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Ulcerative Colitis Emergency Situations and What to Do

Medically reviewed by Saurabh Sethi, M.D., MPH — Written by Valencia Higuera — Updated on October 1, 2024

What to look for
Perforated colon
Fulminant colitis
Toxic megacolon
Severe dehydration
Rectal bleeding
Other complications
Takeaway

Ulcerative colitis is a chronic inflammatory bowel disease that can flare up unexpectedly. Sometimes the symptoms can be life threatening, and it’s crucial to know how to manage an emergency situation.

As someone living with ulcerative colitis (UC), you’re probably no stranger to flare-ups that can cause symptoms such as diarrhea, abdominal cramping, fatigue, and bloody stool.

Over time, you may learn how to deal with your flares and feel better. But that doesn’t mean you should take every symptom in stride.

Recognizing emergency situations

While you may experience only mild or moderate symptoms, life threatening complications can still occur. It’s important to recognize emergency situations and get immediate help.

Symptoms to be aware of include:

fever
rigors (chills), which can be accompanied by a high fever
severe abdominal pain
a faint feeling
dehydration
rectal bleeding
an inability to eat or drink for more than 24 hours

Here are a few possible complications of UC that require an immediate visit to your doctor or an emergency room.

Perforated colon

Medications are often doctors’ first line of treatment for UC. These can include anti-inflammatory and immunosuppressant medications. They work to stop inflammation and heal ulcers associated with UC.

But over time, medications may become less effective. This can lead to unmanaged inflammation that damages or weakens the lining of your colon. Both of these situations can put you at risk for bowel perforation, which is the development of a hole in the wall of your colon.

Bowel perforation is an emergency situation. A hole in your intestinal wall allows bacteria to spill into your stomach. This can result in life threatening infections such as sepsis (a dangerous body response to infection) or peritonitis (inflammation of your abdominal wall).

Abdominal pain and rectal bleeding are common UC symptoms. Bowel perforation can also cause symptoms such as:

severe abdominal pain
high fever
vomiting
nausea
chills

If you suspect you have a bowel perforation, call 911 or your local emergency number or go to the emergency room immediately. Bowel perforation requires surgery to repair the hole in your colon wall.

Fulminant colitis

Fulminant colitis is a rare, severe form of UC that requires emergency care. It can affect your entire colon and occurs as a result of unmanaged inflammation. This condition happens when inflammation causes your colon to swell to the point of distention, which can make your UC symptoms worse over time.

Symptoms of fulminant colitis include:

severe stomach pain
more than 10 bowel movements per day
heavy rectal bleeding
a high fever

Some people also experience anemia and rapid weight loss.

If left untreated, fulminant colitis can progress to become life threatening, so consult a doctor if your UC symptoms worsen.

Treatment may involve hospitalization and high dose corticosteroids. Depending on how severe your condition is, you may need to receive these via intravenous (IV) therapy.

Toxic megacolon

Untreated fulminant colitis can progress to toxic megacolon, another serious complication of UC. With this condition, your colon continues to swell or dilate, resulting in severe abdominal distention.

Gas and feces can build up in your colon, and if this is not treated, your colon can rupture. This can create a life threatening emergency.

Toxic megacolon requires treatment in the hospital. When UC causes toxic megacolon, healthcare professionals typically provide steroids and IV fluids. If that approach does not work to relieve the swelling, surgery may be necessary to prevent colon rupture.

Symptoms of toxic megacolon include:

severe stomach pain
bloating
abdominal tenderness
fewer bowel movements
high fever

Severe dehydration

Severe dehydration is an emergency that can result from persistent diarrhea. It may be especially serious if you’re not consuming enough fluids. Because most water absorption happens in your colon, the more severe your colitis is, the greater your chance of experiencing dehydration.

Dehydration is a major concern in UC because your body can lose a lot of fluid with each bowel movement. You can treat mild cases of dehydration at home by drinking water or a rehydration solution.

Severe dehydration is a medical emergency that typically requires hospitalization so that you can receive IV fluids.

Symptoms of severe dehydration include:

extremely low blood pressure
dizziness
rapid pulse
fainting
severe muscle cramps
sunken eyes

Rectal bleeding

You may need emergency medical care for heavy rectal bleeding. While rectal bleeding can be common in UC, the recommendation is almost always to seek emergency medical attention, because there are few to no home remedies.

Worsening symptoms may be a sign that you need medical attention.

Symptoms of rectal bleeding include:

visible blood in your stool
visible blood on your toilet paper
black, tarry stool

Other complications

Other serious complications relating to UC may not require an emergency room visit, but they can still be serious and warrant medical attention.

Liver disease

Liver disease can occur with UC. Primary sclerosing cholangitis (PSC) is a liver disease that affects 3% to 8% of people who live with UC.

If left untreated, PSC can lead to permanent liver damage or cirrhosis (liver scarring).

If you have UC, your doctor may periodically complete a liver function test to check the health of your liver. Having elevated liver enzymes or PSC may not be an emergency situation unless there are signs of cholangitis (bile duct inflammation). This may be due to an obstruction.

Symptoms of liver complications include:

itchy skin
yellowing of your skin or the whites of your eyes (jaundice)
pain or a feeling of fullness in the upper right side of your abdomen

Schedule an appointment with a healthcare professional if you suspect you may have liver complications.

Colon cancer

The risk of colon cancer increases based on the severity of your UC and how long you’ve lived with it. According to the American Cancer Society, when estimates for men and women are combined, colorectal cancer is the second most common cause of cancer-related death in the United States.

A colonoscopy can help doctors detect tumors in your colon. This procedure involves inserting a flexible tube into your rectum to examine your colon.

People with inflammatory bowel diseases such as UC generally need to have a colonoscopy at least 8 years after getting their diagnosis, along with follow-up colonoscopies every 1 to 3 years.

The frequency may depend on your individual risk factors for colorectal cancer and the findings of your previous exams.

The symptoms of colon cancer are similar to UC symptoms. Because of this, it can be difficult to distinguish one condition from the other.

Contact a doctor if you notice symptoms of colon cancer, which can include:

black, tarry stools
changes in bowel activity
severe stomach pain
unexplained weight loss
severe fatigue
stool that is thinner than usual
blood in your stool

Pelvic abscess

An abscess is a collection of pus that can develop in your pelvis, abdomen, or anus. An abscess is a sign of an infection. It can become life threatening and often requires treatment. But abscesses very rarely occur in UC — they are more commonly a complication of Crohn’s disease.

Symptoms of an abscess include:

fever
severe pain in your abdomen
pus discharge from your anus
painful bowel movements
a red, swollen, or tender lump at the edge of your anus

Treatment often involves IV fluids and antibiotics. In some cases, a doctor may recommend draining the abscess.

The takeaway

UC is a chronic and sometimes debilitating condition. While some people may have only mild or moderate symptoms, emergency situations can happen. Life threatening complications can develop as a result of severe inflammation and ulcers in your colon.

Seek immediate medical attention if you experience worsening symptoms such as severe stomach pain, high fever, severe diarrhea, and heavy rectal bleeding.

Read this article in Spanish.

How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

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Corticosteroids. (2021).https://www.ncbi.nlm.nih.gov/books/NBK548400/
Cowan KB, et al. (2023). Enterocutaneous fistula. https://www.ncbi.nlm.nih.gov/books/NBK459129/
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Khaliq K, et al. (2023). Pelvic abscess.https://www.ncbi.nlm.nih.gov/books/NBK545292/
Krease M, et al. (2016). Fulminant ulcerative colitis complicated by treatment-refractory bacteremia.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5023300/
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Sepsis and perforated bowel. (2021).https://www.sepsis.org/sepsisand/perforated-bowel/
Skomorochow E, et al. (2023). Toxic megacolon. https://www.ncbi.nlm.nih.gov/books/NBK547679/
Tanaka A, et al. (2016). Ulcerative colitis with and without primary sclerosing cholangitis: Two different diseases?https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5988107/
Taylor K, et al. (2022). Adult dehydration.https://www.ncbi.nlm.nih.gov/books/NBK555956/
Underferth D. (2021). Does ulcerative colitis affect your cancer risk?https://www.mdanderson.org/cancerwise/does-ulcerative-colitis-affect-your-colorectal-cancer-risk.h00-159462423.html

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Medically reviewed by Saurabh Sethi, M.D., MPH — Written by Valencia Higuera — Updated on October 1, 2024

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Digestive Health

Treating Ulcerative Colitis

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Causes & Risk Factors

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Diagnosis

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Diet

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Symptoms

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Prevention and Lifestyle

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Treatment

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Types

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Recognizing emergency situations

Perforated colon

Fulminant colitis

Toxic megacolon

Severe dehydration

Rectal bleeding

Other complications

Liver disease

Colon cancer

Pelvic abscess

The takeaway

How we reviewed this article:

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