As someone living with ulcerative colitis (UC), you’re no stranger to flare-ups that can cause symptoms like 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.

While you may only experience mild or moderate symptoms, life-threatening complications can still occur. It’s important that you can recognize emergency situations and get immediate help. Here are a few complications of UC that require an immediate visit to your doctor or an emergency room.

Anti-inflammatory and immunosuppressant drugs are often the first treatments your doctor will prescribe. These work to stop inflammation and heal ulcers associated with UC. But sometimes, these medications don’t work.

This can lead to uncontrolled inflammation that damages or weakens the lining of the colon. This puts you at risk for bowel perforation, which is when a hole develops in the wall of the colon.

Bowel perforation is an emergency situation. A hole in the intestinal wall allows bacteria to spill into your stomach. This can result in life-threatening infections like sepsis or peritonitis.

Abdominal pain and rectal bleeding are common UC symptoms. But signs of bowel perforation include severe abdominal pain, a high fever, and heavy rectal bleeding. Other accompanying symptoms may include body chills, vomiting, and nausea.

If you suspect perforation, call 911 or go to the emergency room. This is a medical emergency that requires surgery to repair the hole in your colon wall.

This complication affects the entire colon and also occurs due to uncontrolled inflammation. Inflammation causes the colon to swell to the point of distention, and your UC symptoms will get worse over time.

Signs of fulminant colitis include severe stomach pain, having more than 10 bowel movements a day, heavy rectal bleeding, and a high fever.

Some people experience anemia and rapid weight loss. If left untreated, fulminant colitis can progress and become life-threatening, so see a doctor if your UC symptoms worsen.

Treatment involves hospitalization and high-dose corticosteroids. Based on the severity of your condition, you may need to receive these via intravenous (IV) therapy.

Untreated fulminant colitis can advance to toxic megacolon, another serious complication of UC. In this case, the colon continues to swell or dilate, resulting in severe abdominal distention.

Gas and feces can accumulate in the colon. If left untreated, the colon can rupture. This is a life-threatening emergency.

Toxic megacolon requires treatment in the hospital. Doctors can attempt to remove excess gas or feces from the colon. If this doesn’t work, surgery can prevent a ruptured colon.

Symptoms of toxic megacolon include severe stomach pain and bloating, abdominal tenderness, fewer bowel movements, and a high fever.

Severe dehydration is an emergency that can occur from persistent diarrhea, especially if you don’t drink enough fluids.

Dehydration is a major concern for people with 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. You may need hospitalization to receive IV nutrients and fluids.

Symptoms of severe dehydration include dangerously low blood pressure, dizziness, a rapid pulse, fainting, severe muscle cramps, and sunken eyes.

Liver disease can also occur with UC. Primary sclerosing cholangitis (PSC) is a liver disease that is sometimes associated with UC.

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

Also, steroid medications used to treat inflammation can cause fat to deposit in the liver. This is known as fatty liver disease. Fatty liver doesn’t require treatment or cause any symptoms, but losing weight can potentially reverse it.

If you have UC, your doctor may periodically complete a liver function test to check the health of your liver. Signs of liver complications may include itchy skin and jaundice, which is yellowing of the skin or whites of the eyes. You may also develop pain or a feeling of fullness in the upper right side of your abdomen.

Schedule an appointment with your doctor if you suspect liver complications.

The risk for colon cancer increases based on the severity of your UC. According to the American Cancer Society (ACS), colorectal cancer is the third most common cancer diagnosed in men and women in the United States.

A colonoscopy can detect the presence of tumors in your colon. This procedure involves the insertion of a flexible tube into your rectum to examine the colon.

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

See a doctor if you notice black, tarry stools, or a change in bowel activity. Also see a doctor if you have severe stomach pain, unexplained weight loss, or severe fatigue. Colon cancer can cause stool that is thinner and has more blood in it than usual, too.

UC is a chronic and sometimes debilitating condition. Medication and lifestyle changes can help you manage the disease.

Speak with your doctor if you feel that your current UC treatment isn’t working. Adjusting your dosage or medication might result in a better outcome and help you achieve remission.

Life-threatening situations can develop when you’re unable to control inflammation and ulcers in your colon. Seek immediate medical attention if you experience worsening symptoms. Some of these symptoms include severe stomach pain, a high fever, severe diarrhea, or heavy rectal bleeding.

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