Signs and Symptoms of Ulcerative Colitis

Classified as an inflammatory bowel disease (IBD), ulcerative colitis is a disease that primarily affects the digestive tract, but usually also has an impact on other parts of the body. It can cause symptoms of bloody diarrhea, abdominal pain, and an urgent need to empty the bowels. Symptoms can cycle through periods of remission and active disease.

Symptoms may differ from person to person, which can make diagnosis and treatment challenging, but there are a few that hint at having the condition.

Frequent Symptoms

The signs and symptoms of ulcerative colitis may vary slightly depending on the stage and the location of the disease, but the most common can include:

• Ulcers (sores) in the lining of the large intestine
• Bloody stool
• Abdominal pain and cramps
• Diarrhea
• An urgent need to have a bowel movement (tenesmus)
• Fever
• Loss of appetite
• Mucus in the stool

Ulcerative colitis can be a progressive disease. The ulcerations begin in the last part of the large intestine, which is called the sigmoid colon, and may spread up through the rest of the colon. Signs and symptoms can be different based on how much of the intestine is being affected by the inflammation.

The different forms of ulcerative colitis and their most common symptoms include:

• Ulcerative proctitis: Inflammation located in the rectum, causing diarrhea, bloody stool, rectal pain, and an urgent need to move the bowels (tenesmus). 
• Proctosigmoiditis: Inflammation located in the rectum and sigmoid colon, causing diarrhea, bloody diarrhea, crampy pain, urgency, and pain on the left side of the abdomen.
• Left-sided colitis (also limited or distal colitis): Inflammation in the left side of the colon (rectum, sigmoid colon, descending colon) causing diarrhea, bloody stools, weight loss, loss of appetite, and sometimes severe pain on the left side.
• Pancolitis: Inflammation throughout the whole colon, causing diarrhea, cramps, significant weight loss, and severe abdominal pain.

Complications

Ulcerative colitis is associated with complications both within the digestive system and outside the digestive system (which are called extra-intestinal symptoms). 

Intestinal complications can include:

• Bowel perforation. A hole in the colon which is a medical emergency that can cause severe bleeding and abdominal pain. This complication is uncommon in people who have ulcerative colitis.
• Fissure. A fissure is a tear that occurs in the lining of the anal canal that can cause bleeding and pain but is usually treatable at home. 
• Toxic megacolon. An uncommon condition that causes severe distention of the colon, toxic megacolon is a serious complication that needs emergency treatment.
• Colon cancer. After having ulcerative colitis for about 8 to 10 years, the risk of developing colon cancer increases. It's important to work with a gastroenterologist to schedule screening for colon cancer at regular intervals.

Extra-intestinal complications can include:

• Delayed growth in children. Some older medications used to treat ulcerative colitis and malnutrition caused by the disease can contribute to growth problems.
• Eye diseases. Several eye conditions, including uveitis, glaucoma, keratopathy, episcleritis, and dry eyes, are associated with ulcerative colitis or the treatments for the disease. 
• Arthritis. The most common of the extra-intestinal manifestations, several different forms of arthritis can occur in people with ulcerative colitis, including peripheral arthritis, axial arthritis, rheumatoid arthritis, and ankylosing spondylitis.
• Skin conditions. Erythema nodosum and pyoderma gangrenosum are uncommon conditions that occur more frequently in people who have IBD. Psoriasis, another immune-mediated condition, is also more common in people who have IBD.
• Mouth ulcers. Also called aphthous stomatitis, these are lesions in the lining of the mouth that may occur along with an ulcerative colitis flare-up.
• Symptoms during menstruation. Some women with IBD find that pre-menstrual syndrome (PMS) occurring in the days leading up to their period brings on more diarrhea and pain.

When to See a Doctor

For people with ulcerative colitis, it can be challenging to know which symptoms are an emergency, which should prompt a call to the gastroenterologist, and which can wait.

After doing well and having few or no symptoms, when symptoms (sleep problems, diarrhea, bloody stools, fevers, weight loss) begin again, it is a reason to call the doctor and get evaluated for a potential flare-up. It may be necessary to change treatments or adjust the current care plan in order to get any inflammation under control quickly.

Ulcerative Colitis Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Download PDF

Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life.

Sign Up

You're in!

Thank you, {{form.email}}, for signing up.

There was an error. Please try again.

In general, symptoms such as severe abdominal pain, excessive bleeding, and signs of dehydration (leg cramps, decreased urine, light-headedness) are a reason to seek medical care right away. When possible, calling the gastroenterologist before going to the hospital might help in deciding what level of care is needed.

However, if treatment is needed right away, going to the emergency department may be the best choice. If a serious condition such as a bowel perforation or toxic megacolon is suspected, it may be necessary to call 911, because these are medical emergencies.