Active ulcerative colitis: symptoms, care and warning signs

A flare may bring looser or more frequent stools, blood or mucus, urgency, abdominal cramps, fatigue and reduced appetite. Activity varies, and symptoms can overlap with bowel infection or medicine effects, so a change from your usual pattern deserves assessment rather than automatic adjustment of treatment.

The care team looks at stool frequency, bleeding, urgency, pain and effects on eating, sleep and daily activity. Blood tests can check for inflammation, anaemia and dehydration, while stool tests may help distinguish a flare from infection. Endoscopy or imaging may be used when the extent or severity of inflammation needs a closer look.

Symptoms and inflammation do not always move together. Some people have persistent bowel inflammation with limited symptoms, while others have troublesome bowel symptoms from another cause. Treatment decisions therefore combine how you feel with examination and test findings.

Contact your usual clinician or inflammatory bowel disease team when symptoms increase. Follow an agreed flare plan if you have one, and continue maintenance medicine unless your prescriber tells you otherwise. Record bowel frequency, visible blood, pain, temperature, ability to eat and drink, and any missed doses; this gives the team concrete information for treatment decisions.

Drink regularly and choose foods you can tolerate while symptoms are active. A restrictive diet does not replace anti-inflammatory treatment. Avoid anti-inflammatory painkillers such as ibuprofen unless a clinician who knows your condition recommends them, because they may worsen bowel symptoms. Tell the team about antibiotics, recent travel, sick contacts and new medicines.

Get urgent medical help for severe or rapidly worsening abdominal pain, a swollen or very tender abdomen, heavy or ongoing rectal bleeding, fainting, confusion, repeated vomiting, high fever, a racing heartbeat, or inability to keep fluids down. These signs can accompany severe inflammation, dehydration, significant blood loss or a bowel complication.

Seek prompt advice if diarrhoea or bleeding is steadily increasing, you are passing much less urine, you feel unusually weak or dizzy, or prescribed treatment is not controlling the flare. Do not wait for a scheduled follow-up when symptoms are deteriorating.

Ask how the team will confirm whether this is inflammation or infection, which treatment changes are appropriate, and when improvement should become noticeable. Discuss medicine side effects, a written flare plan, nutrition support, vaccinations and the monitoring needed while taking treatment. Also ask when colon surveillance should begin and how its timing relates to the extent and duration of your colitis.