Ulcerative Colitis Constipation: Why It Happens and How to Get Relief
Although diarrhea is more common with ulcerative colitis, up to half of people with the condition may have constipation at some point.
When you have ulcerative colitis (UC), bowel issues can develop suddenly or turn into a chronic issue, and one of those difficulties is constipation.
With UC, inflammation is always a concern with any symptoms, and constipation isn't an exception, says Jakob Saidman, MD , a gastroenterology fellow at Northwell Lenox Hill Hospital in New York City.
When this system is disrupted — a situation that can happen more easily with UC — it's like a traffic jam where the signals are mixed up.
Even stress can play a role here, since it can affect the enteric nervous system and lead to digestive changes, Saidman says.
Although constipation can be uncomfortable, the good news is that there are some ways to manage it. Here's what gastroenterologists recommend as a starting point.
Because many types of medication — including some prescribed for UC — can cause constipation, it's helpful to have a conversation with your gastroenterologist or a pharmacist about what could be a possible culprit, says Saidman.
Sometimes, one of these meds won't cause a problem on its own, but they may become an issue when taken in combination. That's why doing a medication review is useful, says Saidman.
The role of dietary fiber in digestive health isn't just hype. While eating too much fiber can lead to constipation in rare cases, that's much less of an issue than getting too little, says Saidman.
Another way to reduce inflammation, improve blood flow in the digestive system, support that enteric nervous system, and reduce stress is to move more often, says Saidman.
"Any type of exercise stimulates the intestinal muscles, and that can have a meaningful effect on moving stool and reducing constipation," he says.
While strategies that get your digestive motor running are helpful, it's crucial to include your brain in the mix, says Ashkan Farhadi, MD, a gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California. The gut-mind connection is powerful, and it can be harnessed with a bit of training.
"You can condition your bowel by setting it up so you expect to go at the same time every day," he says. "The brain loves consistency and predictability, so if you tell the mind that this is the hour for evacuating the bowels, it will do that, and it learns quickly."
For example, let's say you want to have a bowel movement at 7 a.m. every day. Dr. Farhadi suggests sitting on the toilet at that time for 15 minutes, without straining or even trying to poop. Do this every day, even though nothing might happen at first. The point is that every day, you're telling your brain that this is your bowel's "deliver the shipment" time.
"You'd be amazed that after seven or eight days, your body begins to comply," he says. "Your brain begins to anticipate that this is what you want, at that exact time, and it will deliver."
Sometimes, constipation happens because you may have been training your brain in a non-helpful way without realizing it, says Farhadi. For example, it's possible that whenever you've had mild urgency about needing to poop, you put it off to a more convenient time. By then, the bowel's nudging sensation may be gone.
"Postponing your bowel movements until they're at a better time is a good way to develop constipation, whether you have ulcerative colitis or not," he adds. "That's because you've been conditioning both your brain and your bowel to regard urgency as unimportant. You stopped listening to your body's signals, and when that happens, the body may adapt by not sending those signals anymore."
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