Ulcerative Colitis Symptoms: Everything You Need to Know

Ulcerative colitis is a form of inflammatory bowel disease (IBD). The condition affects the colon by causing inflammation there but also has an impact on other parts of the body. Ulcerative colitis symptoms often appear as bloody diarrhea, abdominal pain, and an urgent need to have a bowel movement.

Symptoms may come and go as the condition cycles through periods of active disease and remission. Knowing when to see a healthcare provider about symptoms or to go to the emergency department is an important part of managing ulcerative colitis.

Symptoms

The signs and symptoms of ulcerative colitis may differ based on how much of the large intestine is affected by the inflammation. The symptoms of ulcerative colitis will vary based on the type of the disease and from person to person.

Some of the more classic or typical symptoms of ulcerative colitis that occur in the digestive system can include:

• Abdominal pain and cramps
• Bloody stool
• Diarrhea
• Fever
• Loss of appetite
• Mucus in the stool
• Ulcers (sores) in the lining of the large intestine
• Urgent need to have a bowel movement, including when the bowel is empty (tenesmus)
  

Indicators by Type

The inflammation caused by ulcerative colitis usually begins at the end of the colon, in the rectum. It may spread up through the other parts of the large intestine. This means that ulcerative colitis can be a progressive disorder.

How far the inflammation has progressed in the colon is one of the ways that ulcerative colitis is classified by form or type. These are the different forms of ulcerative colitis and their most common symptoms.

Ulcerative Proctitis

When inflammation caused by ulcerative colitis is located in the rectum, it's called ulcerative proctitis. The main symptoms may be an urgent need to use the bathroom and a feeling that more stool is left in the rectum even after going to the bathroom (called tenesmus). There could also be blood in the stool, diarrhea, and rectal pain.

Proctosigmoiditis

In this type of ulcerative colitis, the inflammation is located in the rectum and sigmoid colon (the last section of the colon). This often causes symptoms of diarrhea, bloody diarrhea, crampy abdominal pain, urgency, and pain on the left side of the abdomen.

Left-Sided Colitis

This form of ulcerative colitis may also be called limited or distal colitis. Inflammation spreads further up the left side of the colon and includes the rectum, sigmoid colon, and descending colon. The symptoms include diarrhea, blood in the stool, weight loss, loss of appetite, and sometimes pain (which can be severe) on the left side of the abdomen.

Pancolitis

This may also be called extensive colitis. In pancolitis, inflammation is found throughout the entire colon. This can cause symptoms of diarrhea (sometimes many times a day), loss of appetite, bloody stools, crampy pain, significant weight loss, and severe abdominal pain.

Less Common Symptoms

Some people have symptoms outside of what are considered the classic or typical symptoms. Not everyone with the disorder has bloody diarrhea, which can sometimes make a diagnosis more difficult.

Some of the less common symptoms that can occur with ulcerative colitis include:

• Constipation
• Excessive gas/bloating
• Nausea
• Rectal pain
  

Signs Beyond the Intestine

Ulcerative colitis causes inflammation in the body and could be considered a systemic disease. Signs and symptoms outside of the digestive tract may also be noted. In some cases, these issues can come up before the symptoms start in the digestive system. 

Symptoms and conditions outside of the intestine may include:

• Anemia (low levels of healthy red blood cells)
• Delayed growth in children (due to malnutrition or a side effect of treatments)
• Fatigue
  
• Joint pain
• Mouth ulcers (aphthous stomatitis)
• Worsening symptoms during menstruation 
• Sleep disturbances
  

Possible Complications

Complications of ulcerative colitis can occur both inside and outside the digestive system. The risk of these conditions is highly individualized, and people who live with ulcerative colitis should speak to their healthcare team about the likelihood of these problems.

Some of the intestinal complications that can occur with ulcerative colitis include: 

• Bowel perforation: This is a hole in the colon, which is a medical emergency. This complication is less common with ulcerative colitis.
  
• Fissure: A tear occurs in the lining of the anal canal, which may cause bleeding and pain.
  
• Toxic megacolon: This uncommon condition causes severe distention (inflation) of the colon and is a serious complication that needs emergency treatment.
  
• Colon cancer: After having ulcerative colitis, and especially pancolitis, for about eight to 10 years, the risk of developing colon cancer increases. People with ulcerative colitis should have regular screenings for colon cancer.
  

Some of the potential extraintestinal (outside of the intestinal tract) complications that can occur with ulcerative colitis include:

• Blood clots (thromboembolism)
• Cardiovascular problems (heart attack or stroke)
• Eye pain or inflammation (episcleritis, uveitis, night blindness, keratoconjunctivitis sicca)
• Gallbladder problems (such as gallstones)
• Kidney or urinary problems (kidney stones, fistulas involving the bladder, amyloidosis)
• Liver disease (primary sclerosing cholangitis)
• Lung disease 
• Neurological conditions
• Pancreatitis (inflammation of the pancreas)
• Skeletal system problems (arthritis, osteopenia, osteoporosis)
• Skin rashes or conditions (pyoderma gangrenosum, erythema nodosum, Sweet’s syndrome, psoriasis, hidradenitis suppurativa)

What Does Ulcerative Colitis Feel Like?

Ulcerative colitis may cause a variety of symptoms both in the digestive system and other parts of the body. It is an immune-mediated condition. A part of the immune system is not working properly, which leads to inappropriate inflammation. It is the inflammation that leads to symptoms.

Ulcerative colitis is a chronic illness that currently has no known cure. There are some "classic" signs and symptoms, but every person experiences the condition differently.

When you have ulcerative colitis, you will need regular care from healthcare providers. The condition can have a significant effect on both physical and mental health as well as quality of life.

Outlook

Not everyone with ulcerative colitis has severe symptoms. In addition, the availability of many treatment options may help more patients treat the disorder more effectively. 

At diagnosis, about 40% of people have proctitis, 30% have left-sided colitis, and 30% have pancolitis. About half of people will achieve remission in the 10 years following a diagnosis. About 40% will have chronic symptoms, and 10% will have chronic or severe symptoms.

One treatment for ulcerative colitis, which is surgery to remove the colon (a colectomy), may be needed in between 20% and 30% of people over a 25-year period after getting diagnosed with the condition. A partial colectomy may remove a segment of the colon. If the condition is more severe, a total colectomy may be performed.

People with ulcerative colitis don’t tend to die at greater rates than other people. The risk of mortality mostly only increases in the period just after diagnosis. The risk also increases when the condition becomes severe and complicated.

However, it’s important to remember that with the increased interest in research and the development of new treatments, people with ulcerative colitis are living full lives. Recent treatment availability is altering the course of ulcerative colitis. However, it may be some time before these changes are reflected in the disease statistics.

People experiencing severe disease may need more time to find a treatment that works. In some cases, getting hospitalized may be necessary to treat severe complications or symptoms.

Knowledge about the condition is increasing every year. Gastroenterologists and colorectal surgeons can help guide treatment and recovery.

Living With Ulcerative Colitis Symptoms

When ulcerative colitis causes symptoms, it can, unfortunately, have a significantly negative effect on quality of life. People with ulcerative colitis can help themselves by establishing a good relationship with a healthcare provider.

Having this relationship to cope with the ongoing issues that ulcerative colitis can bring up is crucial. The clinical signs and symptoms of ulcerative colitis will need treatment. A healthcare provider can help point out when the care plan needs changing.

The condition's lifestyle, financial, and mental health effects must also be considered. People with ulcerative colitis will want to establish a network to help them cope. This can include trusted people in their everyday lives, such as family and friends, healthcare providers, and patient advocacy groups.

When to Contact a Healthcare Provider

Ulcerative colitis causes symptoms that are chronic and may come and go, so knowing when to see a healthcare provider can be challenging. Some signs and symptoms (such as bloody stools) are a reason to get care soon, while some symptoms can wait until your next appointment (such as sleep problems).

However, ulcerative colitis requires care throughout a lifetime. This means that even when no symptoms affect quality of life, people with ulcerative colitis should still get regular care from a specialist healthcare provider (a gastroenterologist).

Treatments that include everything from medications to lifestyle changes to diet are necessary on an ongoing basis to prevent this condition from flaring up.

It’s important to keep track of symptoms. When they start to pick up again or become worse, it is time to call a healthcare provider and get evaluated. This could mean it's time to change your treatment plan to stop the inflammation or prevent it from worsening.

Because the signs and symptoms can affect many different body systems, bringing up things that might not seem related to the digestive system, like joint pains or a new rash, is also key. That they could have something to do with ulcerative colitis is possible. A healthcare team that understands this condition can help with diagnosis and treatment. 

Summary

Ulcerative colitis is a serious and complicated condition. Signs and symptoms may come and go over a lifetime. They include digestive system symptoms such as abdominal pain, bloody stool, and diarrhea, and symptoms beyond the intestinal tract. Symptoms can vary from person to person and their type of ulcerative colitis.

People with this disorder will need to seek care on a regular basis throughout their lifetime. Treating the inflammation is the most important factor in avoiding more serious outcomes.