If you have ulcerative colitis (UC), there’s a good chance that you may need to go to the emergency room (ER) at some point. About 1 in 4 people with UC end up in the hospital due to a flare or complications from a flare.
UC symptoms alone can be scary, since they often involve bloody stool and intense stomach pain. It can be tricky to know what signs can be treated safely at home, what warrant an immediate call to your doctor, and which ones require you to head straight to the ER, or even call 911.
“It can be hard to figure out what is a bad flare-up, what’s a true medical emergency, and how to treat everything in between,” says Arun Swaminath, MD, Director of the Inflammatory Bowel Diseases Program at Lenox Hill Hospital in New York City. “That’s why it’s so important to check in with your doctor, to help you decide next steps.”
Here’s how to know what requires immediate medical attention and how to navigate an ER visit, if you do end up there.
When to Go to the ER With Ulcerative Colitis
Most of the time, people with UC end up in the hospital because they have a flare-up that’s so severe it can’t be safely treated at home.
Severe bleeding. It’s common to have blood in your stool when you have UC. But in general, one red flag warning sign is if you have six or more bloody bowel movements (BMs) in one day. “It can be hard to determine how much blood you are losing, but if you pass a lot of red blood and clots, and you feel very dizzy and weak, then you should go the ER, or call 911,” advises Alyssa Parian, MD, medical director of the Inflammatory Bowel Disease Center at Hackensack University Medical Center in Hackensack, New Jersey.
Severe dehydration. You can easily become dehydrated during a severe UC flare if you have very bad diarrhea. Signs include:
- Headache
- Dizziness
- Weakness
- Lightheadedness
- Rapid heartbeat
- Chills
- Dark-colored pee
“If you have multiple bouts of diarrhea in an hour and feel weak and dizzy, and as if you will pass out, then you need to go to the ER,” says Parian.
Intense stomach pain. Belly cramps happen often with UC. But if you have severe stomach pain that lasts a few hours and your stomach is bloated, call your doctor, then head to the ER, advises Parian. “We always worry about bowel obstructions, which can happen during a severe UC flare and can be life-threatening,” she says.
Fast heart rate. If your heart beats very fast, check it with an at-home heart rate monitor. You can also check your pulse if you place your index and middle fingers on the artery of your inner wrist and count the number of beats in 60 seconds. A heart rate of more than 90 beats per minute should be checked out. “Call your doctor first, but if your heart rate is accompanied by a lot of diarrhea, you should head to the ER because it may indicate that you are dehydrated,” stresses Swaminath.
Persistent fever. Any fever over 100 F along with persistent diarrhea needs to be checked out immediately. “People with UC are at a higher risk to develop colon infections such as salmonella, E. coli, or C. Diff,” says Parian. “Your doctor may be able to do stool tests in their office, but we can often get faster results if we send you to the ER.”
People with UC may also be on medications such as biologics or steroids that suppress their immune system, which makes them more vulnerable to infection. If you have respiratory symptoms and start to run a high fever, have bad chills, or feel very weak or dizzy, Parian stresses that you need to call your doctor right away. They can make the call as to whether you should go to their office or to the ER.
Chest pain. People with ulcerative colitis are more at risk of developing a blood clot, which can be life-threatening. “If you develop severe, sudden shortness of breath, chest pain, or a swollen, painful calf, you should get to the ER,” says Swaminath. “They can run tests immediately to check for blood clots.”
What to Expect When You Go to the ER
You should always inform your doctor on the way to the ER, says Swaminath. Your doctor can call ahead to alert the ER that you are on your way. Ideally, you want to go to an ER where your doctor is on staff. “That way, the ER will have immediate access to your electronic medical records so they can review your medical history quickly,” he explains.
Some ERs even have their own separate pathway for patients with inflammatory bowel diseases such as ulcerative colitis. “At my own hospital, Lenox Hill, our emergency room does a rapid assessment to determine the severity of a flare and whether a patient is having any complications,” says Swaminath.
Here are some things you should expect when you get to the ER:
- Blood tests, such as a complete blood count (CBC) to screen for anemia, as well as a C-reactive protein (CRP) test to look for inflammation
- Imaging tests, such as CT scans and ultrasounds, to look for potential obstructions
- Stool tests to check for bacteria such as C. Diff
- Endoscopy to evaluate inflammation in your gastrointestinal (GI) tract
While they wait for tests to come back, ER doctors will most likely provide supportive care such as IV fluids and electrolytes to help treat and/or prevent dehydration.
It’s important to provide as much information as possible to your treatment team, adds Swaminath. Bring a medication list with you, including doses and the date you last took them. Try to be as specific as possible. “It’s helpful to hear that you’ve had a fever of 100 for the last five days, but today it’s gone up to 102, or you’ve lost five pounds over the last week,” says Swaminath.
What to Expect With Treatment
When you go to the ER to treat a severe flare, most of the time, doctors will put you on IV steroids. Most people with UC will respond to this within three to five days.
If you don’t respond, doctors will put you on a biologic such as infliximab (Remicade). Another option is cyclosporine (Neoral, Sandimmune, or Gengraf), which suppresses the immune system.
People with UC who are in the hospital are also more likely to develop a blood clot. “There is a very high risk in the first couple of days, since overall inflammation in the body is so high,” explains Swaminath. “Since patients also don’t move as much, there’s much more of a chance that blood will clot.” You will most likely be put on a blood thinner such as apixaban (Eliquis) to lower your risk.
Patients with UC are also more likely to develop anemia during a severe flare, since they lose so much blood. If tests reveal you are severely anemic, you may also need an emergency infusion of red blood cells. People who have fevers or other signs of infection are also usually given antibiotics.
You will also be watched carefully to make sure you do not develop any of these complications:
Toxic megacolon. This is when GI inflammation is so severe that your colon stops working properly. It happens in about 20% of people with inflammatory bowel diseases such as ulcerative colitis. Your doctors will try medications first, such as cyclosporine or infliximab, but in severe cases, you’ll need surgery.
Fulminant ulcerative colitis. This is a name for a very severe flare of ulcerative colitis, where your entire colon wall becomes inflamed. If you don’t respond to any medical treatments, your doctors may recommend that you have a colectomy, where part or all of the colon is removed.
Colonic perforation, or a tear in your colon. Colonic perforation is very serious since stool and bacteria can seep out and cause a life-threatening infection. Most patients who develop this need an immediate colectomy.
How to Manage Anxiety at the ER
It’s very normal to feel anxious when you go to the ER. You may worry that your symptoms aren’t “bad enough” to merit ER care. You may also be afraid of an unfamiliar medical environment.
That’s why it is so important to call your doctor before you go there, says Swaminath. Your physician can help figure out if you need to be seen there or if your needs can be met in a regular office visit. “If you do need to go, they can call ahead and let staff know you will be there, to smooth the transition,” reassures Swaminath.
When you get there, make sure the medical team there takes the time to review your chart and listen to you. If you feel like they are not, let your doctor know. They can speak to the physicians and make sure you get the best care, says Swaminath.
It’s also important to make sure you have a good care plan once you are discharged from the hospital. This will help prevent the need for future ER visits. You will want to make sure you do the following:
Schedule follow-up visits. “It’s very important to continue to see your doctor, even if you are in remission and otherwise feel well,” says Swaminath. “Sometimes, patients feel so good that they think they no longer need to take medication. But that can lead to a very serious flare.”
Stay up to date on vaccines. Routine vaccinations against conditions such as the flu, COVID-19, shingles, and respiratory syncytial virus (RSV) can help you stay healthy. They also reduce the risk of complications if you do develop one of these viruses. “People with UC may be immunocompromised, so they can become very sick from these conditions,” explains Swaminath.
