Flares: What to Do Right Now

An IBD flare is a period when symptoms like diarrhea, blood, and pain clearly worsen after a quieter spell. This article describes practical steps people with inflammatory bowel disease can take during a flare, how to protect hydration and medicines, and how to decide between watchful waiting, contacting the IBD team, urgent clinic care, or going straight to an emergency department.

Key Takeaways

• A flare means symptoms are clearly worse than a person’s usual baseline for more than a day or two.

• First steps include following any written flare plan, tracking key symptoms, staying hydrated, and continuing maintenance medicines unless a clinician advises otherwise.

• The IBD team should be contacted promptly for sustained increases in stool frequency, new blood, rising pain, low fevers, or early signs of dehydration.

• Emergency care is needed for severe abdominal pain, heavy or ongoing bleeding, high fevers with frequent stools, signs of blockage, or inability to keep fluids down.

• Children, pregnant people, older adults, and those on strong immunosuppressants usually need a lower threshold for urgent or emergency evaluation.

Understanding Flares and “Baselines”

A flare is a time when Crohn’s disease or ulcerative colitis becomes more active and symptoms return or worsen after a period of relative calm. Typical flare symptoms include more frequent stools, looser stool, blood or mucus, stronger urgency, abdominal pain, and fatigue.(crohnscolitisfoundation.org)

Each person has a personal “baseline” pattern when disease is relatively controlled. A flare usually means a clear change from that baseline, not just a single bad day.

Common changes that suggest a flare include:

• Several more bowel movements per day than usual, lasting longer than 24 to 48 hours

• New or increased blood in the stool

• Stronger or more frequent abdominal cramping

• Worsening urgency or waking at night to pass stool

• New fatigue, low appetite, or unintentional weight loss

Tracking symptoms day to day makes it easier to tell the difference between normal ups and downs and a true flare.

First Steps When Symptoms Are Getting Worse

Follow any existing flare plan

Many gastroenterology teams provide written flare plans that outline when to adjust medicines, when to get labs, and when to call for help. If such a plan exists, that is usually the first guide to follow.

If no written plan exists, the steps below offer general, non personalized guidance that can be adapted with a clinician.

Track symptoms closely for 24 to 48 hours

During early symptom changes, it helps to record:

• Number of bowel movements in 24 hours and how that compares with baseline

• Stool appearance, including blood or mucus

• Level and location of pain

• Temperature once or twice daily

• Ability to eat and drink, including any vomiting

• All medicines taken, including missed doses

• Any recent triggers, such as infections, new medicines, or high NSAID use

This information is very useful if contact with the care team or an emergency visit becomes necessary.

Protect medicines and avoid common triggers

Several factors are known to trigger or worsen flares:

• Missing maintenance medicine doses is a frequent cause of renewed inflammation, so consistent use is important.(crohnscolitisfoundation.org)

• Non steroidal anti inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can aggravate IBD and often should be avoided unless a clinician has advised otherwise.(crohnscolitisfoundation.org)

People are generally advised not to:

• Start or restart leftover steroids without medical guidance

• Stop biologics or immunosuppressants suddenly without a plan

• Use strong anti diarrhea medicines if there is severe pain, blood, or concern for blockage

Focus on hydration and gentle intake

Losing a lot of fluid through diarrhea can lead to dehydration. Signs include thirst, dry mouth, less urination, dark urine, and feeling lightheaded or very tired.(patient.gastro.org)

Helpful steps for many people include:

• Taking small, frequent sips of water and oral rehydration or electrolyte drinks

• Choosing softer, easier to digest foods during active diarrhea if eating is possible

• Avoiding alcohol and very high caffeine intake

If drinking enough fluid is not possible, or dehydration signs appear, medical care is needed.

When to Contact the IBD Care Team Soon

Some flare symptoms can be managed at home for a short time, but still need prompt attention from the IBD team, usually within the same day or the next business day. Examples include:

• An increase of about three or more stools per day above baseline, lasting more than 48 hours

• New blood in the stool, or a clear increase in blood compared with usual

• Worsening abdominal pain that interferes with sleep or daily tasks, but without a rigid or very swollen abdomen

• A low grade fever up to about 101°F (38.3°C) for more than 24 hours together with diarrhea or pain(webmd.com)

• Ongoing nausea or reduced appetite for several days

• New or rapidly worsening perianal problems such as painful swelling, pus, or intense fissure pain

• A pattern of flares despite very good medicine adherence

Contact options can include the gastroenterology office, a nurse triage line, a patient portal message, or primary care if the specialist is unavailable. Sending a recent symptom log and medication list often helps the team respond more effectively.

Red Flag Symptoms That Need Emergency Care

When to call emergency services

Emergency services (for example 911 in the United States) are needed right away if a person with IBD has:

• Chest pain, severe shortness of breath, or sudden trouble speaking or moving one side of the body

• New confusion, collapse, or difficulty staying awake

• Heavy rectal bleeding together with fainting, very pale or clammy skin, or inability to stand

These are medical emergencies whether or not IBD is the cause.

When to go to an emergency department urgently

An emergency department or urgent hospital evaluation is usually appropriate when a person with IBD has:

• Severe abdominal pain, especially if the abdomen feels hard, very tender, or more swollen than usual, often with fever or a fast heart rate. This can signal complications such as obstruction, perforation, or toxic megacolon.(en.wikipedia.org)

• Very frequent bloody diarrhea, for example six or more bloody stools per day, combined with fever, rapid heart rate, or marked fatigue, which matches criteria for acute severe ulcerative colitis that generally requires hospitalization.(journals.lww.com)

• Large volume or continuous rectal bleeding, blood clots in stool, or bleeding with dizziness, shortness of breath, or a racing heartbeat.(webmd.com)

• Inability to keep down fluids because of repeated vomiting, or signs of severe dehydration such as almost no urine, very dark urine, strong dizziness on standing, or confusion.(patient.gastro.org)

• Signs of bowel blockage, such as cramping pain in waves, no gas or stool for many hours, vomiting, and a distended abdomen.(en.wikipedia.org)

• Severe perianal pain with a new hot, very tender lump near the anus, especially if fever or chills are present, which can suggest an abscess.

• Sudden painful leg swelling or severe chest pain and shortness of breath that might indicate a blood clot, a known risk in active IBD.(webmd.com)

Pregnant people, children, older adults, and those on strong immunosuppressants may need emergency assessment even at lower symptom levels, because they can become unwell more quickly.

What to Bring and Share in Urgent or Emergency Care

If there is time and it is safe, it helps to bring:

• A written list or photos of all current medicines, including doses and the most recent doses taken

• A list of medicine allergies or past serious reactions

• A brief symptom timeline, including when the flare started, peak stool counts, and any blood or fevers

• Information on previous IBD surgeries, strictures, fistulas, perianal disease, or prior hospitalizations

Clear information can help emergency and hospital teams choose safer tests and treatments and may reduce repeat investigations.

Planning Ahead Between Flares

Between flares, many people work with their care teams to:

• Create an individualized written flare plan that outlines home steps, lab checks, and thresholds for calling or going to the hospital

• Clarify which numbers to use during office hours and after hours

• Ask about personal risk factors such as strictures, prior toxic megacolon, or clotting problems that might change when emergency care is needed

• Keep an updated list of medicines and diagnoses stored in a phone or wallet

Having this preparation in place often makes frightening flare days feel more structured and can help clinicians respond faster when symptoms suddenly worsen.

FAQs

How long can a person watch symptoms at home before seeking help?

If symptoms are clearly worse than baseline for more than 24 to 48 hours, especially with more stools, blood, or rising pain, most people are advised to contact their IBD team rather than waiting for the next routine visit.

Is every increase in diarrhea an emergency?

No. Mild increases without blood, severe pain, or fever can sometimes be managed at home for a short period while tracking symptoms and staying hydrated. However, heavy or bloody diarrhea, or diarrhea with fever, strong pain, or dehydration signs, needs prompt medical attention and may require emergency care.

Can anti diarrhea medicines be used during a flare?

Mild anti diarrhea medicines may be safe for some people with stable IBD, but they can be dangerous in severe flares or possible blockages. Because of this, many clinicians recommend using these medicines only with specific guidance from the IBD team.

What if the IBD specialist cannot be reached?

If the usual specialist is not available and symptoms are in the urgent or emergency categories described above, people can contact primary care, an on call service, urgent care, or an emergency department. It is safer to be evaluated and told that admission is not needed than to wait through severe or worsening red flag symptoms.