10 Warning Signs and Symptoms of Ulcerative Colitis You Should Know

Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers in the digestive tract. This condition specifically affects the innermost lining of the large intestine (colon) and rectum, leading to a range of uncomfortable and sometimes debilitating symptoms. Understanding the warning signs of ulcerative colitis is crucial for early detection and proper management of this condition.

What is ulcerative colitis? It’s an autoimmune condition where the body’s immune system mistakenly attacks the lining of the colon, causing inflammation and sores. Unlike Crohn’s disease, which can affect any part of the digestive tract, ulcerative colitis (also known as colitis ulcerosa) is limited to the colon and rectum. The symptoms can vary from mild to severe and may develop gradually or come on suddenly.

In this comprehensive guide, we’ll explore the most common ulcerative colitis symptoms to help you recognize the condition early and seek appropriate medical care.

1. Bloody Diarrhea

Bloody diarrhea is one of the hallmark symptoms of ulcerative colitis and often the first sign that prompts people to seek medical attention. The blood in the stool occurs because the inflamed and ulcerated lining of the colon bleeds easily.

Characteristics of bloody diarrhea in UC:

• Blood may appear bright red or darker, depending on where the bleeding occurs in the colon
• Stool may contain visible blood streaks, clots, or may be mixed with mucus
• Frequency can range from a few times daily to more than 10 times per day during flare-ups
• Stools are typically loose or watery rather than formed

The severity of bloody diarrhea often correlates with the extent and intensity of inflammation in the colon. During active disease flares, this symptom can significantly impact daily activities and quality of life, leading to dehydration and anemia if not properly managed.

2. Abdominal Pain and Cramping

Abdominal discomfort is another prevalent symptom experienced by people with ulcerative colitis. The pain results from inflammation in the colon and the increased contractions of the intestinal muscles as the body attempts to move waste through the inflamed digestive tract.

Common patterns of abdominal pain:

• Pain is typically located in the lower left side of the abdomen, though it can occur anywhere
• Cramping sensations that come in waves, often intensifying before bowel movements
• Discomfort may range from mild and manageable to severe and debilitating
• Pain often temporarily improves after a bowel movement

The intensity of abdominal pain can vary throughout the day and tends to worsen during disease flare-ups. Some patients describe the sensation as similar to menstrual cramps but located in different areas of the abdomen.

3. Rectal Bleeding

Rectal bleeding is a distinctive symptom of ulcerative colitis that occurs independently from bowel movements. This happens because the disease almost always affects the rectum (the final portion of the large intestine), causing inflammation and ulceration in this sensitive area.

What to know about rectal bleeding:

• Blood may be noticed on toilet paper after wiping
• Small amounts of blood may drip into the toilet bowl
• Bleeding can occur even when not having a bowel movement
• The amount can range from spotting to more significant bleeding

Persistent rectal bleeding should never be ignored, as it can lead to anemia and iron deficiency over time. While rectal bleeding can have various causes, when combined with other symptoms of colitis, it strongly suggests inflammatory bowel disease.

4. Urgent Need to Defecate (Tenesmus)

Tenesmus is the feeling of needing to have a bowel movement urgently, even when the bowel is empty. This symptom can be one of the most distressing aspects of ulcerative colitis, as it can occur suddenly and frequently throughout the day and night.

Impact of bowel urgency:

• Sudden, intense urges that require immediate access to a bathroom
• The sensation may wake you up from sleep multiple times during the night
• Can cause significant anxiety about being away from bathroom facilities
• May result in occasional accidents if a bathroom isn’t immediately accessible

This symptom often severely impacts quality of life, causing people with ulcerative colitis to limit their social activities, travel, and work commitments. The unpredictability of bowel urgency is particularly challenging and can lead to social isolation and anxiety.

5. Inability to Defecate Despite Urgency

Paradoxically, many people with ulcerative colitis experience the frustrating symptom of feeling an urgent need to have a bowel movement but being unable to pass anything, or only passing small amounts of blood or mucus.

Why this occurs:

• Inflammation and ulceration in the rectum send false signals to the brain
• The rectum may be empty, but the inflamed tissue creates a sensation of fullness
• Straining produces little to no stool, sometimes only blood or mucus
• This can lead to spending significant time in the bathroom without relief

This symptom, combined with tenesmus, creates a frustrating cycle where patients feel constantly compelled to use the bathroom but rarely experience satisfactory relief. The psychological toll of this symptom should not be underestimated.

6. Unintended Weight Loss

Weight loss is a common symptom among people with moderate to severe ulcerative colitis, even when they’re trying to maintain their normal eating habits. Multiple factors contribute to this concerning symptom.

Reasons for weight loss in UC:

• Decreased appetite due to abdominal pain and nausea
• Fear of eating because food may trigger symptoms
• Malabsorption of nutrients due to inflammation in the digestive tract
• Increased calorie needs as the body fights chronic inflammation
• Frequent diarrhea preventing proper nutrient absorption

Significant or rapid weight loss can lead to nutritional deficiencies and weakness. It’s important for people with ulcerative colitis to work with healthcare providers and possibly nutritionists to maintain adequate nutrition and healthy body weight despite the challenges posed by the disease.

7. Extreme Fatigue

Fatigue is one of the most commonly reported yet often overlooked symptoms of ulcerative colitis. This isn’t ordinary tiredness that improves with rest; it’s a profound exhaustion that can interfere with daily functioning.

Contributing factors to fatigue:

• Chronic inflammation causes the body to use extra energy
• Anemia from blood loss reduces oxygen delivery to tissues
• Nutritional deficiencies, particularly iron, vitamin B12, and vitamin D
• Poor sleep quality due to nighttime symptoms
• The psychological burden of managing a chronic illness
• Dehydration from frequent diarrhea

The fatigue associated with ulcerative colitis can be debilitating, affecting work performance, relationships, and overall quality of life. Many patients describe feeling exhausted even after a full night’s sleep, and simple daily tasks may feel overwhelming during flare-ups.

8. Fever

Fever is a systemic symptom that indicates active inflammation in the body. While not everyone with ulcerative colitis experiences fever, it’s more common during severe flare-ups or when complications develop.

Fever in ulcerative colitis:

• Usually low-grade (between 99°F and 100.5°F or 37.2°C to 38°C)
• May be accompanied by chills or night sweats
• Higher fevers might indicate complications such as infection or toxic megacolon
• Often occurs alongside other symptoms like increased diarrhea and abdominal pain

A persistent or high fever in someone with ulcerative colitis requires prompt medical attention, as it could signal a serious complication requiring immediate treatment. Even low-grade fevers should be reported to your healthcare provider, as they indicate increased disease activity.

9. Rectal Pain

Rectal pain, also called proctalgia, is a particularly uncomfortable symptom of ulcerative colitis. Since the disease almost always affects the rectum, inflammation and ulceration in this area can cause significant discomfort.

Characteristics of rectal pain:

• Sharp, stabbing, or burning sensations in the rectal area
• Pain may worsen during bowel movements
• Soreness and tenderness around the anal area
• Discomfort when sitting for extended periods
• May be accompanied by a feeling of pressure or fullness

Rectal pain can be particularly distressing because it’s often constant and difficult to relieve. The combination of inflammation, frequent bowel movements, and wiping can irritate the area further, creating a cycle of discomfort. Some patients also develop complications like hemorrhoids or anal fissures, which can add to the pain.

10. Joint Pain and Inflammation

Ulcerative colitis is a systemic disease, meaning it can affect parts of the body beyond the digestive tract. Joint pain and inflammation are among the most common extraintestinal manifestations, affecting up to 30% of people with inflammatory bowel disease.

Joint-related symptoms in UC:

• Pain, stiffness, and swelling in large joints like knees, ankles, hips, and elbows
• Small joints in hands and feet may also be affected
• Symptoms may mirror arthritis and can be migratory (moving from joint to joint)
• Joint pain often correlates with disease flares but can occur independently
• Morning stiffness that improves with movement
• Lower back pain, particularly in the sacroiliac joints

The exact reason why ulcerative colitis causes joint problems isn’t fully understood, but it’s believed to relate to the systemic inflammation caused by the overactive immune system. For some patients, joint pain can be just as debilitating as the intestinal symptoms, significantly affecting mobility and quality of life.

What Causes Ulcerative Colitis?

The exact cause of ulcerative colitis remains unknown, but research has identified several factors that contribute to its development. Understanding these causes can help explain why symptoms occur and may guide preventive strategies for those at risk.

Immune System Malfunction: The most widely accepted theory is that ulcerative colitis results from an abnormal immune response. In healthy individuals, the immune system attacks foreign invaders like bacteria and viruses. In people with UC, the immune system mistakenly identifies the cells lining the colon as foreign threats and attacks them, causing chronic inflammation and ulceration.

Genetic Factors: Genetics play a significant role in ulcerative colitis development:

• People with a first-degree relative (parent, sibling, or child) with UC have a higher risk of developing the condition
• Multiple genes have been associated with increased susceptibility
• However, most people with UC have no family history, indicating genetics alone don’t determine who develops the disease

Environmental Triggers: Various environmental factors may trigger or exacerbate ulcerative colitis in genetically susceptible individuals:

• Diet: While diet doesn’t cause UC, certain foods may trigger symptoms in those who already have the condition
• Stress: Emotional stress doesn’t cause UC but can worsen symptoms and trigger flares
• Infections: Previous gastrointestinal infections might trigger the development of UC in some people
• Antibiotics: Some research suggests early-life antibiotic use might increase UC risk by altering gut bacteria
• Non-steroidal anti-inflammatory drugs (NSAIDs): Regular use may increase risk and trigger flares

Gut Microbiome Imbalance: The trillions of bacteria living in the digestive tract play crucial roles in health. An imbalance in these microorganisms (dysbiosis) has been observed in people with ulcerative colitis, though it’s unclear whether this is a cause or result of the disease.

Geographic and Lifestyle Factors: Ulcerative colitis is more common in:

• Developed, industrialized nations
• Urban rather than rural areas
• Northern climates
• People who consume Western diets high in fat and processed foods

It’s important to note that ulcerative colitis is not caused by emotional distress, certain personality types, or eating particular foods, despite these common misconceptions. The disease results from a complex interaction between genetic predisposition, immune system dysfunction, and environmental factors.

Prevention Strategies

While there’s no guaranteed way to prevent ulcerative colitis, especially in those with genetic predisposition, certain lifestyle modifications may help reduce the risk of developing the condition or minimize flare-ups in those already diagnosed.

Dietary Considerations:

• Maintain a balanced, varied diet rich in fruits, vegetables, and whole grains
• Consider limiting processed foods, artificial sweeteners, and foods high in saturated fats
• Stay well-hydrated, especially important for those with active symptoms
• Keep a food diary to identify personal trigger foods
• Some people benefit from an anti-inflammatory diet, though this should be discussed with a healthcare provider

Stress Management: While stress doesn’t cause ulcerative colitis, it can trigger flare-ups. Effective stress management techniques include:

• Regular exercise, which has anti-inflammatory effects
• Meditation, yoga, or other mindfulness practices
• Adequate sleep (7-9 hours per night)
• Counseling or therapy to develop coping strategies
• Building a strong support network

Medication Adherence: For those already diagnosed:

• Take prescribed medications as directed, even when feeling well
• Don’t stop medications without consulting your healthcare provider
• Attend all scheduled follow-up appointments
• Report any new or worsening symptoms promptly

Lifestyle Modifications:

• Avoid smoking; smoking may increase the risk of many diseases, though interestingly, the relationship with UC is complex
• Limit NSAID use when possible, as these medications can trigger flares
• Practice good hygiene to reduce gastrointestinal infections
• Consider probiotics after discussing with your healthcare provider

Regular Medical Care: For those at higher risk due to family history:

• Inform your doctor about your family history
• Report any unusual gastrointestinal symptoms early
• Follow screening recommendations if advised

It’s important to emphasize that even with these preventive measures, some people will still develop ulcerative colitis due to factors beyond their control. These strategies are about reducing risk and optimizing overall health, not guaranteeing prevention.

Frequently Asked Questions

What is the difference between ulcerative colitis and Crohn’s disease?

Both are types of inflammatory bowel disease (IBD), but they affect different parts of the digestive tract. Ulcerative colitis only affects the colon and rectum and involves continuous inflammation of the innermost lining. Crohn’s disease can affect any part of the digestive tract from mouth to anus, often in patches, and can penetrate deeper layers of the bowel wall.

Is ulcerative colitis contagious?

No, ulcerative colitis is not contagious. You cannot catch it from or spread it to another person. It’s an autoimmune condition involving your own immune system attacking your digestive tract.

Can ulcerative colitis go away on its own?

Ulcerative colitis is a chronic, lifelong condition. While symptoms may go into remission (periods where you have few or no symptoms), the disease doesn’t go away completely. However, with proper management, many people achieve long-term remission and maintain good quality of life.

How is ulcerative colitis diagnosed?

Diagnosis typically involves a combination of tests including blood tests, stool samples, colonoscopy with biopsy, and imaging studies like CT scans or MRI. A colonoscopy allows doctors to view the colon directly and take tissue samples to confirm inflammation consistent with UC.

Can I live a normal life with ulcerative colitis?

Yes, many people with ulcerative colitis live full, active lives. While the condition requires ongoing management and may occasionally limit activities during flare-ups, proper treatment can help you achieve remission and maintain good quality of life. Working closely with your healthcare team is essential.

What triggers an ulcerative colitis flare-up?

Common triggers include stress, certain foods (which vary by individual), infections, missing medications, NSAIDs, and sometimes no identifiable cause. Keeping a symptom diary can help you identify your personal triggers.

Should I avoid certain foods if I have ulcerative colitis?

There’s no single diet that works for everyone with UC. During flare-ups, many people find low-residue or low-fiber diets easier to tolerate. Common trigger foods include dairy, high-fiber foods, spicy foods, alcohol, and caffeine, but these vary by individual. Work with your healthcare provider or a dietitian to develop a personalized eating plan.

When should I see a doctor about my symptoms?

See a doctor promptly if you experience persistent changes in bowel habits, blood in your stool, ongoing abdominal pain, unexplained fever, or unintended weight loss. If you already have UC, contact your healthcare provider if symptoms worsen or you develop new symptoms, as this may indicate a flare-up or complications.

Can stress cause ulcerative colitis?

Stress does not cause ulcerative colitis, but it can worsen symptoms and potentially trigger flare-ups in people who already have the condition. Managing stress through relaxation techniques, exercise, and counseling can be an important part of managing UC.

Is ulcerative colitis related to cancer?

People with long-standing, extensive ulcerative colitis have an increased risk of developing colon cancer compared to the general population. However, this risk can be managed with regular colonoscopy surveillance and appropriate treatment. Most people with UC do not develop cancer, especially with proper monitoring and care.

References:

• Mayo Clinic – Ulcerative Colitis
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• Crohn’s & Colitis Foundation
• Johns Hopkins Medicine – Ulcerative Colitis
• NHS – Ulcerative Colitis