Ulcerative colitis symptoms can seem like nothing major at first. But for many people with the condition, ulcerative colitis symptoms that start gradually can become worse over time, possibly even taking a significant toll on day-to-day life. Like many health conditions, ulcerative colitis cases can range from mild to severe, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Because of that, it can be easy to blame gut problems on stress, something you ate, or even just a fluke instead of recognizing them as a potential sign of a more serious bowel disease, like ulcerative colitis. So if you’re plagued with bathroom issues all the time—especially diarrhea, abdominal pain, and bleeding—you should be aware of possible ulcerative colitis symptoms and when to check with your doctor.
What is ulcerative colitis?
Ulcerative colitis is a form of inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers in the innermost lining of your large intestine (i.e., colon) and rectum. It’s difficult to find exact numbers on how common ulcerative colitis is, but the most recent figures from the Centers for Disease Control and Prevention (CDC) estimate that about 3.1 million Americans (or 1.3%) have IBD, which includes both ulcerative colitis and Crohn’s disease.
IBD is characterized by chronic inflammation in your digestive tract—not to be confused with irritable bowel syndrome (IBS), which is a chronic condition that affects the contractions of the muscles in your large intestine. Ulcerative colitis and Crohn’s disease share some of the same symptoms, but one main difference is where the disease occurs: Crohn’s disease causes ulceration throughout your digestive tract, while ulcerative colitis is mostly contained to the colon and rectum.
Doctors aren’t sure what causes ulcerative colitis. It’s possible that the disease happens because of an immune system malfunction, according to the Mayo Clinic, but experts aren’t entirely sure. When your immune system tries to fight a virus or bacteria, an abnormal immune response may cause your immune system to attack the cells in your digestive tract as well. Genetics may also play a role, the Mayo Clinic says. However, the organization notes, many people with the condition don’t actually have a family history of the disease.
That said, there are some risk factors to be aware of. According to the NIH, you’re more likely to develop ulcerative colitis if you’re between the ages of 15 and 30 or over the age of 60. The Mayo Clinic also notes that white people have the highest risk of the disease, especially those of Jewish descent.
Ulcerative colitis symptoms
Ulcerative colitis can come with a whole host of unpleasant symptoms and even lead to life-threatening complications, so talking to a doctor when you’re experiencing symptoms is key. Some symptoms that should be on your radar include:
Diarrhea with blood or pus
Abdominal pain and cramping
A strong urgency to go
The inability to poop when you feel like you really have to go
Joint aches and pains
Of these ulcerative colitis symptoms, diarrhea mixed with blood and abdominal discomfort are the most common, per the NIH. Ashwin Ananthakrishnan, M.D., M.P.H., a gastroenterologist at Massachusetts General Hospital who specializes in ulcerative colitis, tells SELF that in his clinical experience, they’re also typically the first to show up, as well as an urgent need to go. On the other hand, symptoms in other parts of the body like rashes or joint pain are less common, he says.
The severity of symptoms can also vary person to person. According to the NIH, most people with ulcerative colitis symptoms first experience mild to moderate signs of the disease, with about 10% experiencing severe symptoms like frequent bloody bowel movements. No matter the severity, most people have periods of remission (when they don’t have symptoms), which can last for weeks or years, the NIH says, and periods of “flares,” or active disease.
Which symptoms you deal with can also depend on the location of your UC. Speaking of…
Types of ulcerative colitis
Doctors typically classify ulcerative colitis by where it shows up in your digestive tract. These are the main forms, per the Mayo Clinic:
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.
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.
Pancolitis: This usually impacts a person’s entire colon, causing bloody diarrhea that can be severe, abdominal pain, fatigue, and severe weight loss.
Acute severe ulcerative colitis: This form of colitis is rare, and it affects the entire colon. It can cause severe pain, diarrhea, bleeding, fever, and an inability to eat.
Complications of ulcerative colitis can be dangerous, which is why it’s so important to get treatment.
People with ulcerative colitis can get very sick from weight loss and malnutrition, and develop anemia (low blood counts) which can cause issues like fatigue, Dr. Ananthakrishnan says. In more severe cases, ulcerative colitis can affect a person’s ability to function normally, he says. It can also put people at risk of toxic megacolon, which can cause the colon to burst and can expose them to a systemic infection like sepsis, Darrell Gray, M.D., M.P.H., a gastroenterologist at the Ohio State University Wexner Medical Center, tells SELF. People with more severe cases are also 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.
Ulcerative colitis can be deadly if you have a severe case that’s left untreated, Dr. Bedford says. The possibility of an ulcerative colitis diagnosis might be scary (or you might feel embarrassed by your symptoms), but you shouldn’t let any of that keep you from seeking the help you need. With a doctor in your corner, you can find the best ways to manage your ulcerative colitis together. (And if you do get a diagnosis? We’ve got advice for that too.)
Depending on your ulcerative colitis symptoms, the disease isn’t always easy to diagnose, especially since they can be mild at first. “These symptoms can be subtle and representative of other things,” Dr. Gray says.
However, doctors can conduct blood tests, stool tests, and a colonoscopy to give you a proper diagnosis. If you have more serious symptoms, your doctor might also perform a standard X-ray of your abdominal area or a CT scan of your abdomen or pelvis to check for more serious complications (like a perforated colon), per the Mayo Clinic.
The most common ulcerative colitis treatments are oral medications called 5-aminosalicylates, often used for milder cases, Dr. Ananthakrishnan says. Depending on the location of your ulcerative colitis, you might instead take them as an enema or suppository. Your doctor might also prescribe short-term corticosteroids like prednisone or budesonide in moderate to severe cases, according to the Mayo Clinic.
For more severe cases, people are sometimes given immunomodulator medications, which suppress the immune system response that leads to inflammation, and biologics, which work in a variety of ways including stopping inflammatory cells from reaching the site of your inflammation. Surgery may also be needed in some cases, Dr. Ananthakrishnan says.
According to the Mayo Clinic, some lifestyle changes can help too, typically around modifying your diet. For example, limiting dairy, fiber, and other problem foods such as spicy foods, alcohol, and caffeine may help. Similarly, you can try swapping to eating five or six small meals a day versus two or three large ones, as well as drinking plenty of water. Lastly, although stress doesn’t cause ulcerative colitis, some people find that their symptoms flare up when they’re feeling overwhelmed, so you might find keeping your stress as under control as possible through relaxation exercises, self-care, and other adjustments makes a difference too.
Remember: The sooner you seek help, the sooner you can treat your symptoms. “It’s possible to lead a long, healthy, and comfortable life, provided you are compliant with medications and see your doctor regularly,” Dr. Bedford says.
Additional reporting by Korin Miller.
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