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Contact your IBD healthcare team promptly if you think your Crohn’s disease or ulcerative colitis is flaring. Get immediate medical help for severe symptoms such as heavy bleeding, severe abdominal pain, ongoing vomiting, high fever or dehydration. Worsening symptoms do not prove that inflammation is the cause: infection and other problems can look similar, so ask a clinician what to do rather than changing prescribed treatment yourself.
What counts as a possible IBD flare?
A flare generally means that symptoms have become active, increased, changed or worsened. There is no single symptom pattern that identifies every flare. Crohn’s disease and ulcerative colitis affect people differently, and a person’s own symptoms may also change over time.
Possible warning signs include abdominal pain, diarrhea, blood in the stool and fatigue. A change from your usual pattern can matter even if it does not match a symptom list exactly. If you have a personal flare plan from your IBD team, use it; otherwise, contact the team for guidance rather than trying to diagnose the cause on your own.
Symptoms can have causes other than active IBD, including infection. Your healthcare team may ask questions or arrange tests to work out what is happening and what care is appropriate. The Crohn’s & Colitis Foundation advises contacting the healthcare team when you think you are having a flare.
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How urgently should you seek help?
Use the most urgent applicable route in your personal care plan. A planned call to your IBD team is appropriate for a suspected flare without severe symptoms; severe or rapidly worsening symptoms need immediate attention. The examples below are not an exhaustive checklist, and no single stool count or symptom duration is a universally safe threshold for every person.
| Situation | What to do | Examples and context |
|---|---|---|
| Possible flare without severe symptoms | Contact your established IBD team promptly and follow its advice. | New or worsening abdominal pain, diarrhea, blood in the stool or fatigue can be reasons to check in. The team can decide whether assessment or testing is needed. |
| Symptoms that need urgent advice | Seek same-day or urgent medical advice using the route available where you live, or the route in your flare plan. | Examples in NHS ulcerative-colitis guidance include very bad or bloody diarrhea, high temperature or chills, a fast heartbeat, and being unable to pass stool or gas. NHS Crohn’s guidance advises urgent contact for bloody diarrhea or black or dark-red stool. These are UK pathways and examples, not universal local service instructions. |
| Severe symptoms or possible emergency | Contact your care team right away or seek emergency medical care. If you cannot reach the team quickly, use your local emergency service. | The Crohn’s & Colitis Foundation names heavy bleeding, severe stomach pain, ongoing vomiting, high fever and dehydration as severe symptoms. NHS ulcerative-colitis guidance gives emergency examples including severe abdominal pain, continuous rectal bleeding, a lot of blood or large clots, and vomiting blood or stool. |
Call the IBD team for a suspected flare
If symptoms have changed but you are not experiencing severe warning signs, contact the IBD team that manages your care. Explain what has changed and ask whether the team wants you to be assessed. Your clinicians know your diagnosis and treatment history and can advise whether to monitor symptoms, arrange an appointment, or seek care elsewhere.
Do not wait for a particular number of days or bowel movements if your symptoms are worsening or you are concerned. The sources do not establish one duration or stool-count cutoff that applies to all people with IBD. Follow any individualized thresholds your clinician has given you.
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Get urgent advice when symptoms are more concerning
Urgent advice is appropriate when symptoms suggest you may need prompt assessment but the situation is not clearly an immediate emergency. Examples listed by the NHS for ulcerative colitis include very bad or bloody diarrhea, high temperature or chills, a fast heartbeat, and inability to pass stool or gas. For Crohn’s disease, NHS guidance advises urgent GP or NHS 111 contact for bloody diarrhea or black or dark-red stool, and medical review if diagnosed symptoms worsen or treatment is not helping.
GP and NHS 111 are UK services. If you live elsewhere, use the urgent-care or clinician contact route available in your country; do not assume the UK service names or pathways apply to you. If you cannot get timely advice or symptoms become severe, seek emergency care locally.
Seek emergency help for severe symptoms
Heavy or continuous bleeding, a lot of blood or large clots, severe abdominal pain, ongoing vomiting, vomiting blood or stool, high fever, or signs of dehydration warrant immediate attention. These are examples of severe warning signs, not a complete list. If you are unsure whether a symptom is an emergency, contact your care team or local emergency service for guidance rather than relying on a checklist.
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The NHS distinguishes urgent advice from emergency action in its ulcerative-colitis guidance. Its emergency examples include severe abdominal pain, continuous rectal bleeding, a lot of blood or large clots, and vomiting blood or stool; its listed UK emergency route is A&E. For readers outside the UK, use the local emergency department or emergency service rather than treating A&E as a universal term.
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A suspected flare is a reason to contact your care team, not proof that inflammation has returned. Infection or another problem may produce similar symptoms. Depending on what you report, the team may ask follow-up questions, arrange testing or recommend an examination before deciding what is causing the change.
That distinction matters because the right response depends on the cause. Do not start, stop, increase, reduce or otherwise adjust prescribed IBD treatment without medical guidance. University College London Hospitals’ guide to managing an IBD flare specifically cautions that changing immunosuppressant or biologic doses without advice from the IBD team is not safe. If you think a medicine is causing a problem or your current treatment is not helping, tell the team and ask what to do.
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What information to give the clinician
A concise, specific account can help the team decide how quickly you need care and what assessment may be useful. If you can, have the following details ready when you call:
- What changed: Describe the symptoms and when they began, including whether they are getting worse, improving or fluctuating.
- Bleeding: Say whether you have seen blood, whether it is continuing, and whether the amount seems heavy. Mention black or dark-red stool if present.
- Other severe symptoms: Report severe pain, fever or chills, a fast heartbeat, ongoing vomiting, difficulty keeping fluids down, or signs of dehydration.
- Your IBD context: State whether you have Crohn’s disease or ulcerative colitis and identify your current prescribed treatment if you know it.
- Your plan and access needs: Say whether you have already contacted the team, what advice you received, and whether you can reach your usual clinician or need an after-hours route.
Do not delay urgent or emergency care to gather records or complete a symptom log. Share the information you have and follow the clinician’s instructions.
How to prepare a flare plan before symptoms start
The Crohn’s & Colitis Foundation recommends discussing a flare plan before a flare occurs. A plan makes it easier to choose a contact route when you are unwell and helps avoid guessing about symptoms or after-hours arrangements.
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- Ask what to do first. Ask your IBD team: “What should I do if I think I’m having a flare?” Find out whether the team wants an initial phone call, an appointment or another step.
- Clarify escalation signs. Ask which symptoms mean you should call the office, which require same-day or urgent advice, and which mean emergency care. Ask for advice that reflects your own history rather than relying on a general symptom count.
- Confirm how to reach care. Find out the best contact method during office hours and after hours, and whether a same-day or urgent appointment option is available.
- Ask what emergency clinicians may need. Discuss how relevant history and treatment notes can be accessed if you need care away from your usual team.
- Write down your personal warning signs. The Foundation suggests identifying and recording the symptoms that tend to signal a change for you. An ordinary notebook or symptom journal is optional; it is a way to keep information together, not a diagnostic tool or a substitute for medical advice.
Why a stool-count threshold cannot replace your plan
Some clinical resources describe symptom counts to illustrate disease severity, but those examples are not personalized instructions about when it is safe to wait or when every patient should seek care. NIDDK’s ulcerative-colitis information, last reviewed in September 2020, describes mild disease as possibly involving fewer than four bowel movements a day. It gives more than six bowel movements with blood most of the time as an example of severe symptoms, and more than ten bloody bowel movements in a day as an example of extremely severe or fulminant disease.
These are severity examples for ulcerative colitis, not a universal flare action plan, and they should not be applied as a threshold for Crohn’s disease or used to delay help. A person’s symptoms, medical history and clinician-provided plan all matter. Contact your team about a suspected flare even when your count is below an example in a general resource.
Sources and scope
The Crohn’s & Colitis Foundation’s patient guidance on managing flares covers flare symptoms, contacting the healthcare team, severe warning signs and planning ahead. NHS guidance for ulcerative colitis and Crohn’s disease provides UK-specific urgent and emergency examples. NIDDK’s ulcerative-colitis symptom and severity examples were last reviewed in September 2020. University College London Hospitals NHS Foundation Trust’s Guide to managing an IBD Flare was updated on 10 December 2025, with review due 1 December 2027.
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