Let's Talk About the Signs and Symptoms of Ulcerative Colitis
And if we're talking UC, that means talking about poop, people. But ulcerative colitis isn't only a GI problem. It's a chronic disease that can manifest in all sorts of ways. These are UC symptoms to watch for. by Lara DeSanto Health Writer
Maybe you’re having belly woes and you’re wondering if it could be something serious—like ulcerative colitis (UC). Or maybe you’ve already been diagnosed and you’re not sure if these weird new symptoms are UC-related—or something else. What’s “normal” with UC varies from person to person, but we’re here to help you understand the basics when it comes to the many potential signs and symptoms of this type of inflammatory bowel disease (IBD). No matter what you’re going through—from digestive issues like diarrhea to other problems such as fever, joint pain, and beyond—we’ll help you navigate your symptoms so you can get the best care possible.
Our Pro Panel
We went to some of the nation's top UC experts to bring you the most scientific and up-to-date information possible.
Aline Charabaty Pishvaian, M.D.
Director of the Inflammatory Bowel Disease Center
Sibley Memorial Hospital
Jason Schairer, M.D.
Senior Staff Gastroenterologist
Henry Ford Inflammatory Bowel Disease Center
Megan Elizabeth Riehl, Psy.D.
Clinical Health Psychologist
University of Michigan
Ann Arbor, Michigan
While everyone’s UC symptoms will vary, the most common include blood in your stool and frequent diarrhea (like four or more times a day). Many people also experience abdominal pain.
UC is an autoimmune condition that causes systemic inflammation. So while the symptoms may be mostly GI-focused, the effects can ripple from head to toe. You might experience fatigue, flu-like symptoms, achy joints, and problems with your skin and eyes.
UC and Crohn’s have many similar symptoms, so it’s not really possible to tell them apart from those alone. Diagnosis involves tests to look inside the GI tract to see what's going on. UC generally affects only the colon and/rectum while Crohn's can impact any part of the GI system.
Your doctor may diagnose you with a specific type of UC based on what part of the rectum and colon are affected. These can include ulcerative proctitis, left-sided colitis, and extensive colitis. Each of these subtypes can have slightly different symptoms.
What Are the Signs and Symptoms of Ulcerative Colitis?
First, let’s review: What is ulcerative colitis, anyway? This condition occurs when your large intestine—that includes your colon and your rectum—is chronically inflamed. Somehow, your immune system’s signals got scrambled, so the body ends up attacking healthy cells as if they’re foreign invaders. The resulting inflammation is the root cause of most of its symptoms, too.
While most people associate the digestive system and intestinal issues with UC, not all UC symptoms stem from the large intestine. Because the inflammation of UC is systemic, it can affect your entire body, leading to problems like joint pain, extreme fatigue, and more—not to mention the stress and anxiety that can come with dealing with a serious chronic disease.
Here’s a quick list of the main symptoms:
Blood or pus in your stool
Tenesmus, or when you have a sudden and constant feeling that you need to have a bowel movement
Abdominal pain or discomfort
Now, let’s do a deeper dive into some of the most common symptoms.
What Are the Digestive Symptoms of UC?
Many UC symptoms are intestinal. The big three? Blood, diarrhea, and pain. So, yeah, really fun ones. Here are the specifics:
Blood or pus in your stool. One of the most common signs that you may have UC is seeing blood or pus (white or yellow mucous) in your poo—which can be a scary experience. Blood in your stool may look like bits of red mixed in with the brown, or the poop may appear black and tarry. You might even notice blood on your toilet paper when you wipe. So, what do you do if you see blood in your toilet bowl? Well, experts say blood in the stool always warrants a trip to the doctor. Many times, it ends up being something mild and easy to treat, like hemorrhoids. But it’s important to see your doctor to rule out other causes and consider the possibility of UC. Also, it’s possible to have blood in your stool that isn’t visible to the naked eye—that’s one reason why doctors often take a stool sample when diagnosing UC. That way they can get a closer look and make sure they’re not missing this key sign that frequently comes with UC.
Frequent diarrhea. You may find yourself running to the bathroom with ongoing diarrhea. We’re not talking about your typical bout of diarrhea—with UC, the onslaught may last more than four days (sometimes for weeks at a time), wake you up in the middle of the night, and strike more than four times per day. This symptom can be one of the most difficult for people with UC to deal with, since it can interrupt daily life and be downright embarrassing. If you realize that you’re always clocking the location of the nearest bathroom in your travels, or you find yourself canceling plans for fear of having diarrhea, this could be a sign that you have something more serious going on—like UC.
Some people with UC also have what’s called tenesmus. That’s perhaps a more polite term to describe the constant feeling that you need to poop. And then sometimes, when you try to go, nothing comes out—or the urge doesn’t go away even after you’re done. Diarrhea can happen to anyone, but start paying attention if yours worsens, lasts longer than a few days, or wakes you up at night.
Abdominal pain. Though less common than bloody stool and diarrhea, abdominal pain is another possible symptom of UC. Kinds of pain include general discomfort (like a squeezing, bloated feeling), constipation, or sharp abdominal cramps. Watch for a swollen, distended stomach and tenderness to the touch—these could be signs that your inflammation is severe.
How Do I Gauge Symptom Severity?
UC symptoms can range from mild to severe, and your doctor will take all your symptoms into account when assessing the severity of your case. For example, if you’re experiencing more than six loose, bloody stools a day and your abdomen is swollen and tender, your UC is likely severe. But if you’re experiencing four or fewer loose stools a day with only mild abdominal pain, your UC may be considered mild.
And remember: Symptoms can vary from person to person. Over time, as you learn to manage your UC, you’ll learn what your version of “normal” is. It’s also important to know that your UC can change over time—it may get worse (called “progressive” disease), or you may find you’re having different symptoms than you were initially. On the other hand, your UC may also improve with treatment, leading to periods of remission when you have few symptoms, if any. And that’s the real goal with UC treatment—to get your disease and symptoms under control to the point where they’re barely noticeable, if at all.
What Are the Non-Digestive Symptoms of UC?
Less talked about are the UC symptoms beyond the digestive tract—called “extraintestinal symptoms” in the world of IBD. Some research, such as this review in World Journal of Gastroenterology, finds that these farther-flung symptoms are a sign of greater disease severity. Here’s what to watch for.
Weight loss. One sign you should head to the doctor to get evaluated for UC is any unexplained weight loss. If you’re not actively trying to lose weight but the number on the scale keeps dropping (more than 5% of your body weight in less than six months), make the call—it could be UC or another health issue that needs treatment.
Flu-like symptoms. Feeling under the weather pretty much constantly? That can be UC, too. Some people with UC deal with fevers, extreme fatigue, achiness, and reduced appetite. If you’re experiencing these symptoms, see your doctor. For fatigue, the solution may be as straightforward as working to improve your sleep quality. It’s not uncommon for UC symptoms to interrupt sleep (pooping all the time can do that)—so getting a handle on those disruptions with treatment can help you get some proper shut-eye, which will improve your energy levels and help you feel better overall. It’s basically a positive feedback loop!
Joint pain. Up to 40% of people with IBD may experience achy joints due to that body-wide inflammation, which can cook up problems head to toe. Most commonly, people with IBD experience peripheral arthritis, a form that typically affects large joints like the hips, shoulders, and knees. No surprise here: Joint symptoms usually flare up whenever your digestive symptoms do.
Some people also experience axial arthritis, which affects your lower back. The first signs of this type of arthritis may be morning stiffness or low-back pain that gets worse if you sit or stand for long periods of time and improves with activity. Less commonly, people with UC may have arthritis in the smaller joints, like those in the hands. Luckily, many joint-related symptoms improve with treatment of overall UC symptoms. Your doctor may also recommend physical therapy and a gentle exercise program to target these issues. Axial arthritis follows an independent course from IBD disease activity.
Skin problems. UC runs deep, starting within the lining of your colon. But systemic inflammation can also affect the outermost layer of your body: your skin. The most common skin issues for people with IBD are:
Erythema nodosum, which is characterized by painful, red nodules on the skin, especially on the shins, affects about 10% of people with UC.
Pyoderma gangrenosum is similar to erythema nodosum in that it presents with nodules on the skin—but in this case, these lumps can turn into painful ulcers. It affects about 0.5% to 2% and higher in UC than in Crohn’s disease, according to a study in Frontiers in Physiology.
Eye problems. It’s bad enough that your butt feels like it’s on fire, but your eyeballs may, too. UC can cause redness, inflammation, and dryness.
When to Call Your Doctor
If you’re having any of the above UC symptoms, especially bloody stool, endless diarrhea, or severe pain, make an appointment with your primary-care doctor. It could always be something other than UC, but it’s important to get it checked out.
The sooner you treat UC and work to stop the damage to your intestinal lining and overall health, the better. If your GP suspects UC, they will likely refer you to a gastroenterologist, which is a type of physician specializing in digestive health care. This doc can further evaluate your symptoms, run any necessary tests, and get you a diagnosis.
If you’ve already been diagnosed with UC, call your gastro if you’re experiencing any increase in symptoms like bloody stools, diarrhea, and pain, along with weight loss, fatigue, and fever.
And we totally get it. Talking about UC symptoms with your doctor—or anyone!—can feel awkward or embarrassing (we are talking about poop, after all). But it’s hugely important that you’re honest about what’s going on so your doctor can get you the best treatment possible.
Are There Different Types of UC?
When you get diagnosed with UC, your gastroenterologist may tell you that you have a certain type of UC. There are a few different subtypes, and each can have slightly different symptoms. Here’s a breakdown.
Ulcerative proctitis. In this type of UC, the inflammation is confined to the rectum, rather than both the rectum and the colon. Symptoms of this type of UC include rectal pain and bleeding and a sense of urgency to have bowel movements.
Left-sided colitis. In left-sided colitis, inflammation can extend from the rectum to the splenic flexure, a bend in the colon near your spleen. Another type of UC called proctosigmoiditis also falls under the umbrella of left-sided colitis, and it affects your rectum and the sigmoid colon, which is the lower part of your colon. Symptoms of these types of UC include bloody diarrhea, weight loss, reduced appetite, and pain (can feel like pressure or cramping) on the left side of your abdomen.
Extensive colitis. This type of UC involves usually inflammation involving the entire colon is called pancolitis. Symptoms include bloody diarrhea, abdominal pain, weight loss, and reduced appetite.
What Are the Complications of Ulcerative Colitis?
UC can also lead to complications, especially if left untreated or if you don’t follow the directions for your medications to a T (for example, skipping doses). Common complications of UC include:
Rectal bleeding, which can lead to iron-deficiency anemia
A rupture of the bowel
Increased risk of colon cancer
Deficiencies in vitamins and minerals, which can lead to bone loss in the form of osteopenia or osteoporosis
Inflammation throughout the body, such as the eyes, skin, and joints
If you’ve had surgery for UC, keep in mind there may be surgical complications as well. Talk with your doctor about any warning signs to watch for.
UC and Your Mental Health
It almost goes without saying that UC can have a major impact on your mental health. The mind-gut connection is real, meaning that everyday stress can manifest in digestive symptoms. Of course, this relationship goes both ways, too: Stress can cause GI symptoms that can cause stress… you get the idea.
What’s more is that research, like this study in the Canadian Journal of Gastroenterology and Hepatology, shows that people with IBD are at increased risk of developing symptoms like anxiety and depression, and sometimes full-blown depressive or anxiety disorders.
It’s no wonder—living with a condition like UC that’s shrouded in stigma can be isolating, and the fear of symptoms flaring up unexpectedly is often anxiety-provoking and stressful. When your symptoms can interfere with your ability to go to work, go to school, or even just hang out with friends and family, it can take a serious toll on your mental health.
Building a strong support system of friends, family, and your health care team is important to remove some of that emotional burden. Working with a therapist is also a valuable option—they can teach you techniques to reduce your anxiety, transform your mindset, and more.
- UC Basics: The Crohn’s and Colitis Foundation. (2019). “What is Ulcerative Colitis.” crohnscolitisfoundation.org/what-is-ulcerative-colitis/
- Treatment Guidelines for Mild-to-Moderate UC: Gastroenterology. (2019). “AGA Clinical Practice Guidelines on the Management of Mild-to-Moderate Ulcerative Colitis.” doi.org/10.1053/j.gastro.2018.12.009
- How UC Can Affect Your Skin: Frontiers in Physiology. (2012). “Skin Manifestations of Inflammatory Bowel Disease. Huang, Chandra, and Shih.” dx.doi.org/10.3389%2Ffphys.2012.00013
- UC Symptoms Beyond the GI Tract: Journal of Gastroenterology and Digestive Diseases. (2018). Extraintestinal manifestations of inflammatory bowel disease: Clinical aspects and pathogenesis. alliedacademies.org/articles/extraintestinal-manifestations-of-inflammatory-bowel-disease-clinical-aspects-and-pathogenesis-9942.html
- Information About Arthritis in UC: The Crohn’s and Colitis Foundation. (2015). “Arthritis and Joint Pain.” crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/arthritiscomplications.pdf