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 to recognize emergency situations and get immediate help.

Symptoms to be aware of include:

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

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

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 sometimes, these medications may stop working as effectively as in the past.

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

Bowel perforation is an emergency situation. Having a hole in your intestinal wall allows bacteria to spill into your stomach. This can result in life threatening infections, like sepsis, which is a dangerous body response to infection, or peritonitis, which refers to inflammation of the abdominal wall.

Abdominal pain and rectal bleeding are common UC symptoms. Signs of bowel perforation can also include:

  • severe abdominal pain
  • high fever
  • vomiting
  • nausea
  • chills

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

Fulminant colitis is a rare, severe form of UC that requires emergency care. It can affect the entire colon and occurs due to uncontrolled inflammation. Inflammation causes the colon to swell to the point of distention, which can make UC symptoms get worse over time.

Signs of fulminant colitis include:

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

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

Treatment may involve 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 can create a life threatening emergency.

Toxic megacolon requires treatment in the hospital. When UC causes toxic megacolon, doctors typically provide steroids to the person along with IV fluids. If it doesn’t work to relieve the swelling, surgery may be needed to prevent a ruptured colon.

Symptoms of toxic megacolon include:

  • severe stomach pain
  • bloating
  • abdominal tenderness
  • fewer bowel movements
  • high fever

Severe dehydration is an emergency that can occur from persistent diarrhea, especially if you don’t drink enough fluids. Because most water absorption happens in the colon, the more severe your colitis is, the greater chance that you may experience dehydration.

Dehydration is a major concern for 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

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

If you experience worsening symptoms, it may be a sign that you need medical attention.

Signs of rectal bleeding include:

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

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

Liver disease

Liver disease can also occur with UC. Primary sclerosing cholangitis (PSC) is a liver disease that occurs in 3 to 8 percent of people living with UC.

If left untreated, this can lead to permanent liver damage or scarring, known as cirrhosis.

Some steroid medications used to treat inflammation can worsen fatty liver disease when taken over a long period of time or in high doses. Fatty liver disease does not require treatment and typically does not cause symptoms on its own.

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 a cause for an emergency unless there are signs of cholangitis, or bile duct inflammation. This may be due to an obstruction.

Signs of liver complications include:

  • itchy skin
  • jaundice, which is yellowing of the skin or whites of the eyes
  • pain or a feeling of fullness in the upper right side of your abdomen

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

Colon cancer

The risk for colon cancer increases based on the severity of your UC and how long you have lived with it. According to the American Cancer Society, colorectal cancer is the third most common cause of cancer-related death across genders 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.

According to the American Cancer Society, people with inflammatory bowel diseases, such as UC, generally need to get colonoscopies at least 8 years after receiving their diagnosis, along with follow-up colonoscopies every 1 to 3 years.

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

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 symptoms of colon cancer, which can include:

  • black, tarry stools
  • change 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 develops in the pelvis, abdomen, or anus. An abscess is a sign of an infection. It can become life threatening and often requires treatment. However, it very rarely occurs with UC and is more commonly a complication of Crohn’s disease.

Symptoms of an abscess include:

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

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

UC is a chronic and sometimes debilitating condition. While some people may only experience mild or moderate symptoms, emergency situations can happen.

Speak with a doctor if 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, high fever, severe diarrhea, and heavy rectal bleeding.

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