What should you know about fulminant ulcerative colitis?

Ulcerative colitis causes inflammation and open sores in the lining of the large bowel. A fulminant flare is extreme and may affect the bowel's ability to absorb fluid. Severe diarrhoea, abdominal pain, fever, dehydration, a fast heartbeat, weakness, or a swollen abdomen can occur. Complications may include heavy bleeding, bowel dilation, or a tear, so this is not a flare to manage alone at home.

Diarrhoea is a common presentation of ulcerative colitis, but diarrhoea by itself does not establish that diagnosis. Infection and other bowel conditions can produce similar symptoms.

Contact an urgent medical service or attend hospital if a severe flare is suspected. Clinicians may assess hydration, blood loss, abdominal tenderness, blood tests, stool tests, and imaging. Treatment can involve fluids, medicines to calm inflammation, correction of electrolyte changes, and close observation. A gastroenterology team may discuss surgery if the bowel does not respond or a dangerous complication develops.

Bring a list of medicines and note the frequency of bowel movements, visible blood, vomiting, fluid intake, and any recent antibiotics or travel. Do not start anti-diarrhoeal medicines or stop prescribed treatment without medical advice.

Seek emergency help for severe or worsening abdominal pain, a swollen or rigid abdomen, repeated vomiting, fainting, confusion, heavy rectal bleeding, inability to drink, or very little urine. Fever with a racing heartbeat, profound weakness, or rapidly increasing diarrhoea also requires urgent assessment. These signs can indicate dehydration, significant inflammation, bleeding, or a bowel complication.

Ask how severe the flare appears, which tests are needed to exclude infection, how hydration and bleeding will be monitored, when specialist review is required, and what would make surgery safer than continued medical treatment. Ask for a clear plan for medicines after leaving hospital.