Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation in the colon. This leads to flare-ups that can trigger bowel movement changes, cramping and tenderness, fatigue, weight loss, and blood in the stool. A person with ulcerative colitis can also experience periods of remission between flare-ups.
Learn about the common symptoms of ulcerative colitis, as well as how to identify severe symptoms that require immediate medical attention.
The most common symptoms of ulcerative colitis include the following:
Diarrhea
Rectal bleeding, or passing stools that contain blood
Belly pain and cramps
Feeling an urgent need to poop
An ongoing urge to poop even when your bowels are empty — a sensation known as tenesmus
In about half of people with ulcerative colitis, these symptoms are mild. Ulcerative colitis symptoms can start suddenly, or they can begin gradually and worsen over time. If ulcerative colitis is more severe or affects more of the large intestine, you may experience other symptoms that affect other parts of your body:
Severe tiredness
Fever
Nausea and vomiting
Unwanted or unexpected weight loss
Some doctors define the severity of ulcerative colitis based on how many daily episodes of rectal bleeding you experience:
Mild: Under four episodes of rectal bleeding a day
Moderate: Four or more daily rectal bleeding episodes
Severe: More than four daily episodes of rectal bleeding, as well as systemic symptoms and low blood levels of a liver protein called albumin
However, there is no universally accepted formal definition of mild, moderate, or severe ulcerative colitis.
In children, ulcerative colitis often affects a larger area of the colon. Children tend to have more severe and aggressive symptoms than adults.
A doctor will usually classify ulcerative colitis based on the location of the inflammation in the colon. The different types of the disease, along with their corresponding symptoms, include:
Ulcerative proctitis: This form of the disease tends to be the least severe, usually affecting the rectum (bottom of the colon). Feeling urgency when you need to poop and having problems passing stool, along with rectal bleeding, may be the only symptoms of ulcerative proctitis.
Left-sided colitis and proctosigmoiditis: This affects the rectum and colon up to an area called the descending colon, sometimes reaching a bend in the colon near the spleen called the splenic flexure. Bloody diarrhea, belly pain and cramps, appetite loss, and tenesmus may suggest left-sided colitis. Proctosigmoiditis is a subtype of left-sided colitis that causes inflammation in the rectum and the area just above the rectum called the sigmoid colon. Symptoms of proctosigmoiditis are similar to those of left-sided colitis.
Pancolitis or extensive colitis: This affects the entire colon, starting at the rectum and continuing past the splenic flexure. Pancolitis might cause severe episodes of bloody diarrhea, belly pain, and significant weight loss.
Around 27 percent of people with ulcerative colitis develop complications outside of the digestive system.
Anemia: Anemia occurs when levels of red blood cells are low, causing fatigue, pale skin, and reduced exercise capacity. Most often, it develops due to low iron levels caused by blood loss in the gut, higher inflammation levels, and a reduced ability to absorb and use iron.
Ankylosing spondylitis: Around 1.7 percent of people with ulcerative colitis develop ankylosing spondylitis. The main symptoms of ankylosing spondylitis are pain and stiffness in the lower back, hips, or both, which gets worse after rest. Pain can also spread to other parts of the spine and the rest of the body.
Bone issues: Both ulcerative colitis and the corticosteroid medications used to manage inflammation may lead to low bone mass and osteoporosis.
Eye problems: Around 10 percent of people with inflammatory bowel disease experience eye problems. This can result in conditions such as uveitis, dry eye disease, keratopathy, and episcleritis, all of which are treatable.
Primary sclerosing cholangitis: This occurs when ulcerative colitis inflammation causes scarring of the tubes, or bile ducts, that carry digestive juices from your liver to your gut. Over time, the scarring narrows and hardens the bile ducts, causing severe liver damage or infections.
Joint inflammation: Arthritis is the most common complication of inflammatory bowel disease outside of the digestive system. This can lead to swollen, stiff, and painful joints throughout the body. Peripheral arthritis, or inflammation of the elbows, wrists, knees, and ankles, is more common in people with ulcerative colitis than in the general population, with the level of joint inflammation generally being in line with the level of colon inflammation.
Skin inflammation: Various skin disorders are the second most common complication of ulcerative colitis outside of the colon, including erythema nodosum and pyoderma gangrenosum. Red bumps or small blisters on the shins or ankles may develop in people who live with ulcerative colitis.
Blood clots: Ulcerative colitis makes blood clotting in the veins, arteries, and capillaries more likely. Depending on the location of the blood clots, they can be fatal.
Canker sores: People with ulcerative colitis can develop canker sores, or painful sores on the tongue or the inside of the mouth. These ulcers may be round, small, gray, white, or yellow with a red border.
Growth and development problems in children: Weight loss and reduced appetite can lead to growth and development problems in young children. These may include short stature, slow growth, slower weight gain than normal, and late puberty.
Severe Complications of Ulcerative Colitis
Ulcerative colitis can lead to serious and sometimes fatal complications, including the following:
Fulminant colitis: One of the most serious and potentially life-threatening ulcerative colitis complications is fulminant colitis (also known as acute severe ulcerative colitis), a rare complication that leads to more than 10 bloody stools per day, continuous rectal bleeding, and severe anemia. Symptoms of fulminant colitis rapidly get worse and can lead to life-threatening complications.
Toxic megacolon: Toxic megacolon occurs when a section of the colon becomes dilated and paralyzed, often stemming from fulminant colitis. Common symptoms include pain, a swollen belly (bloating), fever, shock, diarrhea, and a rapid heart rate. Using certain medications, such as antidiarrheal medicines, opioids, or anticholinergic drugs, can worsen the condition. Toxic megacolon can be fatal, as it increases the risk of shock, dehydration, and infection throughout the body. In many cases, toxic megacolon requires surgery to remove all or part of the colon and rectum.
Perforated colon: Toxic megacolon can lead to a perforated colon, or a hole in the wall of the colon, and spillage of its contents into the abdomen. This can cause severe belly pain and cramps, fever, bloating, nausea, and vomiting. A perforated colon is a medical emergency requiring urgent surgery.
Peritonitis: This is an infection of the abdominal wall, known as the peritoneum, that can occur due to leaking bowel contents after a perforated colon. You may experience severe belly pain, fever, nausea and vomiting, an inability to pass stools or gas, breathing problems, low blood pressure, and shock. You might also feel soreness, swelling, or fluid in the abdomen.
Ulcerative Colitis and Colorectal Cancer
People with severe colon inflammation may have a higher risk of colorectal cancer. This especially applies to people with a family history of colorectal cancer, an 8- to 10-year history of ulcerative colitis, primary sclerosing cholangitis, or abnormal cell changes in the colon and rectum.
Ulcerative colitis isn’t usually fatal, but symptoms can be severe and interfere with daily life. It is important to see a gastroenterologist for ongoing checkups and care, even if you are not experiencing any symptoms.
It is especially important to check in with a healthcare professional if you notice the following symptoms:
Abdominal pain
Bloody stools
Continuous diarrhea that doesn’t get better even if you take over-the-counter medications or make dietary changes
Diarrhea that wakes you up from sleep
A fever with no other explanation that continues for two or more days
Nausea or vomiting that lasts for more than one day
Skin lesions that won’t heal
Joint pain that interferes with daily activities
A feeling of increased bowel urgency
An inability to gain an appropriate amount of weight (in children)
Dehydration
If you have known ulcerative colitis and experience severe pain, continuous rectal bleeding, more than 10 bloody bowel movements per day, or systemic symptoms like a fever or rapid heartbeat, call 911 or go to your nearest emergency room. These symptoms might suggest that you have fulminant colitis that needs emergency treatment.
Ulcerative colitis causes diarrhea, bloody stools, tenesmus, and abdominal pain and discomfort. The severity of the disease is usually based on how many bloody stools a person passes daily.
The condition can also cause inflammation outside of the digestive tract, affecting the joints, skin, and eyes, as well as contributing to potential liver conditions.
Different types of ulcerative colitis cause various other symptoms, depending on how much of the colon is affected.
Contact 911 or go to an emergency room if you experience abdominal pain, continuous bloody stools, dehydration symptoms, fever, and a rapid heartbeat.
