Signs and Symptoms of Ulcerative Colitis

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD). It irritates the lining of the intestines, which are the tubes that connect the stomach to the anus. It specifically affects the colon and rectum, the parts of the intestine closest to the anus. This irritation may lead to sores or ulcers.

In the United States, UC affects 214 out of 100,000 people. It can develop at any age, but it typically appears in your 30s.

Bloody diarrhea, abdominal pain, and a sudden urge to have a bowel movement (poop) are the most common symptoms of ulcerative colitis. These symptoms typically come on slowly and get worse over several weeks.

Symptoms might also include changes in bowel habits, rectal pain, fecal incontinence, fatigue, appetite changes, weight loss, and fever.

Unfortunately, UC is a chronic condition and there is not yet a cure. However, there are ways to manage it.

Woman bends over desk with lower abdominal pain.

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Common Symptoms of Ulcerative Colitis

UC symptoms can come and go and vary for everyone. Some people experience a temporary break from symptoms for years (which is called remission), while others have frequent flare-ups (periods of worsening symptoms). 

Most people with ulcerative colitis experience mild symptoms. However, 27% have moderate symptoms, and 1% experience severe symptoms.

Diarrhea and Bloody Stool

Diarrhea and blood in the stool are the most common symptoms of ulcerative colitis. Irritation and sores in the rectum and colon cause blood and pus to come out in the stool.  

Clinically, people who have four or fewer non-bloody diarrhea episodes a day have mild symptoms. Those who have five or more bloody diarrhea episodes daily with severe cramping or pain have severe symptoms.

Blood could be mixed in the stool or sitting on top. Sometimes, blood and pus are the only things present during a bowel movement. Rectal bleeding can also appear when you wipe in between bowel movements.

Abdominal pain

Inflammation in the rectum and colon due to UC can cause cramps and abdominal pain that comes and goes with flare-ups. The location of the ulcers and how much area is affected affect the severity and persistence of pain. Stress, certain foods, and menstrual cycles are common triggers.

Changes in Bowel Habits

In addition to bloody diarrhea, ulcerative colitis can cause unhealthy changes in bowel habits which include:

  • Increased urgency and frequency: Urge or need to have a bowel movement more often than usual
  • Tenesmus: Urgency even though the bowels are empty
  • Fecal incontinence: Inability to control bowel movements which can lead to stool leakage
  • Constipation: Inability to have a bowel movement for several days
  • Nocturnal diarrhea: Waking up frequently with diarrhea at night

These bowel habits changes often disrupt daily living activities and quality of life. 

Multiple trips to the bathroom can interrupt school, work, or social activities. Nocturnal diarrhea can cause sleep deprivation (poor rest) and fecal incontinence can lead to social isolation.

Systemic and Extraintestinal Symptoms 

Systemic symptoms affect the whole body. Extraintestinal symptoms affect areas of the body outside the intestines. 

While these symptoms are less common than bloody diarrhea and abdominal pain, 25-30% of those with UC will have extraintestinal symptoms. The most frequent is peripheral arthritis. This is a type of arthritis that commonly affects the elbows, wrists, knees, and ankles.

Other examples of systemic or extraintestinal symptoms of ulcerative colitis include:

  • Fever 
  • Fatigue
  • Shortness of breath 
  • Heart palpitations 
  • Blood clots
  • Anemia (from blood loss)
  • Malnutrition
  • Weight loss or muscle wasting
  • Rash
  • Fatty liver
  • Eye problems

Healthcare providers classify ulcerative colitis by the area of irritation and how far it spreads. Most symptoms overlap between types, but a couple of unique characteristics exist.

  • Ulcerative proctitis: Inflammation in the rectum where rectal bleeding is sometimes the only symptom
  • Proctosigmoiditis: Irritation in the rectum and sigmoid colon (lower end of the colon).
  • Left-sided colitis: The inflammation extends up the color to the left side of the body around the spleen. Abdominal pain is on the left side.
  • Pancolitis: Inflammation in the whole colon

Symptoms in Children 

While ulcerative colitis is more common in teenagers and adults, it can occur in children. It’s worth mentioning because inflammatory bowel disease (IBD) can cause growth failure in children. 

Growth failure from IBD is most likely due to a decrease in appetite, malabsorption (difficulty absorbing nutrients from food), abdominal symptoms, growth hormone resistance, and possibly genetics.

Crohn’s disease is another type of inflammatory bowel disease (IBD) and is more common in children than adults.

UC Severity Varies by Sex

The prevalence or occurrence of ulcerative colitis is equal among genders. However, those assigned female at birth often report worsening symptoms leading up to their menstrual period.

When to See a Healthcare Provider

Talk with a healthcare provider if you experience bloody diarrhea, abdominal pain, changes in bowel habits, or any other symptoms of ulcerative colitis. This is especially important if you don’t have a diagnosis and your healthcare provider is unaware.

For those with a diagnosis of ulcerative colitis, make a plan with your provider regarding when they want to hear from you. It’s always a good idea to let them know if you experience a prolonged recurrence. It’s also best to contact them if your treatment plan fails to manage your symptoms or pain at home. 

While ulcerative colitis is not fatal, it can cause serious and life-threatening complications such as a perforated colon, dehydration, anemia, severe bleeding, or sepsis. Symptoms that require emergency care include:

  • Severe or uncontrolled abdominal pain
  • Excessive bleeding in the stool
  • Decreased urine output
  • Lightheadedness 
  • Severe leg cramps
  • Breathing difficulties
  • Chest pain

A Quick Review

Ulcerative colitis is a chronic inflammatory bowel disease (IBD). It’s most common in teens and adults but can occur at any age. This disorder results in irritation of the colon and rectum, the areas of the large intestine closest to the anus. Inflammation and irritation in the intestines can cause ulcers or sores. 

The most common symptoms of ulcerative colitis are bloody diarrhea (with or without pus) and abdominal pain. Other bowel symptoms include tenesmus, urgency, and frequency, nocturnal diarrhea, fecal incontinence, or constipation. 

Ulcerative colitis can also cause systemic or extraintestinal (outside the intestine) symptoms. These include fever, malnutrition, anemia, weight loss, arthritis, and more. Possible complications include dehydration, severe rectal bleeding, sepsis, and a perforated colon.

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