Ulcerative colitis (UC) is a chronic inflammatory bowel disease that primarily affects the large intestine, including the colon and rectum. This condition involves inflammation and the formation of small ulcers on the lining of the bowel. While individuals with UC may experience periods of minimal or no symptoms, known as remission, they can also encounter “flares” or “flare-ups” where disease activity increases and symptoms worsen. Understanding the specific symptoms that indicate a flare is important for effective management and can help individuals recognize when to seek medical attention.
Understanding Gastrointestinal Symptoms
During an ulcerative colitis flare, gastrointestinal symptoms are often the most prominent indicators of increased disease activity. A common sign is an increase in the frequency and urgency of bowel movements, often presenting as diarrhea. Diarrhea may contain blood, mucus, or pus, often resulting from inflammation and ulceration of the colon’s lining, and rectal bleeding can be a direct result. Abdominal pain and cramping are frequently reported during flares, typically localized in the lower left abdomen, and can range from mild to severe.
Tenesmus, the sensation of needing to have a bowel movement even when the bowels are empty, often stems from inflammation in the rectum. While less common, some individuals may also experience nausea and vomiting during a flare-up.
Broader Body Manifestations
Beyond the direct impact on the digestive system, ulcerative colitis flares can also manifest through broader bodily symptoms and extra-intestinal manifestations (EIMs). Systemic symptoms like fatigue are widely experienced, and low-grade fever can also occur, signaling the body’s inflammatory response. Loss of appetite often accompanies flares, which can lead to unintended weight loss over time. Anemia, characterized by a reduced number of red blood cells, can develop due to chronic blood loss from the inflamed colon.
Joint pain, or arthritis, is a frequent EIM, affecting up to 40% of individuals with inflammatory bowel disease, often in large joints like the knees, ankles, hips, and wrists. Skin lesions, such as tender red bumps (erythema nodosum) or ulcers (pyoderma gangrenosum), can appear, along with painful mouth ulcers. Eye inflammation, including uveitis or episcleritis, can cause redness, irritation, and pain in the eyes.
When to Get Medical Help
Recognizing when to seek medical attention during an ulcerative colitis flare is important for preventing complications. A sudden and significant increase in the severity of symptoms, such as severe abdominal pain, profuse rectal bleeding, or a high fever, warrants immediate medical consultation. Signs of dehydration, including extreme thirst, dark urine, or dizziness, especially if accompanied by persistent vomiting or an inability to keep fluids down, require prompt evaluation. If current medications or home management strategies are not improving symptoms, or if symptoms are worsening despite treatment, it is important to contact a healthcare provider. New or unusual symptoms that have not been experienced before should also prompt medical advice.
Individuals should work closely with their gastroenterologist to manage their condition and discuss any concerns about the severity or duration of a flare. Hospitalization may be necessary for severe flares, especially if there are more than six bloody bowel movements per day, a high temperature, or severe abdominal pain. Prompt medical attention helps stabilize the condition and can prevent serious complications like toxic megacolon or bowel perforation.