Frequent bowel movements, urgency, abdominal pain — if you’re living with the unpredictable symptoms of ulcerative colitis (UC), you may often find yourself wondering, “Is this normal?”
In truth, there is no real norm when it comes to ulcerative colitis, an inflammatory bowel disease that affects different people differently, says Arun Swaminath, MD, a gastroenterologist at Lenox Hill Hospital in New York City and an assistant professor at Hofstra North Shore-LIJ School of Medicine in Hempstead, New York.
But the disease does have some consistencies. People with ulcerative colitis may have an aggressive course or a more slowly developing course. “Those with the slower course, which is the majority of patients, will progress over months," Dr. Swaminath says. "People with the more aggressive course will get really sick quickly, over a matter of weeks.”
The variability in UC symptoms also has to do with the extent the inflammation, or colitis, travels up the four- to six-foot colon,” says Patricia Raymond, MD, a gastroenterologist in Norfolk, Virginia. “The more of the colon that is involved, the looser the stools, as the inflamed colon is unable to absorb water well.”
Despite the differences in symptoms, most people can expect to be able to live normal lives with ulcerative colitis. While there’s no current cure for ulcerative colitis and flares can be unpredictable, treatment and management often help get and keep symptoms under control, according to the Crohn's and Colitis Foundation of America (CCFA). That’s why it’s important to be open with your doctor about your symptoms and discuss your treatment options.
This overview can help you better understand your ulcerative colitis symptoms and know when it's time to check in with your medical team.
8 Common Ulcerative Symptoms
Bloody stools. “This is the hallmark symptom of ulcerative colitis,” Swaminath says. The disease causes open sores in the large intestine, which can become irritated to the point of bleeding. “It is important to recognize that there is a difference between hemorrhoidal bleeding, which is a little blood on the toilet paper when you wipe, and the bleeding of ulcerative colitis, which tends to be more dramatic, with blood actually in the stool,” he explains. Whenever you experience bloody diarrhea with mucus or pus, or if the bleeding seems to be coming directly from your rectum, you should discuss it with your doctor.
Urgency. The average person might form stools anywhere from three times a week to three times a day, with a reasonable amount of time between awareness of stool in the rectum and needing to get to the bathroom, Dr. Raymond says. With ulcerative colitis, you may have little time to reach a toilet. “Inflammation in the rectum associated with ulcerative colitis is very uncomfortable, so when the stool hits that area, most people with ulcerative colitis have to find a bathroom right away,” Swaminath says. And this can really affect quality of life. In fact, urgency is so prevalent among people with ulcerative colitis that many map out restroom locations before they leave the house or use smartphone apps to locate bathrooms when they’re out on the town. But that doesn’t mean the symptom should be ignored. Urgency warrants a call to your doctor when you can no longer make a socially appropriate bathroom visit, Raymond says.
Loose stools. People with ulcerative colitis also tend to have intermittent diarrhea. This may progress from an episode now and then to experiencing loose stools almost every time you go.
Abdominal pain. “Ulcerative colitis tends to cause low abdominal cramping,” Raymond says. If that cramping becomes severe or suddenly worse, call your doctor.
Worsening symptoms. “People with a more slowly developing course of ulcerative colitis usually notice their symptoms gradually getting worse,” Swaminath says. “You may first see a little blood in your stool and then notice you are going to the bathroom a little more frequently. Over time, you may go from twice a day to three to four times a day to waking up in the middle of the night to go.” If you see a noticeable change in your symptoms, you could be experiencing a flare; always check in with your doctor.