Questions to Ask a Gastroenterologist About Colitis

The questions worth asking a gastroenterologist about colitis are the ones that change a decision. Which type of colitis do I have, and what is that based on? How much of the bowel is involved? What is this treatment meant to achieve, and by when? Which test will show whether it worked? What happens if it does not? Everything else can be sent as a message afterwards.

That sounds obvious until you are sitting in the chair. A common post in r/UlcerativeColitis describes booking a follow-up, forgetting every question, and leaving with no information at all, so that the visit felt almost pointless (r/UlcerativeColitis thread). The usual advice, bring a list, is only half of the answer. What matters more is which questions you ask, when in the appointment you ask them, and whether you can tell a real answer from a polite one.

The short answer: five questions that change what happens next

If you only get five questions, make them these. Each one forces a specific, checkable answer rather than reassurance.

1. Which type of colitis do I have, and what is that based on? You want the words on the pathology report, not a category.
2. How much of my bowel is involved, and has that changed? Extent drives which treatments are used, how they are delivered, and when cancer surveillance begins (Lamb 2019).
3. What is this treatment meant to achieve, and by when? A target with a date is a plan. "See how you get on" is not.
4. Which test will tell us whether it worked, and when is it booked? Symptoms alone are a poor guide to what the lining is doing (Colombel 2017).
5. What is the next option if this does not work, and what would trigger moving to it? Knowing the escalation path in advance turns a bad result into a step rather than a crisis.

Everything else in this guide expands on those five, adds the ones people forget, and shows what a substantive answer to each sounds like.

Why the first sixty seconds matter more than the list

Getting your agenda out early matters because most consultations never establish one. In a secondary analysis of 112 recorded clinical encounters, clinicians elicited the patient's own agenda in 40 of them, about 36%. In specialty care the figure was 20%, compared with 49% in primary care. When clinicians did ask, they interrupted the patient after a median of 11 seconds. Patients who were left to finish took a median of 6 seconds to state their concern (Singh Ospina 2019).

Read that again: six seconds. The entire agenda for a colitis appointment fits inside one sentence, if you say it at the start.

Something like: "Three things today. The bleeding is back, I want to know whether I still need steroids, and I want to understand what happens if this drug stops working."

Time pressure is real and it is not your doctor's personal failing. A systematic review of 179 studies covering more than 28 million consultations in 67 countries found average primary care consultation length ranging from 48 seconds to 22.5 minutes, with roughly half the world's population getting five minutes or less (Irving 2017). Specialist appointments are typically longer, but not long. In the global Ulcerative Colitis Narrative survey of 2,100 patients and 1,254 physicians, 63% of patients and 79% of physicians said they wished appointments were longer (Rubin 2021). Both sides feel it.

The honest reading of that evidence is that a list is worth bringing and will not transform the appointment on its own. The size of the effect is small. What you can control is the quality and the order of what is on it.

"Which colitis do I have?" is not a silly question

Colitis means inflammation of the colon. It is a description, not a diagnosis, and several conditions sit underneath it that are treated differently. Getting the specific label, and what it rests on, is the foundation for every other question.

The main possibilities a gastroenterologist is distinguishing between are ulcerative colitis, Crohn's disease affecting the colon, inflammatory bowel disease unclassified when the features overlap, microscopic colitis, and colitis from an infection, a medication or reduced blood supply. If your diagnosis lands on the Crohn's side, our companion guide on questions to ask your doctor about Crohn's disease covers the questions that differ.

Microscopic colitis is the one most often missed, because it is defined by what the biopsies show rather than what the colonoscopy sees. European guidelines describe it as a chronic inflammatory bowel disease with a normal or almost normal endoscopic appearance of the colon, chronic watery non-bloody diarrhoea, and distinct histological abnormalities that define three subtypes: collagenous colitis, lymphocytic colitis and incomplete microscopic colitis (Miehlke 2021). If your colonoscopy was reported as normal and you still have watery diarrhoea, the question is not "so it is just IBS then?" It is: were biopsies taken from normal-looking bowel, and what did they show?

In an r/IBD thread about how easily people lose track of what normal feels like, one commenter described managing symptoms with a low FODMAP diet for years under an IBS label before a microscopic colitis diagnosis and treatment changed things substantially (r/IBD thread). That is one person's experience, not evidence about how common the pattern is, but it is exactly the scenario that the biopsy question is designed to catch.

Delay is common enough to be worth naming. In the Finnish extension of the Ulcerative Colitis Narrative survey, 508 people with self-reported ulcerative colitis reported a diagnostic delay averaging 2.3 years, and 14.4% had waited five years or more (Molander 2019).

Questions for this section:

• What exactly does my pathology report say, and can I have a copy of it and the colonoscopy report?
• Is this ulcerative colitis, Crohn's colitis or unclassified, and what tipped it one way?
• Were biopsies taken even from parts that looked normal?
• What else was ruled out, and how?
• If the picture changes, what would make you revisit the diagnosis?

Questions about extent, because extent decides a lot

How much of the colon is involved changes the treatment route, the monitoring and the long-term surveillance plan, so it is worth knowing your own answer rather than a general description.

In ulcerative colitis the usual descriptions are proctitis, meaning the rectum only, left-sided or distal colitis, and extensive colitis or pancolitis reaching beyond the splenic flexure. This is not trivia. Extent is one of the main determinants of colorectal cancer risk and therefore of the surveillance interval: people with extensive disease carry the highest risk, left-sided colitis carries intermediate risk, and proctitis alone is described as carrying no increased risk (Lamb 2019).

Extent also shapes delivery. British guidance notes that once-daily dosing of oral 5-ASA is as effective as divided doses, and that people flaring on 5-ASA should have oral dose escalation alongside enemas (Lamb 2019). A question as simple as "is a suppository or enema part of what you are recommending, and where should it reach?" can change how well a treatment works, and it is one people are often too embarrassed to ask.

Questions for this section:

• How much of my colon is affected, in the terms you would write in my notes?
• Does that change which treatments you would consider?
• Should topical treatment be part of this, and for how long?
• If my extent changes over time, how would we know?

What target are we treating to, and by when?

This is the highest-value question most people never ask, because it converts an open-ended "try this" into something with a definition of success and a date.

Modern inflammatory bowel disease care is organised around treat-to-target. The STRIDE-II consensus, developed by the International Organization for the Study of IBD through a systematic review and iterative surveys of 89 members, sets symptomatic relief and normalisation of serum and faecal markers as short-term targets, and confirms clinical remission and endoscopic healing as long-term targets, adding absence of disability, restoration of quality of life and normal growth in children. Histological healing in ulcerative colitis is not a formal target but is assessed as a measure of the depth of remission (Turner 2021).

So a good answer to "what are we aiming for?" names a target, a measure and a timeframe. For example: bleeding gone and stool frequency back to your baseline within a few weeks, calprotectin under the local threshold by three months, and a decision point at that review.

Questions for this section:

• What are we aiming for: fewer symptoms, normal blood and stool markers, or healed lining?
• By what date should we know whether we got there?
• If we are partway, do we optimise this treatment or change it?
• Is endoscopic healing a goal for me, and when would that be checked?

How will you know it is working, if I feel fine?

Feeling well is good news, and it is not proof that inflammation has settled. That is why the monitoring question deserves its own slot.

Two studies make the point concretely. In 103 people with ulcerative colitis, endoscopically inactive disease was associated with the absence of rectal bleeding but not with a return to normal stool frequency: among patients whose lining had healed, a quarter or more still reported increased stool frequency (Colombel 2017). And in 356 people with ulcerative colitis or Crohn's disease, patient-reported symptoms had poor positive predictive value for mucosal inflammation, with depression and somatisation both independently associated with reporting active disease (Gracie 2016). Symptoms measure how you are, which matters enormously. They are a weaker proxy for what the lining is doing.

Guidelines have followed. The American Gastroenterological Association suggests that people with ulcerative colitis in symptomatic remission are monitored with a biomarker and symptom strategy rather than symptoms alone, and suggests using a faecal calprotectin under 150 micrograms per gram, or normal lactoferrin or CRP, to inform decisions and avoid routine endoscopy (Singh 2023). The American College of Gastroenterology guideline on ulcerative colitis in adults sets out the preferred approach to assessment and management of adults with the disease, graded with GRADE (Rubin 2025).

One caveat worth raising with your team: calprotectin thresholds vary between clinical settings and between the commercial assays used, and values are not always interchangeable between labs (Laserna-Mendieta 2019). A number is most useful compared with your own previous numbers from the same lab.

Questions for this section:

• Which tests will we use between appointments, and how often?
• What is my calprotectin now, and what number would worry you?
• Who chases the result, and how will I be told?
• If my symptoms and my markers disagree, what do we do?

The steroid question, asked as a plan rather than a complaint

Steroids are excellent at settling a flare and are not a maintenance treatment, so the number of courses you have had in a year is a useful thing to count out loud.

British guidance defines steroid dependency as an inability to wean below 10 mg of prednisolone or 3 mg of budesonide within three months of starting, or a flare within three months of stopping, and defines steroid excess as two or more courses within a year (Lamb 2019). Those are not abstract definitions. In a multi-centre audit of 1,176 people with inflammatory bowel disease attending British outpatient clinics, 30% had received steroids in the previous 12 months and 14.9% met criteria for steroid dependency or excess. That was more common in moderate to severe ulcerative colitis than in Crohn's disease (42.6% versus 28.1%). On blinded peer review, 49.1% of those cases were judged avoidable, giving an annual incidence of inappropriate steroid excess of 7.1%. Rates were lower in centres with dedicated inflammatory bowel disease clinics (Selinger 2017).

That audit turns an awkward conversation into a factual one. You are not challenging anyone. You are asking about a recognised quality measure that services audit themselves against.

An r/UlcerativeColitis post about preparing for a new specialist appointment describes exactly this situation: several treatments tried and failed, stuck on prednisolone, unable to go below a certain dose without symptoms returning, and wanting to know what to ask so the appointment was not wasted (r/UlcerativeColitis thread). The framing that tends to work is: "This is my second course this year and I cannot get below 15 mg. What is the plan that means I do not need a third?"

Questions for this section:

• How many steroid courses have I had in the last twelve months?
• Would you class me as steroid dependent by the usual definition?
• What is the maintenance plan that means I do not need another course?
• If we are starting steroids now, what is the taper and what are we starting alongside them?

Questions before starting a new treatment

Before any new drug, the questions that matter are about what it is expected to do for you, what it requires of you, what it rules in or out later, and what the alternatives were.

Treatment choice in moderate to severe ulcerative colitis is genuinely difficult, because head-to-head trials are scarce. A network meta-analysis of 36 randomised trials including 14,270 people with ulcerative colitis ranked upadacitinib highest for inducing clinical remission and endoscopic improvement, with risankizumab next, and ranked upadacitinib first for maintaining endoscopic improvement (Shehab 2025). Rankings from network meta-analyses are indirect comparisons, and they do not tell you what is right for one person with a particular history, other conditions, preferences about injections or infusions, and local availability. They do mean it is reasonable to ask why this option rather than that one.

It is also the moment to ask about vaccines, because timing is constrained once treatment starts. The updated American College of Gastroenterology preventive care guideline notes that more than 70% of people with inflammatory bowel disease will at some point be on immune-modifying therapy that may raise the risk of infections, many of which are vaccine preventable, and covers the safety and appropriate timing of vaccination alongside screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer, depression and anxiety, and the need for smoking cessation (Farraye 2025). Live vaccines have particular timing rules around biologics and some oral agents, which is a conversation to have before the first dose rather than after (Lamb 2019).

Questions for this section:

• Why this treatment rather than the alternatives, for me specifically?
• What does starting it involve: screening tests, vaccines, infusion or injection, monitoring bloods?
• When should we expect to see an effect, and what do we do if we do not?
• Does starting this close off any option later?
• What are the side effects that should make me call you rather than wait?

The questions people skip: fatigue, mood, work, sex and food

These come up last in appointments and first in real life. They are worth putting on your list precisely because they rarely get raised otherwise.

Fatigue. British guidance includes an explicit recommendation that people with inflammatory bowel disease should be asked about fatigue, because it is common and often not reported, does not necessarily correlate with disease activity, and can cause significantly worse quality of life. Around half of people report fatigue at diagnosis, cohort prevalence sits between 40% and 72%, and it remains common in inactive disease at around 30% to 50% (Lamb 2019). Iron is one treatable contributor: a systematic review of seven studies and 1,425 people found considerable variation in methods, with two of three studies that directly compared fatigue scores finding worse fatigue in those with iron deficiency without anaemia, and the authors could not pool the results (Sartain 2025). That is a reason to ask about iron studies, not a reason to start supplements on your own.

Mood. A meta-analysis of 77 studies including 30,118 people with inflammatory bowel disease found a pooled prevalence of anxiety symptoms of 32.1% and of depression symptoms of 25.2% (Barberio 2021). The preventive care guideline includes screening for depression and anxiety as part of routine care (Farraye 2025). In the Ulcerative Colitis Narrative survey, 48% of patients did not feel comfortable talking to their physician about emotional concerns (Rubin 2021). If that is you, it is fair to say so out loud and ask what support the service has.

Work. In 510 employed people with inflammatory bowel disease, 63% reported fatigue-related problems at work, 48% felt hampered at work and 48% felt insecure about the future because of their health (van Gennep 2021). Asking about adjustments, sick leave documentation or a letter for an employer is a legitimate use of the appointment.

Food. Ask about a dietitian rather than for a list of banned foods. Guidance recommends a varied diet meeting your energy and nutrient requirements, with dietitian or nutrition team review for anyone at risk of malnutrition, and nutritional assessment including screening for recent weight loss at each clinic appointment (Lamb 2019). If food seems to drive your symptoms, our guide on whether food can trigger a UC flare covers what the research actually shows and why the answer differs for symptoms and inflammation.

Symptoms that persist in remission. A meta-analysis of studies in people with inflammatory bowel disease in remission found that a substantial proportion still meet criteria for irritable bowel syndrome type symptoms (Fairbrass 2020). If your markers are normal and you still feel unwell, that is a real conversation, not a dead end, and it has its own treatment route, and the questions worth asking about IBS-type symptoms are different from the ones on this page. Our guide on finding out what triggers your symptoms explains how to test a suspected trigger properly rather than accumulating a longer and longer avoid list.

Questions about surveillance colonoscopy

Surveillance is one of the few parts of colitis care with a schedule attached, and one of the most commonly misremembered.

The general shape, in British guidance, is that surveillance begins eight years after diagnosis, or after the onset of symptoms if there was a significant delay before diagnosis, and that the interval after the first surveillance procedure is set by the degree of inflammation, the extent of disease, the presence of post-inflammatory polyps and other risk factors. People who also have primary sclerosing cholangitis are recommended annual surveillance colonoscopy from diagnosis (Lamb 2019). Local programmes differ, so the number that matters is yours.

An r/IBD thread asking what people wished they had asked at their pre-procedure appointment is a good reminder that the practical questions are worth asking too: the prep, timing, sedation, what happens to the biopsies and when results come back (r/IBD thread). Another r/UlcerativeColitis post captures the feeling of leaving an overwhelming first appointment and only afterwards realising what should have been asked before the scope (r/UlcerativeColitis thread).

Questions for this section:

• When does my surveillance clock start, and from which date?
• What is my interval, and what determines it?
• Do I have any risk factors that shorten it?
• Who is responsible for calling me, and what should I do if the letter never comes?

Questions about fertility, pregnancy and surgery, asked early

Ask these before they are urgent, because one of the answers depends on a decision that may be made under time pressure.

British guidance states that while medical treatment of ulcerative colitis has not been shown to impair female fertility, any pelvic surgery carries a risk to it. It cites a systematic review and meta-analysis reporting 63% infertility one year after open ileal pouch-anal anastomosis surgery, with a relative risk of 3.91 associated with the surgery, corroborating an earlier meta-analysis that found an infertility rate of 15% for medically treated ulcerative colitis compared with 48% after pouch surgery, and notes that time to conception is longer after surgery. It includes a specific recommendation that for women needing emergency subtotal colectomy and ileostomy, decisions about proctectomy and pouch reconstruction should be discussed because of the potential for impaired fertility, with personalised decisions including laparoscopic techniques and the option of delaying until after completing a family (Lamb 2019).

That is a lot of consequence attached to a conversation that is easy to postpone. If surgery is anywhere on your horizon, it belongs on the list now.

Questions for this section:

• Does my current treatment have implications for fertility, pregnancy or breastfeeding?
• If surgery were ever discussed, what would the options be and what are the trade-offs for fertility?
• Who would I talk to about this: you, a colorectal surgeon, or a specialist nurse?
• What should I do about treatment if I become pregnant?

What a good answer sounds like

Use this table during the appointment. The left column is what you ask, the middle is what a substantive answer contains, and the right is the follow-up that gets you there if the first answer stops short.

A worked example: one appointment, three questions, one page

The practical version of all of this is short. Here is what it can look like.

Before. Maya has left-sided ulcerative colitis, diagnosed three years ago. She is on maintenance 5-ASA and had a steroid course six months ago, and another two months ago. Over the last three weeks her stools have gone from two a day to four or five, with blood on about half of days and two nights of being woken. She is exhausted.

The page she brings. One side of A4. At the top, three questions: is this a flare or something else; am I on the right maintenance treatment given two steroid courses this year; and what happens next if this one does not hold. Underneath, the facts: baseline two stools a day, now four to five; blood on 11 of the last 21 days; woken twice; no missed doses; two steroid courses in the last 12 months; last calprotectin 180 six months ago; no recent antibiotics or anti-inflammatory painkillers.

The first minute. She says the three questions before anything else, rather than answering "how have you been?" with "not too bad". Our guide on how to prepare for a GI appointment covers building that page in the weeks beforehand.

What that produces. The team orders a calprotectin and a stool test to check for infection, because an infection can look exactly like a flare. They discuss whether two steroid courses in a year means the maintenance treatment needs changing rather than repeating, and set a review point with a date. They agree what number would trigger a change, and she leaves knowing who to contact if things worsen before then.

The part people forget. She asks for a summary. A Cochrane review of 16 trials involving 2,318 adults found that when people were given a recording or written summary of a key consultation, between 60% and 100% used it at least once, many shared it with family, and five of nine studies reporting recall found it was better in the group who received one (Pitkethly 2008). Asking "could you write the plan in the letter so I have it?" is a small request with decent evidence behind it.

A structured page is genuinely easier to act on than a long diary. Clairop produces this kind of one-page summary for an appointment: the PRO-2 score trend from the stool frequency and bleeding you have already logged, mean movements per day against your own baseline, days with blood, overnight episodes, medication adherence and lab results. The method page explains what it does and does not claim about those numbers.

The under-reporting problem, and how to beat it

Most people with long-standing colitis systematically under-report, because their sense of normal has moved. This is worth naming, because no list of questions fixes it.

An r/IBD post put it precisely: after eight years of treatment that worked well, the poster realised they automatically discounted fatigue and discomfort as "just normal for me", and wondered how many symptoms they under-reported because nothing felt new or dramatic enough. Replies described the same drift, with one person saying their baseline had quietly become the reference point against which everything else was judged (r/IBD thread).

Two things help. The first is a number rather than an adjective: stools per day this month against your usual, days with blood out of the last 30, nights woken. The second is a validated questionnaire. The IBD-Control questionnaire was developed as a rapid, generic measure of disease control from the patient's perspective. It has 13 items plus a 0 to 100 visual analogue scale, with a validated eight-item subscore, and in its validation study of 299 patients it took a mean of about one minute and fifteen seconds to complete (Bodger 2014). Asking whether your service uses it, or filling one in beforehand, gives the conversation a starting point that is not "fine, thanks".

Guidance is clear that patient-reported measures and objective markers answer different questions and are complementary rather than interchangeable (Lamb 2019). You need both, which is another way of saying you need to report accurately even when the bloods are normal.

If you want a fuller picture of what is worth logging between appointments, our guide on tracking ulcerative colitis covers what a tracker needs to capture and why some things, like bleeding and stool frequency, are not interchangeable.

Questions that rarely produce a useful answer

Not every question has an answer your gastroenterologist can give, and knowing which is which saves the slot for something better.

"What foods should I avoid?" This is the most commonly asked and least answerable question in colitis clinics. Trigger foods vary enormously between people, and nutrition guidance points towards a varied diet with dietitian input rather than a universal exclusion list (Lamb 2019). A better version: "Can I be referred to a dietitian, and is there anything about my nutrition you are worried about?"

"What caused this?" Nobody can tell you why you specifically developed colitis. A better version: "Are there things that could make a flare more likely for me, such as infections, painkillers or missing doses?"

"Will this ever go away?" A better version: "What does long-term control look like for someone with my extent and history, and what is realistic to aim for?"

"Am I going to need surgery?" Usually unanswerable in the abstract. A better version: "What would have to happen for surgery to come onto the table, and who would I talk to about it first?"

"Is there anything natural I could take instead?" This tends to stall the conversation. A better version: "I want to understand what I can do alongside treatment. What has evidence behind it, and is there anything that could interfere with my medication?" Never stop or change a prescribed treatment to try something else without talking to your team first.

When the answers are not forthcoming

If your questions are not being taken seriously, the problem is the fit, not you. That is worth saying plainly, because a lot of people conclude the opposite.

Several patterns show up repeatedly in colitis communities. A post in r/UlcerativeColitis describes the relief of finally seeing a gastroenterologist who spent an hour going through their history and symptoms, after a long search, and frames it as advocacy that eventually paid off (r/UlcerativeColitis thread). A post in r/IBD makes the same point more bluntly: the search for a specialist who listens is worth the effort, and the difference between the third and the first was night and day (r/IBD thread). Another r/UlcerativeColitis post describes being effectively dismissed as a patient within minutes of asking questions at a follow-up (r/UlcerativeColitis thread). And a newly diagnosed poster asked directly how to tell whether they had been matched with a good specialist or a dismissive one (r/UlcerativeColitis thread).

These are individual experiences, not data on how common any of it is. But there is evidence that information needs go unmet at scale. In a nationwide survey of 571 people with inflammatory bowel disease, participants rated the amount of information they received at disease onset at 0.9 out of 5 on average, while rating the importance of that information at 4.2 out of 5 for a newly diagnosed patient (Daher 2019). In the Ulcerative Colitis Narrative survey, 72% of patients wished for more information and support at initial diagnosis, and while 84% of physicians thought patient advocacy organisations were important, 54% never mentioned them (Rubin 2021).

Practical steps that tend to help:

• Ask once more, in writing. Send your question through the patient portal or to the specialist nurse, so there is a record and a considered reply.
• Ask for the reasoning, not the conclusion. "What would need to change for you to reconsider?" is harder to wave away than "are you sure?".
• Use the nurse route. Specialist nurses are described in guidance as a vital part of the team, providing education, therapy monitoring, continuity and rapid access for advice and review during flares (Lamb 2019). They are often the fastest way to get a question answered.
• Ask for a second opinion or a specialist clinic. This is a normal request, not an insult. Rates of inappropriate steroid excess were lower in centres with dedicated inflammatory bowel disease clinics (Selinger 2017).
• Bring someone. A second person remembers different things and can ask the question you cannot get out.

Myths about asking your gastroenterologist questions

Myth: "A long list makes the most of the appointment." Longer lists take longer to read out and leave less time for answers. The trial evidence for pre-consultation question lists shows small effects on question asking and satisfaction (Kinnersley 2007). Three well-chosen questions stated early usually beat twelve read at the end.

Myth: "If I felt well, there is nothing to discuss." Symptoms are a weak proxy for inflammation. Patient-reported symptoms had poor positive predictive value for mucosal inflammation in a cohort of 356 people (Gracie 2016), and a quarter or more of people with healed lining still report increased stool frequency (Colombel 2017).

Myth: "Asking about steroids will make me look like a difficult patient." Steroid dependency and excess are recognised quality measures that services audit (Selinger 2017), and prolonged steroid therapy is explicitly described as harmful and something to minimise (Lamb 2019).

Myth: "Fatigue is just part of having colitis, so it is not worth mentioning." Guidance specifically directs clinicians to ask about fatigue because it is common and often not reported, and it does not necessarily track disease activity (Lamb 2019).

Myth: "Vaccines and screening are my GP's job, not my gastroenterologist's." The preventive care guideline is addressed to gastroenterology teams and covers vaccination timing, osteoporosis, cervical and skin cancer screening, and mental health screening, with coordination across teams (Farraye 2025).

Myth: "Asking for a second opinion means starting over." It means another specialist reviews the same records and gives a view. Your existing reports, scopes and pathology travel with you.

When not to wait for your appointment

Some symptoms should not be saved up for the next clinic slot. If any of these apply, contact your inflammatory bowel disease team promptly rather than waiting, and seek urgent care where indicated.

Contact your team promptly if you have:

• New blood in your stool, or noticeably more than usual
• Stool frequency rising above your usual baseline for more than a couple of days
• Symptoms waking you at night
• New or worsening abdominal pain
• Unintended weight loss, or eating much less because of symptoms
• Feeling unusually tired or breathless, which can be a sign of anaemia
• Recent antibiotics, a stomach bug, or regular use of anti-inflammatory painkillers alongside worsening symptoms

Seek urgent same-day medical help if you have:

• Six or more bloody stools a day
• A fever, a racing heart, or feeling faint
• Signs of dehydration such as passing very little urine, dizziness on standing, or being unable to keep fluids down
• Severe abdominal pain, or a swollen, tender abdomen

An r/UlcerativeColitis post about a first flare since diagnosis asked exactly the right thing in advance: when should I go to the emergency department (r/UlcerativeColitis thread). That is a question to settle at a calm appointment, written down, so you are not deciding it at 2am. Ask your team where their threshold sits, and what route they want you to use.

For more on preparing for appointments and describing symptoms clearly, browse our doctor visits guides.