21 Ulcerative Colitis Symptoms

Ulcerative Colitis symptoms can be extremely distressing and worrying and they can also be mistaken for evidence of other disorders. You may be wondering if your symptoms fit this illness. Read on to find out the full set of signs and symptoms and how it is diagnosed.

What Does the Name Mean?

Colitis means inflammation of the colon. Inflammation is a localized reaction which causes swelling, redness, pain and heat. 

Ulcerative means causing the development of ulcers. When the lining of the colon is inflamed for a long period of time it becomes damaged and ulcers (craters) can develop and these ulcers can bleed and become infected.

Ulcerative colitis is sometimes abbreviated to UC.

Do Ulcerative Colitis Symptoms Affect All Parts of the Gastrointestinal Tract?

No this is not the case. Ulcerative colitis affects only the colon (also called the large intestine) and the rectum. It only affects the top layer of the intestinal lining.

Ulcerative Colitis Symptoms - Diagram of The Large Intestine

UC is divided into different categories depending on how widespread it is. 

  1. Ulcerative proctitis only affects the rectum or back passage. This form is generally milder than other types and it affects about 30% of people with ulcerative colitis. It has a better outlook than other types although in some cases the illness can start like this and then spread into other areas.
  2. Proctosigmoiditis - The sigmoid colon is the part of the colon that lies horizontally from the left hip area across to the midline and attaches to the rectum. When both the rectum and the sigmoid colon are affected your illness will be put into this category. The symptoms will be worse, with more pain, blood and tenesmus (see below).
  3. Left-sided colitis - This diagnosis means that the inflammation extends all the way up the left side of the colon (descending colon). The symptoms will inlclude more severe bleeding and pain (left sided abdominal) with weight loss and lack of appetite.
  4. Total colitis (sometimes called pan-ulcerative colitis) - With this type the whole colon is affected which can lead to severe bleeding and weight loss and carries the risk of complications requiring surgery.

Will I Have Ulcerative Colitis Symptoms All The Time?

No. People with this disorder tend to have flare ups when their symptoms are very bad and then periods of remission when the symptoms settle down. However UC is a long term condition which will need life long monitoring and treatment.

In any one year 48% of people with a diagnosis of ulcerative colitis will have no current symptoms, 30% will have mild ulcerative colitis symptoms, 20% will have moderate symptoms and 1-2% will be suffering with severe symptoms.

How Common Are Ulcerative Colitis Symptoms?

Ulcerative colitis symptoms are on the rise and it appears that if you live in an industrial society especially in a city you are more at risk, although the reason for this is not clearly understood.

Although there appear to be some genetic factors at work it is complicated as many different genes have been implicated. If you have a close family member who suffers then you are more likely to have ulcerative colitis.

You are more at risk if you are of European descent especially if you have Ashkenazi Jewish ancestors.

The Cause of Ulcerative Colitis Is Unknown

Although the exact cause of ulcerative colitis is not known it is thought to be an auto-immune disease where the immune system attacks its own body and is influenced by genetic susceptibility. Environmental factors may also contribute.

The Cause of Ulcerative Colitis Is Unknown

Although the exact cause of ulcerative colitis is not known it is thought to be an auto-immune disease where the immune system attacks its own body and is influenced by genetic susceptibility. Environmental factors may also contribute.


There are currently close to a million people in the USA with UC although figures are sketchy. In the UK there are about 243 people per 100,000 with UC.


Diagram Showing the Sigmoid Colon with Ulcerative Colitis

Diarrhea, Bleeding and Mucus

Diarrhea is one of the main ulcerative colitis symptoms and often contains fresh blood and or mucus.

The diarrhea can happen at any time of the day or night and it is common to have up to six episodes a day but some people have been known to have more than 20 bouts a day.  It is common to pass a small amount of fresh blood during a bowel movement.

Pus

If your ulcers become infected then you may pass pus when you have a bowel movement.

Pain

Abdominal pain is another of the main ulcerative colitis symptoms. The pain tends to be more on the left side of the belly as it is more common to have inflammation of this part of the colon. It normally has a cramping nature coming in waves and it can be very severe.

Pain can take the form of abdominal tenderness. This is pain which is caused by pressing the outside of the belly in a specific area. Usually this would be on the left side in the case of ulcerative colitis.

A member of my own family was rushed to hospital in an ambulance before they were diagnosed because the pain was so severe.

The pain can be so debilitating that it can make the person who is suffering difficult to live with but they really cannot help being in a bad mood.

Urgency

Ulcerative Colitis Symptoms - Hotel Bathroom

Urgency is one of the very common ulcerative colitis symptoms and it is also one of the most distressing. When you have the urge to have a bowel movement you cannot hang on but have to go immediately. This means that many people who suffer with UC have stories to tell of soiling themselves in public and of being afraid to leave the house.

Due to the horrible nature of suffering with urgency it is common behavior for all people with ulcerative colitis to scan every place they go to for bathroom facilities before they do anything else. Unless they know that they have easy access to a bathroom then stress levels can sky rocket.

Many UC support groups issue special 'can't wait' cards so that sufferers of this disorder can jump the queue for the bathroom by showing their card.

Constipation

As ulcerative colitis symptoms go, constipation is less common, however some people do suffer in this way. You may have classic constipation where you do not have a bowel movement very often and when you do it is hard and difficult to pass.

Sometimes you may have urgency with a real feeling that you need to go but then you have great difficulty actually getting the stool to leave the back passage. This can lead to a great deal of pain and soreness.

Tenesmus

Tenesmus means a feeling that you want to have a bowel movement but in fact there is nothing or very little there to come out. It can be a continual feeling or it can be intermittent.

It is a very annoying and distressing symptom because you constantly feel that you have to go to the bathroom but when you get there nothing happens.

This is a very common symptom if you have ulcerative colitis.

It is important to see a doctor if you have this symptom because although it is a symptom of ulcerative colitis, Crohn's Disease, and irritable bowel syndrome in some cases it can be a sign of a tumor in the rectum.

Tiredness

This is one of the common ulcerative colitis symptoms. It often occurs because being kept awake at night or taking many trips to the bathroom is extremely tiring and can lead to extreme fatigue.

Another reason for tiredness is that bleeding from the intestinal tract can cause anemia if it is severe. One of the main symptoms of anemia is feeling abnormally tired.

This happens because you do not have enough red blood cells to carry oxygen to all the body parts that need it to function properly.

Fever and Night Sweats

If the ulcers in the lining of the colon wall become infected then this will often lead to you having a higher than normal body temperature.

Sweating at night is very common with Crohn's Disease but is one of the less common symptoms of ulcerative colitis but it can happen and this is very distressing and difficult to cope with as bedclothes tend to get soaked.

Nausea and Vomiting

Nausea is quite common and can make you feel quite unwell and also put you off eating. Vomiting is less common but can occur especially if there is a blockage in your bowel.

Loss of Appetite and Weight Loss

One of the worrying ulcerative colitis symptoms is weight loss. Quite large amounts of weight can be lost. I have heard of one man losing 28lbs in 2 weeks!

Weight loss is common if you are having frequent episodes of diarrhea. This is not helped by having a poor appetite which is also very common with this disorder.

Any unexplained weight loss should be investigated by a doctor.

Failure to Thrive

This is common in children. Children who have ulcerative colitis symptoms find it difficult to grow and thrive. If their symptoms are not carefully controlled it can leave their growth permanently stunted.

Less Common Ulcerative Colitis Symptoms Outside the Intestinal Tract

  • Mouth ulcers
  • Inflammation of the eye
  • Arthritis
  • Skin problems such as rashes, nodules and ulcers particularly of the lower legs
  • Primary Sclerosing Cholangitis - inflammation and scarring of the bile ducts inside and outside the liver

Which Other Disorders Is Ulcerative Colitis Often Confused With?

Ulcerative Colitis

Crohn's Disease

IBS

Inflammation usually only seen in the colon and only in the top layer of the intestinal lining. The gut wall is thinner than normal.

Inflammation may happen anywhere in the gastrointestinal tract from the mouth to the anus. The inflammation and ulcers often penetrate deep into all layers of the gut lining. The gut wall is thickened.

Affects only the function of the colon which may run faster or slower than normal but the bowel itself is normal.

The inflammation is continuous in the affected parts.

The inflammation is patchy with normal areas in-between.

No inflammation.

Rectal bleeding with fresh blood being seen in the stools during a bowel movement common.

Occasional fresh rectal bleeding but bleeding during a bowel movement not very common. Bleeding more common from higher up so it will be darker.

No bleeding.

Symptoms at any time of the day or night .

Symptoms any time.

No symptoms at night if asleep.

Abdominal pain mainly left sided.

Abdominal pain mainly right sided.

Pain felt anywhere in the abdominal area.

Normal age for development 10-40. Slightly more common in men than women. Men are more likely to be older when they develop it.

Usually develops before 30. Slightly more common in women than men and women are more likely to have symptoms outside of the digestive tract.

Can develop at any age from a teenager to older adult. IBS is twice as common in women as men.

Weight loss sometimes.

Weight loss very common.

No weight loss.

Tenesmus very common.

Tensesmus not common.

Tenesmus can be a symptom.

Fever if the disease is severe.

Fever is common.

No fever.

Complications

Possible complications include nutritional deficiencies, thinning of the bones, toxic colitis and toxic megacolon where a buildup of trapped gas can cause the colon to swell which may lead to perforation of the bowel. This is a medical emergency.

People diagnosed with UC have a higher risk of developing colon cancer the longer that they have had their colitis. From 8 years onwards they should have colonoscopy checks to rule out any pre-cancer.

How Will My Doctor Diagnosis Ulcerative Colitis?

If you have ulcerative colitis symptoms then your doctor will want to perform some tests to confirm the diagnosis. He or she will also want to rule out other things that can have similar symptoms like infection, parasites, colon cancer and Crohn's Disease.

Expect to have some blood tests. Most often a full blood count to look for anemia which can indicate bleeding and c-reactive protein (CRP). This is a protein released by the liver and which will show raised levels in the blood plasma in response to inflammation in the body.

Blood will also be tested to measure the erythrocyte sedimentation rate (ESR) sometimes abbreviated to 'sed rate'. If this is high it indicates inflammation.

Stool analysis can be useful to rule out infections and parasites.

Also expect to have x-rays and or a C T scan of the abdomen. Sometimes a barium enema x-ray will be done but this is not used as often these days.

The most useful test is a flexible sigmoidoscopy or colonoscopy which allows the doctor to look directly at the wall of the sigmoid or the whole colon with a camera and to take a biopsy.

What Happens Next If I Receive A Diagnosis of Ulcerative Colitis?

We do not have room on this page to go into all the treatment options but in most cases ulcerative colitis symptoms can be kept under control with anti-inflammatory medication.

The person in my family who has UC has not had a flare up for seven years. It must be remembered though that it is a life long condition and medication has to be taken carefully and regularly to prevent the symptoms of ulcerative colitis from worsening.

Unfortunately a few people will go on to have severe disease and in these cases sometimes surgery is necessary. In the worst case scenario the colon will have to be removed and replaced with a colostomy bag. 

Lifestyle and Psychological Factors

In contrast to what many people believe UC is not caused by a poor diet or indeed by any particular kind of diet. It is true, however, that many people find that certain foods and drinks can aggravate their ulcerative colitis symptoms.

In general things which might cause anybody in the general population to have gut symptoms are best avoided. This means things like spicy food, alcohol, caffeine, beans and pulses and artificial sweeteners. People with UC are also advised to cut down on foods containing sulfur.

A new study has found that relapses occur more often when high levels of red meat are consumed and foods high in sulfur but contrary to what many people believe diary products do not appear to have any effect.

It is a good idea for each individual to experiment and see what they can tolerate by keeping a food and symptom diary.

Another common myth is that ulcerative colitis is caused by stress. This is not true but ulcerative colitis symptoms can be made worse if you are having a stressful time. Of course this is a chicken and egg situation as living with the symptoms of UC is very stressful in itself.

The best advice is to keep in close contact with your doctor and follow their advice carefully but at the same time seek out support from fellow sufferers. Most countries have support organizations and forums which can provide amazing help to people sharing the same condition. 

Lastly it has to be said that if you live in a country where healthcare is not freely available then this unfortunately causes even more stress as the ongoing costs of paying for healthcare and having time off work during a flare up are considerable. 

Ulcerative Colitis Symptoms - Conclusion

If you have the symptoms of ulcerative colitis then it is important that you seek medical attention to get a proper diagnosis. If you do find out that you have UC, although it is a long term condition, with modern medications many people can lead a relatively normal life.

For more information about other inflammatory bowel diseases and irritable bowel syndrome please see the pages below.


Crohn's Disease Symptoms - Could This Be Your Problem?

Are you tired all the time? Do you have cramps? Are your bowels loose, sometimes with blood? You could have Crohn's Disease.

Go to Crohn's Disease Symptoms  - Could This Be Your Problem?

7 Main IBS Symptoms

Ulcerative colitis is often mistaken for IBS and vice versa. Check the symptoms of IBS here.

Go to 7 Main IBS Symptoms

Inflammatory Bowel Disease - Risk Factors and Symptoms

If you have intestinal symptoms which are not going away you could have inflammatory bowel disease. Do not delay before finding out and seeking help.

Go to Inflammatory Bowel Disease - Risk Factors and Symptoms

Microscopic Colitis - Causes, Symptoms and Treatment

Not many people know about microscopic colitis but it could explain your symptoms.

Go to Microscopic Colitis - Causes, Symptoms and Treatment


Return to Inflammatory Bowel Disease


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Photo attributions:

Colon diagram (modified) by Blausen.com staff. "Blausen gallery 2014". Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762. - Own work

Ulcerative colitis of the sigmoid colon image (modified): https://commons.wikimedia.org/wiki/File:UC_granularity.png

Hotel bathroom (modified) by Ann Worner https://www.flickr.com/photos/wefi_official/9441482029


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