If your symptoms are occurring more frequently or becoming more painful, you may need to adjust your treatment plan with your doctor or go to the hospital if you are having a severe flare-up.

Approximately 600,000 to 900,000 people in the United States have a form of inflammatory bowel disease (IBD) called ulcerative colitis (UC). UC is a chronic condition that can cause a variety of uncomfortable symptoms, including abdominal pain and irregular bowel movements.

While there’s no cure yet for UC aside from complete surgical removal of the colon, treatments can help reduce symptoms.

People with UC can also experience periods of remission with few or no symptoms. But you may also experience flare-ups. This is when symptoms may be more severe, even if you’re receiving treatment.

This article explains why UC can evolve and why symptoms may seem more severe at times, and how you can address those changes if you experience them.

A flare-up can cause UC symptoms to become more severe. Flare-ups may occur from stress, eating certain foods, or the need for medication changes.

It’s normal for people to go through periods when their UC seems to have minimal symptoms and times when it is more active. It’s important to notify your doctor when you have a flare-up. They can adjust treatments to manage your symptoms and bring relief.

Symptoms of UC may also become more painful if inflammation and sores have expanded to other parts of the colon.

If your symptoms have changed, your doctor may wish to perform additional tests or request scans to better understand what is happening inside your intestines.

There is not one set definition of mild, moderate, and severe UC. Over time, a variety of different scales and ways to measure UC have been developed.

The Truelove-Witts classification of disease severity was first used in 1955 to measure UC severity. It looked at variables like:

  • number of stools per day
  • blood in the stools
  • body temperature
  • pulse
  • hemoglobin levels
  • erythrocyte sedimentation rate (ESR)

Researchers defined severe UC as:

  • six or more bloody stools a day
  • fever on at least 2 out of 4 days
  • a pulse rate more than 90 beats per minute
  • anemia
  • increased ESR

Since then, other severity scores have been developed. One of the most popular in clinical practice is the Mayo Score, also called the Mayo Clinic Score and the Disease Activity Index.

The Ulcerative Colitis Endoscopic Index of Severity was developed in 2012 and may help standardize endoscopic scoring for UC.

Surgery may be required for severe UC. The Oxford (Travis) index and the Ho index can help predict the need for a colectomy.

Three common criteria frequently used to determine UC severity are:

  • impact of the disease on the person
  • degree of inflammation
  • course of the disease

Doctors typically assess these criteria by asking a person about their symptoms, doing lab work, and performing an endoscopy.

To determine the impact of the disease on a person, doctors will consider the type and amount of symptoms as well as the impact they have on the person’s quality of life.

When thinking specifically about inflammation, a doctor will look at not only the amount of inflammation but also where it is located.

Finally, when assessing the course of the disease, doctors will consider any structural damage and the frequency of flare-ups.

You may treat mild or moderate UC at home. Severe UC flare-ups should be treated at a hospital to minimize the chance of potentially fatal complications and dehydration.

In the hospital, healthcare professionals may give medications like infliximab or ciclosporin intravenously. They may also suggest biologic medications or JAK inhibitors.

If symptoms are not responding to medications and other forms of treatment, severe UC may require surgery to remove the affected part of the colon. This surgery is called a colectomy.

Colectomy will prevent UC-related symptoms from returning in the future, but it does come with risks. Learn more about colectomy.

Always contact your doctor about your UC if new or worsening symptoms develop.

Symptoms of severe UC include:

  • more than six bowel movements in a day
  • diarrhea with blood or mucus for more than 3 days
  • fever and chills
  • nausea and vomiting
  • severe abdominal pain

You may also notice symptoms elsewhere in your body. These can include:

  • rashes
  • eye swelling
  • joint pain

If your UC symptoms are occurring more frequently or becoming more painful, it’s important to talk with your doctor. They can help determine what changes need to be made to your treatment plan to bring you relief.

You may need to receive treatment in the hospital if you are having a severe flare-up to reduce the risk of dehydration and potentially life threatening complications, like a perforated colon.

The length of your hospital stay will depend on how your UC responds to treatments.