Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that causes inflammation of the large intestine (colon), and it can be difficult to differentiate early symptoms of UC from those of other IBD and gastrointestinal conditions.
The variety of early signs people report can make diagnosing UC difficult, says Jamil Alexis, MD, a gastroenterologist at Stamford Health in Connecticut.
The inflammation caused by UC can get worse over time and symptoms may be mild at first.
About 50 percent of people with ulcerative colitis have early symptoms, which often come and go, or are mild enough to not require medical attention.
“My patients with ulcerative colitis often have had symptoms for several months,” says Robert Fearn, MD, a gastroenterologist at the University of California Irvine Medical Center in Orange. “They often tell me that their symptoms were initially thought to be a passing virus or irritable bowel syndrome.” But it’s important to recognize the early signs of ulcerative colitis so you can get a diagnosis, start treatment, and prevent complications.
1. Blood in your stool
Blood in the stool is an important early symptom of ulcerative colitis, says Adam Pont, MD, a gastroenterologist in private practice in New York. According to research, bloody diarrhea is the most common symptom that prompts people with UC to seek medical attention for the condition.
Typically, blood in the stool is abnormal and requires medical attention to evaluate the cause.
In addition to blood, some people notice mucus in their stools.
The passage of mucus that acts as a protective lining in your gastrointestinal tract may be normal if you don’t feel inflammation or see blood nearby. But the passage of blood is usually caused by the effects of inflammation of the colon and rectum.
“Ulcerative colitis causes inflammation and swelling of the intestinal wall,” says Dr. Fearn.
2. Loose, watery stools
Diarrhea with or without visible blood is another common early symptom of ulcerative colitis.
“One of the signs we look for is bloody diarrhea – where blood is mixed with the unformed stool, indicating that more of the intestine is significantly inflamed,” says Fearn.
Having loose, watery stools three or more times a day counts as diarrhea, but any loose stools that aren’t usual for you also count.
Diarrhea associated with UC occurs because inflammation affects the colon in a way that prevents the absorption of fluids while allowing excess fluid in, making the stool itself more watery.
3. Cramps and abdominal pain
Abdominal cramping and pain associated with ulcerative colitis is usually due to irritation of the muscles in the lining of the colon, Dr. Alexis says, and more than 70% of people with IBD report abdominal pain.
This inflammation also triggers stretch receptors in intestinal nerves, which detect the presence of stool in the colon and can cause waves of painful cramps, says Fearn.
At first, the cramps and tenderness may seem mild and easily pass for gas or a pulled muscle.
But if it continues, your doctor may want to look for another cause, such as IBD.
4. Bloating
Bloating occurs when gas becomes trapped in the stomach and intestines, and it is common in ulcerative colitis.
Excess gas can build up because UC-related inflammation makes it difficult to digest certain foods, like sugars and starchy foods.
When these undigested foods reach your large intestine, bacteria break them down and create gas as a byproduct. Besides poor digestion, excess gas and bloating in EC can also occur due to constipation, an imbalance of gut bacteria (microbiome), increased intestinal sensitivity, and food intolerances.
5. Changes in bowel habits
Bowel movements follow an extensive program that looks different for everyone. Some people poop every day, while others only go three times a week.
But when you have ulcerative colitis, bowel movements can feel unpredictable and urgent.
“In healthy adults, the rectum can expand to hold a little more than a cup of stool,” says Alexis.
“In ulcerative colitis, inflammation makes the rectum stiff and less able to accommodate stools over time, leading to a more urgent need to pass stools and, in some cases, fecal incontinence.”
According to a research review, international surveys reveal that more than 80 percent of people with UC report a bowel emergency. Urgency is more common in people with active inflammation, but it can occur even when symptoms such as increased frequency and rectal bleeding have subsided.
In addition to a more pressing need to go to the bathroom, UC can cause tenesmus, which describes the feeling of needing to poop even though you don’t.
This happens in up to 30% of people with UC or Crohn’s disease because swelling in the large intestine irritates the nerves that tell the brain that you need to have a bowel movement.
“Although ulcerative colitis is probably not the most common cause of these symptoms, you should definitely talk to your doctor if you experience them,” says Dr. Pont.
Takeaways
- Early signs of ulcerative colitis may be subtle and easily attributed to other causes, but early detection and treatment can protect against future complications.
- Early symptoms of ulcerative colitis may include blood in the stool, diarrhea, abdominal pain or cramping, bloating, and changes in bowel habits.
- If you experience these symptoms, talk to your healthcare professional, who can assess the likely cause and refer you to a gastroenterologist.
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