Signs Your IBD May Be Flaring


Abdominal Pain

woman Having cramps
Eva Katalin Kondoros / Getty Images

Abdominal pain (what some people might also call stomach pain) is a common symptom of an inflammatory bowel disease (IBD) flare-up. The pain will be different based on what kind of IBD is present and where any inflammation in the small or large intestine is located.

Pain from ulcerative colitis tends to be located in the lower left quadrant (or section) of the abdomen and patients is often describe it as being crampy in nature.

Pain from Crohn's disease could be located in almost any area of the abdomen, depending on what section of the intestine (either the large intestine or the small intestine) is affected. In the two most common forms of Crohn's disease, ileocolitis and ileitis, pain might be found in the middle or the lower right abdomen.

Pain in the abdomen has many potential causes; for that reason, the location is an important factor in helping a physician understand and diagnose what might be causing it.


Persistent Diarrhea

One of the more troublesome symptoms of IBD, diarrhea can also be an indication of a flare-up, especially if it is bloody. Some people with IBD also experience an intense need to move the bowels (called tenesmus) along with diarrhea. In some cases, people feel exhausted after having IBD-related diarrhea, particularly when it is happening several times a day.

Diarrhea happens to everyone, but diarrhea that is not caused by IBD (such as that caused by common illnesses) will typically go away by itself in a few days. With IBD, diarrhea will not resolve on its own.

For most people, the normal range for bowel movements is between one and three a day. During a flare-up, people with IBD could experience many more—in a severe case, that could mean 10 or more bouts of diarrhea a day.

Diarrhea that is accompanied by blood or abdominal pain should always be discussed with your physician as soon as possible, even if those symptoms have happened before.


An Unexplained Fever

Fevers are a common symptom, and as most adults experience viral illnesses a few times a year, a short-term fever is usually no cause for alarm. However, a fever can also be an indication that there is inflammation somewhere in the body. IBD causes inflammation in the intestinal tract, and that inflammation, in turn, could wind up causing a fever. In some cases, fevers can occur during the night, leading to disrupted sleep and ultimately causing night sweats.

When another cause of a fever can't be found, such as a viral illness like the flu, it could be a result of an IBD flare-up, especially if other signs and symptoms of a flare-up are also occurring.

If a fever is not going away in a few days, it should be discussed with a physician.


Blood In the Stool

Blood in the stool is one of the more common signs of ulcerative colitis, but it happens less frequently in people who have Crohn's disease. There are many possible causes of blood in the stool, but for those who have already been diagnosed with IBD, frank bright red blood in the stool is probably a good indication that the IBD is flaring up.

Another common cause of blood in the stool or on the toilet paper after wiping is a hemorrhoid. Hemorrhoids tend to be more common in people who have IBD, especially if diarrhea is also present.

Blood in the stool should always be evaluated by a physician, whether it's thought to be from an IBD flare-up or not. A gastroenterologist can help determine the cause of the blood, and whether it is coming from the colon, some hemorrhoids, or even further up in the intestinal tract.


Problems With Sleep

Many people with IBD have problems falling asleep or staying asleep. There are several reasons for this, including pain, diarrhea, or fevers. Certain medications, such as prednisone, can also make getting to sleep more difficult. In some cases, having problems with sleep might start to occur even before a flare-up starts. In other words, poor sleep might even be an early sign of an IBD flare-up. For this reason, it is important for those with IBD to practice good sleep hygiene and to take care to get enough rest.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Inflammatory bowel disease (IBD).

  2. Hendrickson BA, Gokhale R, Cho JH. Clinical aspects and pathophysiology of inflammatory bowel disease. Clin Microbiol Rev. 2002;15(1):79-94. doi: 10.1128/CMR.15.1.79-94.2002

  3. John's Hopkins Medicine. Crohn's disease: Introduction.

  4. Centers for Disease Control and Prevention. Inflammatory bowel disease (IBD).

  5. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & causes of hemorrhoids.

  6. NIH MedlinePlus. Prednisone.

  7. Kinnucan JA, Rubin DT, Ali T. Sleep and inflammatory bowel disease: exploring the relationship between sleep disturbances and inflammation. Gastroenterol Hepatol (N Y).

Additional Reading

By Amber J. Tresca
Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.