Common Changes in Ulcerative Colitis Stool

Ulcerative colitis (UC) is a chronic inflammatory condition in which the large intestine and rectum can develop ulcers. This inflammation can also cause changes in stool, such as color and consistency.

For some people it can be awkward to talk about changes in their stool and to find out if it is normal or not. However, there is no need to feel embarrassed about looking up poop and wanting to know if yours is normal.

A survey conducted by Eligibility.com found that 89% of people do an internet search for their health symptoms before going to a doctor, with South Carolina’s and Wisconsin’s top-searched medical symptoms being related to the color of their stool.

People with UC need to be poop savvy when it comes to recognizing any changes so they can differentiate between flares and periods of remission, especially since UC is a lifelong condition.

This article will discuss digestive changes in ulcerative colitis, including those in stool. It will also offer guidance on how to talk about them with your doctor, as well as tips for living with UC.

Digestive Changes in Ulcerative Colitis 

Ulcerative colitis is a chronic condition, meaning it comes on slowly over a long period of time. Currently, there is no known cure for UC.

With UC, inflammation and ulcers (sores) develop on the lining of the large intestine (colon). Sometimes the rectum is affected, as well. 

This inflammation can cause changes in bowel habits, including urgency, diarrhea, blood or mucus in the stool, and abdominal pain. When your large intestine is inflamed, it contracts and empties often, which is why you may have urgent bowel movements and diarrhea.

When chronic inflammation damages the lining of your colon, ulcers can develop. The ulcers can bleed, leading to blood in your stool. If you regularly lose a lot of blood in your stool, you might develop anemia (having too few red blood cells).

Though diarrhea is more common, some people with UC experience constipation. Inflammation limited to the rectum, known as ulcerative proctitis, may result in constipation.

Other symptoms of UC include painful bowel movements, nausea, vomiting, fatigue, unintentional weight loss, and fever.

Flare-Ups

Times when you are experiencing moderate to severe symptoms are known as flare-ups. This is when the disease is active.

Flares can be triggered or symptoms made worse by a variety of factors, including medication changes, certain foods or beverages, stress, antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and smoking.

Symptoms can vary from person to person. However, flare-up symptoms typically include stomach pain and cramps, urgent bowel movements, diarrhea, and bloody stool.

Pain can range from mild to severe and can be felt in the rectum or on the left side of the abdomen, or you may experience severe all-over abdominal pain.

Remission 

When you have little to no symptoms, you are in remission. There is no official definition of UC remission, and being in remission doesn’t mean your UC has been cured. However, during times of remission you should be able to enjoy your normal everyday activities. 

Remission can last anywhere from months to years. Even in remission, mild bowel symptoms may still linger. It is common to have occasional diarrhea or abdominal pain during periods of remission. 

Facts About Ulcerative Colitis Poop

Ulcerative colitis stool changes are due to inflammation damaging the lining of the large intestine. Stool changes may include the color, appearance, texture, smell, and frequency of your bowel movements.

Color/Appearance 

A Bristol Stool Chart is helpful in learning to recognize healthy bowel movements or to help your healthcare professional identify possible problems. It is a scale that classifies stools into seven groups:

• Types 1-2: Suggest constipation
• Types 3-4: Ideal stools, as they are easier to pass
• Types 5-7: Suggest diarrhea and urgency

In addition to the texture and appearance of your stool, the color may be different with UC:

• Red, pink or maroon-colored stool: Any variation of red stool in UC is typically due to intestinal bleeding from ulcers in the colon or rectum.
• Black stool: Black, tarry stool may be due to blood that has been in the intestinal tract for a longer time.

Smell 

Foul-smelling stool may be experienced with UC. Malabsorption and decreased healthy gut bacteria may be to blame for foul-smelling stool.

Frequency 

You may have changes in how often your have bowel movements:

• Frequent bowel movements: Mild UC is usually described as having four or fewer loose bowel movements per day. Moderate UC is identified as having four to eight bowel movements daily with urgency. Severe UC is described as having six or more bloody stools daily.
  
• Reduced frequency of bowel movements: Constipation may be seen with ulcerative proctitis.

Other Bowel Symptoms

Diarrhea 

In UC, diarrhea occurs when the large intestine has become so inflamed and damaged that its ability to absorb water from stool passing through is severely decreased. This causes the stools to retain too much water, resulting in liquid bowel movements, or diarrhea.

Constipation 

Diarrhea is one of the main symptoms of UC. However, some people also experience reduced bowel movements, or constipation. This is more common in people with ulcerative proctitis, in which only the rectum is inflamed and ulcerated.

Symptoms of constipation include:

• Reduced frequency of bowel movements
• Firm stools
• Difficulty passing stools
• Painful bowel movements
• Bloating
• Abdominal cramping
• Feeling of having incomplete bowel movements

Incontinence 

Bowel incontinence is characterized by the inability to control bowel movements, resulting in the involuntary passing of stool.

The following factors may cause bowel incontinence:

• Increased sensitivity of the rectum: As the rectum becomes inflamed, it will also become more sensitive. Heightened sensitivity in the rectum can cause it to become more active, pushing out stools as soon as they arrive.
• IBD surgery: People with severe UC may need to have all or a portion of their large intestine surgically removed. A “pouch surgery” is when the colon is replaced with an internal pouch. Between 24% and 30% of people experience frequent incontinence within two to five years of surgery.
• Severe constipation: Reduced bowel movements cause a buildup of stools in the large intestine. This buildup can aggravate the lining of the rectum, causing an overproduction of mucus. If the rectum continuously contains a large volume of stool, the anus muscles become relaxed, causing fecal waste to leak out.

Feeling Comfortable With Your Doctor 

It’s not always easy to talk about your bowel habits. Talking about poop can be embarrassing, and many people may not be ready to open up to their doctor about it.

Others may ignore the changes to their stool or think that nothing is wrong. However, ignoring symptoms will only make things worse. 

Your doctor has studied the gastrointestinal (GI) tract along with all that it does and produces. They have seen and heard it all. Nothing you say about your bowel symptoms is going to offend or shock them. 

It’s part of their job to know about any changes in your symptoms. Your doctor is there to help you, not to judge you.

You don’t have to know any fancy medical terms when talking with your doctor about your symptoms. Share your concerns and any changes in your bowel habits you have noticed. Talking with them about changes in your stool can only help get you closer to resolving the problem.

Tips for Healthy Ulcerative Colitis Poop 

There are several different approaches to UC treatment. Medications, diet, and other lifestyle changes can all help improve bowel symptoms in UC.

The foremost treatment for ulcerative colitis inflammation and related stool changes is medication. These include:

• Aminosalicylates such as Asacol (mesalamine) or Azulfidine (sulfasalazine), to reduce inflammation
• Corticosteroids such as prednisone and Entocort EC (budesonide), to reduce inflammation
• Immunomodulators such as Imuran (azathioprine) or cyclosporine, to reduce your immune system response
• Biologic therapies such as Remicade (infliximab) or Simponi (golimumab), to neutralize proteins made by the immune system and reduce inflammation
• Janus kinase (JAK) inhibitors such as Xeljanz (tofacitinib) or Zeposia (ozanimod), to suppress specific parts of your immune system to help reduce inflammation

Your diet also plays a role in your bowel habits. After all, what goes in, must go through and come out. The following diet modifications may help reduce bowel symptoms:

• Avoid your individual trigger foods.
• Limit dairy products.
• Avoid carbonated beverages.
• Avoid caffeinated beverages, like coffee.
• Avoid alcohol.
• Reduce high-fiber foods, like raw fruits and vegetables, nuts, and seeds.
• Avoid spicy foods.
• Drink plenty of water throughout the day.
• Eat small meals.

Stress is another factor that can contribute to changes in the stool. The brain-gut connection may play a role in inflammation of the GI tract. Managing your stress levels might be able to decrease diarrhea and other changes in your stool.

In addition, participating in regular physical activity is healthy for the GI tract. Exercise helps with the movement of stools, which can be especially helpful for constipation.

Summary

Ulcerative colitis can produce changes in your stool and bowel habits. These changes often include urgency, diarrhea, blood or mucus in the stool, and abdominal pain. However, people with inflammation of the rectum (ulcerative proctitis) may have constipation.

UC can be unpredictable—at least until you know how to identify your individual triggers. Take note of any changes in your stool, and try to recognize the impact your diet makes on your symptoms.

Be sure to inform your healthcare professional whenever you notice a change in your stool or other GI symptoms. This way, you can get the care you need and make a plan to manage your bowel symptoms and live a better quality of life.