Diarrhea and bloody stools are the most common symptoms of ulcerative colitis, affecting over 86% of people with the condition. People with ulcerative colitis may also experience rectal or abdominal pain, persistent muscle spasms, and cramping. Symptoms tend to alternate between periods of remission and flare-ups. Flares can occur weeks apart to years between episodes.
What is Ulcerative Colitis?
Ulcerative colitis causes inflammation and ulcers along the lining of the intestines. It's one of the two primary types of inflammatory bowel disease (IBD), along with Crohn's disease.
In the United States, about 214 out of every 100,000 people have ulcerative colitis, which is equivalent to approximately 700,000 people. Symptoms most often start between the ages of 15 and 30. The second most common period for onset is between the ages of 50 and 70.
People with ulcerative colitis often have symptoms like the frequent need to have a bowel movement, diarrhea, and blood in their stools. Symptoms tend to appear in flare-ups and can go into remission for weeks to years at a time.
The severity of ulcerative colitis symptoms varies between people. Those with the mildest form experience a typical number of stools per day and have no noticeable blood in their stools. People with severe ulcerative colitis may experience five or more bowel movements per day and may have significant bleeding.
Ulcerative colitis tends to come on slowly and get worse over time as inflammation spreads. Getting proper treatment can help prevent symptoms from getting worse. Minimizing stress can also help prevent flare-ups.
People with ulcerative colitis often experience watery diarrhea, as well as frequent and sudden urges to have a bowel movement. For some people, the urge to have a bowel movement may occur so suddenly that it significantly disrupts their daily life. Some people need to have a bowel movement more than 10 times per day.
You may notice blood, pus, or mucus in your stools. You may also experience rectal bleeding if you're having a flare-up. Blood comes from ulcers along the surface of your rectum.
If you have uncontrollable diarrhea or notice blood in your stool, you should see a doctor. Diarrhea caused by ulcerative colitis can lead to medical emergencies like severe dehydration, a perforated colon, or sepsis.
People with ulcerative colitis often experience rectal or abdominal pain. Having a large amount of abdominal pain may be a sign that you're having a flare-up or that your condition is getting worse. Pain can range from mild to severe and may also affect your rectum. Pain may also be accompanied by persistent muscle spasms and cramping.
About 40% of people with ulcerative colitis develop a fever. Most of the time, the fever is chronic and low-grade. If you develop a fever over 103°F (39°C), you should seek emergency medical attention.
Frequent bleeding can result in anemia (a low number of red blood cells). Anemia leads to fatigue and other symptoms like pale skin, problems concentrating, and shortness of breath. You can avoid anemia by getting your iron levels checked every 6–12 months. If you develop difficulty breathing or chest pain, you should seek immediate medical attention.
Ulcerative colitis can lead to a number of other symptoms. Some people may develop constipation—although it's not as common as diarrhea. Systemic inflammation throughout your body can lead to general symptoms like eye inflammation, joint pain and swelling, mouth swelling, and skin rashes.
Ulcerative colitis can be broken into subtypes depending on where the inflammation is in your colon:
Ulcerative proctitis: Affects your rectum, the part of your colon closest to your anus. It's the most common type and affects 30–60% of people with ulcerative colitis.
Proctosigmoiditis: Causes inflammation of your rectum and the lower part of your colon, called the sigmoid colon.
Left-sided colitis: Affects your rectum, your sigmoid colon, and the descending part of your colon on the left side of your body.
Pancolitis: Affects your entire colon.
Symptoms typically become worse as inflammation spreads farther along your colon. Common symptoms by type include rectal bleeding across all types, bloody diarrhea (except in ulcerative proctitis), rectal pain, weight loss in more extensive disease, abdominal pain and cramping, and a frequent, strong urge to have a bowel movement.
Ulcerative colitis tends to alternate between periods of mild and no symptoms to flare-ups that cause a worsening of the symptoms above. The exact cause of flare-ups isn't completely known, but it's thought that certain food triggers and stress could play a role.
When ulcerative colitis flares up, you have a higher risk of developing severe complications or needing emergency medical attention. Possible complications include toxic megacolon (expansion of your colon), severe bleeding, dehydration, and an increased risk of blood clots.
In a 2019 study, researchers surveyed 483 people with IBD. The researchers found that the most common initial symptoms in people with ulcerative colitis were bloody bowel movements (86.6%) and diarrhea (86.5%). The most common initial symptoms in people with Crohn's disease were fatigue and abdominal pain.
Ulcerative colitis is an autoimmune disorder. According to research, about 80% of people with autoimmune disorders are assigned female at birth. However, IBD seems to affect all people similarly. Most research has found no difference between ulcerative colitis prevalence and sex, though some studies find that it's slightly more prevalent in people assigned male at birth.
Symptoms of ulcerative colitis are similar regardless of sex, but unique issues may occur for some people. For example, rectovaginal fistulas may develop, which are holes that allow stool to leak from the bowel to the vagina. Ulcerative colitis may also lead to irregular periods or increased menstrual pain. People assigned female at birth may also be at a higher risk of anemia and osteoporosis, and ulcerative colitis can further increase this risk.
Ulcerative colitis flare-ups can last from days to weeks. They can happen as close together as weeks apart, or you may go years without a flare-up. Taking medication, avoiding trigger foods, and managing stress can help reduce the frequency and severity of your flare-ups.
Crohn's disease and ulcerative colitis are the two primary types of IBD and cause similar symptoms. Crohn's disease is an inflammatory bowel disease that can affect any part of your GI tract between your mouth and your anus. It typically affects the end of your small intestines or the first part of your large intestines.
Both conditions share common symptoms including abdominal pain, bloody stools, fatigue, diarrhea, fever, rectal pain, malnutrition, weight loss, and rectal bleeding. Ulcerative colitis is characterized by a frequent urge to have a bowel movement, while Crohn's disease may cause an inability to have a bowel movement despite the urge, as well as mouth sores.
What does an ulcerative colitis flare-up feel like? An ulcerative colitis flare-up is when symptoms return after a period of remission. Symptoms may include diarrhea, rectal pain and bleeding, an urgent need to have a bowel movement, and abdominal pain and cramping. Pain from ulcerative colitis is typically centered in the lower left side of your abdomen. During a flare-up, the pain can become quite intense.
Does ulcerative colitis go away? Ulcerative colitis is a chronic disease, meaning it can be managed into periods of remission for months and even years, but it's never truly gone.
How serious is ulcerative colitis? Generally speaking, ulcerative colitis is a lifelong condition that you need to manage, rather than a life-threatening illness. However, certain complications of ulcerative colitis are very serious, including toxic megacolon and bowel cancer.
What is the life expectancy of a person with ulcerative colitis? The life expectancy of people with ulcerative colitis is typically the same as people without the condition, as long as the condition is well-managed and more serious complications are avoided.
Ulcerative colitis is a form of inflammatory bowel disease that causes the formation of ulcers in your bowel. Symptoms can range widely in severity and frequency. Diarrhea and bloody stools are the two most common first symptoms of ulcerative colitis. People also often experience abdominal or rectal pain, weight loss, and fever. If you think you may have ulcerative colitis but haven't yet received a diagnosis, it's important to visit a doctor to minimize your chances of developing complications.
