continue maintenance medications during remission periods and avoid triggers; people with UC should avoid taking antibiotics unless medically necessary.

People living with ulcerative colitis should follow a balanced, nutritious diet to help ensure they meet their nutritional requirements. Reducing exposure to their unique dietary triggers, which may differ person to personmay reduce the risk of UC flares.

The Takeaway

  • Call 911 or go to an emergency room if your loved one with ulcerative colitis experiences severe, frequent rectal bleeding, extreme belly pain and bloating, dehydration symptoms, or severe anemia symptoms.
  • These symptoms and others, such as a high fever or rapid heartbeat, may indicate a severe flare, fulminant ulcerative colitis, or complications like toxic megacolon or perforated colon.
  • Ensure that your loved one takes medications as prescribed, avoids triggers, and eats a nutritious diet to control ulcerative colitis inflammation and limit flares and complications.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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  2. Gastrointestinal bleeding. Mayo Clinic. October 13, 2023.
  3. Ulcerative Colitis. Merck Manuals. May 2024.
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  5. Dehydration. Mayo Clinic. October 14, 2021.
  6. Mahadea D et al. Iron Deficiency Anemia in Inflammatory Bowel Diseases — a Narrative Review. Nutrients. November 10, 2021.
  7. Feuerstein JD et al. AGA Clinical Practice Guidelines on the Management of Moderate to Severe Ulcerative Colitis. Gastroenterology. April 2020.
  8. Heart palpitations. Mount Sinai.
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  10. Toxic Megacolon. Johns Hopkins Medicine.
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  13. Toxic Megacolon. Mount Sinai.
  14. Sepsis and Perforated Bowel. Sepsis Alliance. March 14, 2024.
  15. Intestinal complications. Crohn's and Colitis Foundation.
  16. University of Michigan Severe Ulcerative Colitis Protocol. University of Michigan. June 3, 2022.
  17. Stauffer CM et al. Colonoscopy. StatPearls. July 24, 2023.
  18. Definition & Facts of Ulcerative Colitis. National Institute of Diabetes and Digestive and Kidney Diseases. September 2020.
  19. Lo B et al. Specific Antibiotics Increase the Risk of Flare-Ups in Patients with Inflammatory Bowel Disease: Results from a Danish Nationwide Population-Based Nested Case-Control Study. Journal of Crohn’s & Colitis. August 2024.
  20. Ulcerative Colitis Treatment Options. Crohn’s and Colitis Foundation.
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Yuying Luo, MD

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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.

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