Emergencies

A medical emergency in inflammatory bowel disease (IBD) happens when inflammation or its complications suddenly threaten life, organs, or long‑term gut function. This article explains how serious problems like toxic megacolon, bowel obstruction, perforation, severe bleeding, blood clots, and dehydration may show up, and how they are usually handled in the hospital. It is educational only and does not replace emergency care.

Key Takeaways

• Certain symptoms in IBD, such as severe abdominal pain, high fever, or heavy bleeding, need same‑day urgent or emergency care.

• Toxic megacolon is a rare but life‑threatening complication where the colon becomes very swollen and inflamed, and can perforate.

• Other gut emergencies in IBD include acute severe colitis, bowel obstruction, uncontrolled bleeding, and perforation. (wjes.biomedcentral.com)

• IBD also raises the risk of blood clots in the legs or lungs, especially during flares and hospital stays. (pubmed.ncbi.nlm.nih.gov)

• In emergencies, doctors focus on stabilizing breathing and blood pressure, controlling infection and inflammation, and deciding quickly if surgery is needed.

What Counts as an IBD Emergency?

Many IBD flares are managed in clinic or by telehealth. Some situations, however, can rapidly become life‑threatening.

Examples of true emergencies in ulcerative colitis and Crohn’s disease include: (wjes.biomedcentral.com)

• Acute severe colitis

• Toxic megacolon

• Uncontrolled intestinal bleeding

• Perforation of the bowel

• Free air with abscess or fistula

• Intestinal obstruction (blockage)

Emergency services (911 in the United States) should be called if a person with known or suspected IBD has:

• Severe, sudden, or spreading abdominal pain, with a hard or very swollen belly

• Fainting, collapse, or confusion

• Very fast heartbeat, trouble breathing, or chest pain

• Heavy, ongoing rectal bleeding with dizziness or severe weakness

Urgent same‑day hospital assessment is also needed for:

• New severe abdominal pain with vomiting, or inability to pass gas or stool

• High fever with shaking chills and abdominal pain

• More than 6–8 bloody stools per day with signs of feeling very unwell

Major Bowel Emergencies in IBD

1. Acute Severe Colitis and Toxic Megacolon

Acute severe ulcerative colitis (ASUC) is defined by frequent bloody diarrhea (at least 6 stools per day) plus whole‑body signs of serious illness, such as fever, fast heart rate, anemia, or high inflammation markers. It is a medical emergency and needs hospital treatment. (mdpi.com)

Toxic megacolon is a complication where the colon becomes very dilated and loses its normal movement, together with signs of toxicity like fever, fast heart rate, low blood pressure, or confusion. It can lead to perforation, sepsis, and shock. (hopkinsmedicine.org)

Warning signs of toxic megacolon may include: (hopkinsmedicine.org)

• Marked abdominal swelling and pain

• Fewer or no bowel movements after a period of severe diarrhea

• High fever, chills, and feeling very ill

• Fast heart rate, low blood pressure, or confusion

Typical hospital management:

• Admission to a monitored unit

• Stopping medicines that slow the gut or some pain medicines that may worsen colonic paralysis, under medical supervision (hopkinsmedicine.org)

• Intravenous (IV) fluids and correction of salts

• IV steroids to reduce inflammation, plus antibiotics if infection is suspected

• Abdominal X‑ray or CT scan to measure colon size and check for perforation

• Very close surgical involvement, with colectomy if the colon does not improve or perforates

2. Intestinal Obstruction (Blockage)

Crohn’s disease can cause narrowing of the bowel (strictures) from inflammation and scarring. These strictures may partly or completely block the passage of food and gas. (healthline.com)

Warning signs of obstruction:

• Crampy abdominal pain that comes in waves and may become constant

• Bloating and visible abdominal swelling

• Nausea and vomiting

• Little or no gas or stool passing, sometimes severe constipation

• Possibly fever or worsening pain

Hospital care may include: (healthline.com)

• No food or drink by mouth

• IV fluids and pain control

• A nasogastric tube to drain stomach contents in some cases

• CT or MRI to locate the blockage

• Steroids or other medicines if active inflammation is a major driver

• Emergency surgery if there is complete obstruction, suspected dead bowel, or perforation

3. Perforation and Severe Infection

A perforation is a hole in the bowel wall. It can occur as a complication of very severe colitis, toxic megacolon, or a Crohn’s ulcer, and can quickly lead to peritonitis and sepsis. (pmc.ncbi.nlm.nih.gov)

Typical features:

• Sudden, very severe abdominal pain

• A rigid or board‑like abdomen

• Fever, fast heart rate, and often low blood pressure

• Feeling acutely and visibly unwell

Perforation almost always requires emergency surgery, along with IV fluids, broad‑spectrum antibiotics, and intensive monitoring.

4. Severe Intestinal Bleeding

Active IBD can cause bleeding from ulcers in the colon or small bowel. Mild bleeding is common. Emergency care is needed when bleeding is heavy or persistent.

Red‑flag bleeding:

• Large amounts of bright red blood or clots in the stool

• Continuous blood with nearly every movement over a short period

• Signs of blood loss, such as dizziness, fainting, pale skin, or racing heart

In the hospital, care teams may give IV fluids, blood tests, transfusions if needed, urgent colonoscopy or imaging, and surgery or interventional radiology if bleeding does not stop. (wjes.biomedcentral.com)

Serious Problems Outside the Gut

Blood Clots (Venous Thromboembolism)

People with IBD have about a 2 to 3 times higher risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) in the legs and pulmonary embolism (PE) in the lungs. The risk is highest during active disease and hospital stays, and VTE is a major cause of morbidity and mortality in IBD. (pubmed.ncbi.nlm.nih.gov)

Emergency signs of VTE:

• New, one‑sided leg swelling, redness, warmth, and pain in the calf or thigh (possible DVT)

• Sudden chest pain, shortness of breath, coughing up blood, or unexplained fast heartbeat (possible PE)

In hospital, most people admitted with IBD are advised to receive preventive blood thinners, unless bleeding risk is too high. (pubmed.ncbi.nlm.nih.gov)

Severe Dehydration and Electrolyte Loss

Frequent watery stools can cause severe dehydration and abnormal levels of sodium, potassium, and other salts. This is more likely during acute severe colitis.

Alarming features:

• Very low blood pressure, rapid pulse

• Dizziness, fainting, severe muscle cramps

• Dry mouth, little or no urine, sunken eyes (healthline.com)

Hospital staff treat this with IV fluids, careful electrolyte replacement, and treatment of the underlying flare or infection.

Severe Infections and Abscesses

Crohn’s disease can lead to abscesses inside the abdomen or around the anus. Toxic megacolon and perforation also increase the risk of systemic infection and sepsis. (hopkinsmedicine.org)

Urgent care is needed for:

• Fever and shaking chills with new or worsening abdominal or rectal pain

• Painful redness or swelling near the anus, especially with fever

• Confusion, very fast breathing, or other signs of sepsis

Management may include antibiotics, drainage of abscesses by radiology or surgery, and review of current IBD therapies.

Quick Reference: Key Emergency Patterns

Planning Ahead for Emergencies

Because emergencies in IBD can evolve quickly, it helps if a person and their support network have a plan:

• A written list of diagnoses, past surgeries, and current medications, including biologics and recent doses

• Contact details for the gastroenterologist and IBD center

• Knowledge among family or close friends of key red‑flag symptoms and when to activate emergency care

• Awareness that sudden severe symptoms should not be blamed only on “a usual flare,” since complications may be present

Having IBD does not mean emergencies will happen, but understanding these warning signs and typical hospital steps can help families act quickly if a serious complication ever arises.

FAQs

Is every IBD flare an emergency?

No. Many flares are managed with planned medication changes and close follow‑up. An emergency is more likely when symptoms are suddenly much worse than usual, when there are whole‑body signs like high fever or fainting, or when there is heavy bleeding, severe pain, or breathing problems.

Can toxic megacolon be prevented?

Prompt treatment of acute severe colitis, careful monitoring in hospital, and avoidance of medicines that slow the colon in high‑risk situations may reduce the chance of toxic megacolon. However, even with good care, it can still occur, which is why early recognition and rapid hospital treatment are so important.