Ulcerative colitis (UC) symptoms range from mild to severe. Symptoms may vary over time and from person to person, depending on what part of the large intestine is inflamed and the severity of the inflammationImmune response to tissue injury that causes redness, swelling, and pain.. Because symptoms are different depending on the person, the way to assess what you consider a symptom flare-up is relative to what is “normal” for you.
Ulcerative colitis symptoms can include:
- Abdominal pain/discomfort
- Blood or pus in stool
- Weight loss
- Frequent, recurring diarrhea
- Reduced appetite
- Tenesmus: A sudden and constant feeling that you have to move your bowels
When discussing your UC with your doctor, it is important that you have an open and honest conversation about your symptoms, since your doctor will use that information to help decide what treatment plan is appropriate for you.
The chart below can help you understand the differences between mild, moderate and severe symptoms. Your doctor may use similar measures to determine your symptom severity. It's important to remember every person is different and symptoms may vary from person to person.
Ulcerative Colitis Symptom Severity
- Up to 4 loose stools per day
- Stools may be bloody
- Mild abdominal pain
- 4-6 loose stools per day
- Stools may be bloody
- Moderate abdominal pain
- More than 6 bloody loose stools per day
- Fever, anemia, and rapid heart rate
Very Severe (Fulminant)Symptoms of disease coming on suddenly with great severity.
- More than 10 loose stools per day
- Constant blood in stools
- Abdominal tenderness/
- Blood transfusion may be a requirement
- Potentially fatal complications
After you have talked with your doctor about your symptoms, along with certain other tests and additional information, your doctor will create an appropriate treatment plan for you. It’s important to follow directions and take your treatment as prescribed. If you ever have any questions or concerns about your treatment, you should ask your doctor before making any changes or adjustments.
Ulcerative colitis is unpredictable and can be progressiveIncreasing in extent or severity. (get worse). Over time, your symptoms may change in severity or change altogether. You may go through periods of remission—when you have few or no symptoms. Your symptoms may also come on suddenly, without warning.
Tips for patients with IBD
Gastroenterologist Dr. Millie Long discusses 3 key tips for patients with Crohn’s and ulcerative colitis.
Millie Long, M.D., M.P.H., is an Associate Professor at the University of North Carolina Chapel Hill School of Medicine.
The location of your disease may determine what kind of symptoms you have
The four types of UC and their symptoms:
Ulcerative ProctitisAffects the rectum. Symptoms include rectal bleeding, rectal pain, and a feeling of urgency.
ProctosigmoiditisAffects the rectum and sigmoid colon (the lower segment of the colon right above the rectum). Symptoms include bloody diarrhea, pain in the lower left side of the abdomen, and a constant feeling of the need to pass stools (tenesmus).
Left-Sided ColitisAffects the rectum and extends as far as a bend in the colon near the spleen. Symptoms include bloody diarrhea, pain in the left side of the abdomen, loss of appetite, and weight loss.
Pan-Ulcerative ColitisAffects the entire colon. Symptoms include bloody diarrhea, severe abdominal pain, loss of appetite, and weight loss.
To help you be prepared for unexpected symptoms, carry a Restroom Request Card* when you’re out and about. It can help you discreetly ask for access to restricted restrooms.
Complications of ulcerative colitis
In addition to painful symptoms, ulcerative colitis can lead to complications such as:
- Profuse bleeding
- Rupture of the bowel
- Severe symptoms that do not respond to medication
Your doctor may recommend surgery to remove a damaged portion of your large intestine or repair damage caused by ulcerative colitis.
Along with the symptoms listed above, ulcerative colitis complications may include:
- Increased risk of colon cancer, due to chronic inflammation of the colon
Vitamin and mineral deficiencies:
- Over time, blood loss from inflammation and ulceration of the colon can lead to iron-deficiency anemia.
- People with ulcerative colitis can have decreased vitamin D, which can lead to bone loss (osteopeniaReduction in bone volume to below normal levels. and/or osteoporosisA condition that is characterized by the decrease in bone mass with decreased bone density causing brittle bones, usually occurs in older women.). Corticosteroid use can make bone loss worse.
UC can affect more than the large intestine
Sometimes, ulcerative colitis causes inflammation outside of the large intestine, in areas such as:
These symptoms are called extra-intestinalSituated or occurring outside the intestines. symptoms and can also be linked to inflammation. You should talk to your doctor if you experience any symptoms—even if they seem to have nothing to do with your digestive system.
Inflammation can lead to UC symptoms
Painful flare-upsThe sudden intensification of disease symptoms or the return of symptoms suddenly. occur when your large intestine is inflamed (raw, red, and swollen). Learn more about your ulcerative colitis symptoms and how they could be linked to damaging inflammation with Expert Advice.