11 Ulcerative Colitis Symptoms You Should Never Ignore

If you find yourself doubled over with diarrhea and cramps, your first move might be to check the expiration date on that milk you poured in your cereal. But if your digestive woes persist, or you also see blood in the toilet, it’s possible you could be experiencing something like ulcerative colitis symptoms instead of food poisoning. Ulcerative colitis (U.C.) is an autoimmune disease in which your body’s immune system mistakenly attacks cells in the colon or large intestine. Cue the stomach trouble. Let’s jump into the details of what to look for and what you can do.

Ulcerative colitis (U.C.) is one of the two main forms of inflammatory bowel disease (IBD). The other is Crohn’s disease. U.C. occurs when the immune system malfunctions, causing inflammation and ulcers (sores) to appear on the inner lining of the large intestine, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). It’s not comfortable, to put it mildly, and not something that will clear up quickly.

Ulcerative colitis is a chronic illness that does not yet have a medical cure. That doesn’t mean nothing can be done though, so don’t despair if you’re experiencing symptoms. Sidhartha Sinha, M.D., a gastroenterologist, assistant professor at Stanford Medicine, and researcher who specializes in IBD, tells SELF that while there aren’t medical cures for ulcerative colitis, there are medical treatments. “And we have made great advancements in these treatments,” he says. The last resort is a surgical option called colectomy—the removal of the entire colon—which can eliminate U.C. entirely.

Early ulcerative colitis symptoms usually include things that could easily be overlooked. Don’t be afraid to talk to a doctor if you’re having any worries though, even if your symptoms seem mild. If symptoms are ongoing and start to feel more severe, like persistent pain in your abdomen or unintentional weight loss, you should seek medical treatment as soon as possible.

Here are some of the most common symptoms of ulcerative colitis to watch out for, per the NIDDK:

Okay, so this isn’t the most pleasant one to start with, but it is actually the most common ulcerative colitis symptom—it’s also a pretty good tip-off that something isn’t quite right and that you should schedule an appointment with your doctor. Remember those ulcers we talked about earlier? Yeah, that’s where the blood in your stool comes from, and you might also see mucus in there as well.

This is another pretty common symptom, and contrary to popular belief, those ulcers in the colon are not actually what causes the pain. Instead, it’s a combination of abdominal cramping and bowel distension (stretching) that occurs due to the inflammation in the intestines, according to a 2013 study published in Inflammatory Bowel Diseases.¹

Pain in your rectum (the part of the colon right before your anus) is also another unpleasant symptom you may deal with. Ulcerative colitis often starts in this portion of your bowel, according to the Cleveland Clinic, so it’s no surprise that the inflammation and damage that occurs in that area can cause some uncomfortable feelings. If your symptoms only affect that area and don't progress, it’s actually called ulcerative proctitis.

This could be a constant, phantom urge (you don’t really need to poop), or an actual urgent need to run to the bathroom. In terms of how many bowel movements are considered “normal,” it varies. You may have fewer than four bowel movements a day (this is considered mild symptoms), and others may have more than six bowel movements with blood most of the time (this is considered severe). In extremely severe cases, you might have 10 bloody bowel movements in a day.

If you feel an overwhelming sense of exhaustion, a complete lack of energy, or tired despite getting enough sleep, you’re not alone. According to a 2019 study published in the journal Nature Reviews Gastroenterology and Hepatology, fatigue affects up to 80% of people with active inflammatory bowel disease, and 50% of people in remission.² That’s because it can be caused by everything from inflammation to nutritional deficiencies to medication side effects, or all three.

Speaking of nutritional deficiencies, unintended weight loss and malnutrition can occur with ulcerative colitis for a few reasons. Severe diarrhea and blood loss can lead to dehydration or an iron deficiency, while abdominal pain and nausea can make you lose your appetite. You may also avoid eating at times to stop yourself from having to go to the bathroom as often. These things can then lead to weight loss.

Again, dehydration is a concern if you are having severe diarrhea. When you have diarrhea, your body loses lots of fluids along with nutrients and electrolytes, like sodium, potassium, magnesium, and zinc, according to the Crohn’s and Colitis Foundation. This can make you feel dizzy, fatigued, and cause a headache.

With all that’s going on in the digestive tract with ulcerative colitis, nausea can sometimes be an issue. This occurs more often when symptoms are severe, or if the inflammation affects more of the large intestine, according to the NIDDK.

Sometimes people can get ulcerative colitis symptoms outside of the bowels, which are called extraintestinal complications. Arthritis is actually the most common one, occurring in up to 30% of people with IBD.³ These complications occur due to the immune system being out of whack, which then causes inflammation in areas outside of the bowels.

The second most common type of extraintestinal complication is skin disorders, including rashes and other skin issues, like ulcers on the skin. These affect up to 20% of people with IBD.⁴ Like joint pain, skin issues can occur because the immune system overreacts, causing inflammation outside of the bowels.

If you thought there is no way your eyes could be affected by ulcerative colitis, think again. According to a 2015 study published in the Scientific World Journal, when ulcerative colitis affects the eyes, it can cause eye pain and blurry vision (uveitis), which could lead to permanent vision loss if not treated right away. It can also show up as inflammation and redness in the white of the eye, which does not cause vision loss.⁵

Do different types of ulcerative colitis cause different symptoms?

Certain symptoms may point to different types of ulcerative colitis. These types, as outlined by the Mayo Clinic, are classified by location within the body:

• Ulcerative proctitis: With this form of the condition, which tends to be the mildest, a person has inflammation in the area closest to the rectum. Rectal bleeding may be the only sign of the disease.
• Proctosigmoiditis: Inflammation with this form of the disease involves a person’s rectum and lower end of the colon. Symptoms can include bloody diarrhea, abdominal pain, and an inability to go despite feeling like you need to let loose.
• Left-sided colitis: This involves inflammation from the rectum, through the lower colon, and into the descending colon. In addition to bloody diarrhea and abdominal pain on the left side, you may also experience weight loss. “Most patients will have left-sided disease,” Dr. Sinha says.
• Pancolitis: This usually impacts a person’s entire colon, causing bloody diarrhea that can be severe, abdominal pain, fatigue, and rapid weight loss.

With treatment (we’ll talk more about that in a second), many people with ulcerative colitis will go into remission. That just means that you will have periods of time where your symptoms will be greatly reduced or nonexistent. That could mean weeks, months, or even years for some people, according to the Mayo Clinic. Unfortunately, ulcerative colitis flare-ups can occur. If you start feeling familiar symptoms like increased diarrhea, cramping, or rectal bleeding, let your medical team know.

Dr. Sinha says that sometimes symptoms can be more subtle during a flare, like bloating or fatigue. As far as triggers go, he says there are clear associations between IBD and stress. “In my practice, I treat patients who are also students. Not uncommonly, we see students experiencing flares during exam times or other periods of high stress.”

This is why, he says, it’s important that we not only consider medical treatments, but also take the overall picture into account, including diet, exercise, and other therapies.

The list of symptoms for ulcerative colitis and Crohn’s disease are very similar, including diarrhea, abdominal pain, and rectal bleeding. The biggest difference can be found in the location of the active inflammation. Since Crohn’s can appear anywhere in the gastrointestinal tract, you might see things like inflammation of the small bowel that you wouldn’t see with ulcerative colitis. Another difference is that Crohn’s doesn’t stop at the intestine lining. It can actually affect the entire thickness of the bowel wall.⁶

One important thing to note is that people with more severe cases of ulcerative colitis are at an increased risk of developing colon cancer and other serious health conditions, like liver disease, Rudolph Bedford, M.D., a gastroenterologist at Providence Saint John's Health Center in Santa Monica, California, tells SELF. That’s why it’s important to reach out to a medical professional if you do have any of the above symptoms.

However, an ulcerative colitis diagnosis can be challenging because other conditions can mimic symptoms of IBD, like infections or even hemorrhoids, Dr. Sinha says. In terms of differentiating between Crohn’s and ulcerative colitis, he says, “There’s no single test that we have that 100% distinguishes between the two. We rely on the patient history and other information such as radiographic imaging and endoscopy. Doing a colonoscopy, for example, can be one of the most reliable ways to identify IBD and to then distinguish between Crohn’s and ulcerative colitis.”

While a colonoscopy is an effective tool, Dr. Sinha clarifies that it’s not the only way. Rather, there’s “an entire constellation of tests and data” that can be considered, including imaging, lab tests, and a detailed intake of the patient’s symptoms and presentation.

Depending on the location and severity of your case of ulcerative colitis, there are different treatments that can help you feel better. For a long time, corticosteroids (anti-inflammatory medications) were the main form of medical treatment for IBD, but they can potentially have adverse effects when used long-term. With more research, options like immunosuppressants arrived. According to the Centers for Disease Control and Prevention (CDC), the newest type of medication approved for the treatment of IBD is biologics. These medications are made from living things—rather than chemical compounds—and work to target proteins made by the immune system to reduce inflammation. If medication isn’t effective, surgery is also an option.

Dr. Sinha emphasizes that keeping your health care team informed is key to managing ulcerative colitis. “Having this regular communication helps facilitate labs, imaging, or endoscopy that may be necessary,” he says. “It also allows the providers to understand many other facets of the disease's impact on the patient, such as the psychosocial impact.”

“In my practice, we very much approach patients that have U.C. from a multidisciplinary perspective,” Megan Riehl, Psy.D., a G.I. psychologist and clinical director of the G.I. Behavioral Health Program at the University of Michigan, tells SELF. “A G.I. psychologist comes in to assess the individual to see what they need in their ulcerative colitis treatment plan, whether it be helping them with strategies to manage their symptoms, helping them manage side effects of medications, or anxiety about different medical treatments that are being recommended.”

When taking care of your physical well-being, don’t forget that ulcerative colitis can take a toll on your emotional and mental well-being too. If it turns out your symptoms are ulcerative colitis, you can find a support group, or ask your doctor if they can connect you with a therapist or G.I. psychologist. Dr. Riehl, for example, works with patients on aspects of body image and even connects them with other patients who have experienced colectomy or ostomy (surgeries that reroute bodily waste outside the body through a hole in the abdomen). “We talk openly about the impact that it can have on them from an intimacy perspective to how it impacts their self-identity,” she says.

Since ulcerative colitis often starts at an age when people are thinking about their first job or starting a family, it can be particularly tough. “One of the reasons that I and several of my colleagues went into this field is precisely because of that—so that we can hopefully make a difference in people’s lives early, and have them be able to lead productive and complete lives by putting their disease in remission,” Dr. Sinha says.

If you think your symptoms match those of ulcerative colitis, speak with a doctor before jumping to conclusions. And if you do get a diagnosis, know that there are resources available to you. Dr. Riehl encourages ulcerative colitis patients to try to be their own advocates and ask for whatever support they need, whether it’s physical, emotional, or spiritual. “All of that really matters when it comes to managing a chronic illness,” she says. “You can live a very full life once you've received adequate treatment and have the right treatment team in place.”

Sources:

1. Inflammatory Bowel Diseases, Abdominal Pain in Ulcerative Colitis
2. Nature Reviews Gastroenterology and Hepatology, Fatigue in IBD: Epidemiology, Pathophysiology and Management
3. Crohn’s and Colitis Foundation, Arthritis and Joint Pain
4. Crohn’s and Colitis Foundation, Skin Complications
5. Scientific World Journal, Ocular Complications of Inflammatory Bowel Disease
6. Crohn’s and Colitis Foundation, Crohn’s Disease and Ulcerative Colitis: A Guide for Parents

Related:

• Are There Certain Foods to Avoid with Ulcerative Colitis?
• I’m Pooping Blood—Do I Need to See a Doctor?
• These Crohn’s Disease Tests Can Help Confirm a Diagnosis