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What are the symptoms of ulcerative colitis?

The typical symptoms of someone with ulcerative colitis are frequent loose watery, and often bloody bowel movements [2]. Patients with severe disease can report moving their bowels15-20 times a day. Moderate to severe colitis also can cause diarrhea at,night, a strong urge to pass stool that is difficult to ignore (urgency) and, occasionally, inability to hold in bowel movements (incontinence). Prolonged diarrhea may lead to weight loss in severe cases and anemia if there is blood loss or severe enough inflammation. Yet, paradoxically, patients who have disease localized to the rectum can also be constipated. The extent of colon affected by the disease and the location, as well as disease severity influences which symptoms dominate.

Diarrhea +++
Crampy abdominal pain +++
Bloody stool +++
Urgency ++
Incontinence of stool +
Weight loss +
Fevers +
Joint pains +

Crampy abdominal pain is also common, often relieved by passing stool. The pain is usually on the lower left side, but may be across the entire abdomen. A feeling of distension and bloating may also be present. About 30-50% of patients experience symptoms outside the intestinal tract, including joint pains, skin rashes, and eye irritation. Fever may occur during severe flares of the disease. Anemia can occur due to blood loss. As with many chronic diseases, malnutrition, psychological stress, and work disability may become problematic as a consequence of persistent active disease. Fertility may be affected by active UC, as well as by medications or surgery for the disease.

Fatigue is not specific to UC but can be often occur with other issues. Fever, particularly low-grade (below 101F) can be caused by UC, but it is important to make sure there is no ongoing infection. Temperatures greater than 101F are usually due to other causes such as infection, and would require you to notify your health care provider.

Unfortunately the symptoms described above are not exclusive to ulcerative colitis. In young adults with new-onset diarrhea, infections of the colon are the most important causes to consider. After these infections have been excluded, ulcerative colitis is an important consideration.
In addition to these bowel related symptoms, UC can cause symptoms which are outside the bowel (or extra-intestinal manifestations). Joint pains, particularly in the larger joints- hips, knees- can occur in more than 40 % of people. People may also experience eye and skin problems, mouth, and rectal sores.

Other conditions that produce similar symptoms to ulcerative colitis include:

  • Irritable Bowel Syndrome, which can cause diarrhea and crampy abdominal pain, but bleeding and night-time diarrhea are unusual.
  • Intestinal infections (Clostridium difficile, Salmonella, Shigella and Campylobacter), which can cause profuse diarrhea, rectal bleeding, fevers and abdominal pain (infectious colitis).
  • Crohn's disease of the colon, which may cause similar symptoms to ulcerative colitis, but usually the colon is inflamed only in a patchy manner.
  • Insufficient blood supply to the colon, which in older patients can cause bloody diarrhea and severe abdominal pain (ischemic colitis).
  • Celiac disease, microscopic colitis, bacterial overgrowth and lactose intolerance are among the other conditions that can cause diarrhea and crampy abdominal pain without bleeding.

All of the symptoms above require medical attention, but symptoms alone are insufficient to diagnose ulcerative colitis. Nevertheless, once the diagnosis is established, changes in symptoms are a reliable way of determining whether the disease is active or not.

Contact Information

Inflammatory Bowel Disease Program
Digestive Disease Center
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215