Common Changes in Ulcerative Colitis Stool

A recent study suggests that a prebiotic supplement may help reduce bloody stools and other symptoms of UC.

Ulcerative Colitis

Inflammation in ulcerative colitis starts in your rectum and may spread to your colon. Symptoms may be constant or come and go. They include diarrhea, weight loss, abdominal cramping, anemia, and blood or pus in bowel movements. There isn’t a cure for ulcerative colitis, but medications can help calm inflammation. Surgery is an option for more difficult cases.

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Overview

Ulcerative colitis (UC) causes irritation and ulcers (open sores) in your large intestine. It belongs to a group of conditions called inflammatory bowel disease (IBD). It often causes diarrhea with blood, cramping and urgency. Sometimes, these symptoms can wake you up at night to go to the bathroom.

The inflammation in ulcerative colitis usually starts in your rectum, which is close to your anus (where poop leaves your body). The inflammation can spread and affect a portion of your entire colon. When the inflammation occurs in your rectum and lower part of your colon, it’s called ulcerative proctitis. If your entire large intestine is affected, it’s called pancolitis. If only the left side of your colon is affected, it’s called limited or distal colitis.

The severity of UC depends on the amount of inflammation and the location. Everyone is a little different. You could have severe inflammation in your rectum (small area) or very mild inflammation in your entire colon (large area).

If you have ulcerative colitis, you may notice a pattern of flare-ups (active disease), when symptoms are worse. During times of remission, you might have little to no symptoms. The goal of therapy is to remain in remission as long as possible (years).

About half of the people diagnosed with ulcerative colitis have mild symptoms. Others experience frequent fevers, bloody diarrhea, nausea and severe abdominal cramps. Ulcerative colitis may also cause issues such as arthritis, inflammation of the eye, liver disease and osteoporosis. It isn’t known why these problems occur outside of your colon. Scientists think these complications may be the result of inflammation triggered by your immune system. Some of these issues go away when the colitis is treated.

Ulcerative colitis can occur in people of any age, but it usually starts between the ages of 15 and 30, and less frequently between 50 and 70 years of age. It affects all sexes equally and appears to run in families, with reports of up to 20% of people with ulcerative colitis having a family member or relative with ulcerative colitis or Crohn’s disease. In addition, about 20% of people are diagnosed before they’re 20 years old, and it can occur in children as young as 2 years of age.

What’s the difference between colitis and ulcerative colitis?

Colitis means your colon is inflamed, or irritated. This can be a result of many things, such as infections from viruses or bacteria. Ulcerative colitis is more severe because it isn’t caused by an infection and is lifelong.

How common is ulcerative colitis?

Ulcerative colitis isn’t an uncommon condition. Together with Crohn’s disease, another type of inflammatory bowel disease, it affects up to 1 in 250 people in North America and Europe.

Who gets ulcerative colitis?

Anyone at any age, including young children, can get ulcerative colitis. Your chance of getting it is slightly higher if you:

• Have a close relative with inflammatory bowel disease (IBD).
• Are between 15 and 30 years old, or older than 60.
• Are Jewish.
• Eat a high-fat diet.
• Use frequent nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil® or Motrin®).

Symptoms and Causes

What causes ulcerative colitis?

Researchers think the cause of ulcerative colitis is complex and involves many factors. They also think it’s probably the result of an overactive immune response. Your immune system’s job is to protect your body from germs and other dangerous substances. But sometimes, your immune system mistakenly attacks your body, which causes inflammation and tissue damage.

What are the symptoms of ulcerative colitis?

Ulcerative colitis symptoms often get worse over time. In the beginning, you may notice:

• Diarrhea or urgent bowel movements.
• Abdominal (belly) cramping.
• Tiredness.
• Nausea.
• Weight loss.
• Anemia (reduced number of red blood cells).

Later you may also have:

• Blood, mucus or pus in bowel movements.
• Severe cramping.
• Fever.
• Skin rashes.
• Mouth sores.
• Joint pain.
• Red, painful eyes.
• Liver disease.
• Loss of fluids and nutrients.

Symptoms are similar in pediatric ulcerative colitis and may also include delayed or poor growth. Some ulcerative colitis symptoms in children can mimic other conditions, so it’s important to report all symptoms to your pediatrician.

Diagnosis and Tests

How is ulcerative colitis diagnosed?

To diagnose ulcerative colitis in children, teenagers and adults, your healthcare provider has to rule out other illnesses. After a physical exam, they may order:

• Blood tests: Your blood can show signs of infection or anemia. Anemia is a low level of iron in your blood. It can mean you have bleeding in your colon or rectum.
• Stool samples: Signs of infection, parasites (tiny organisms that can live in a person’s body) and inflammation can show up in your poop (feces).
• Imaging tests: Your healthcare provider may need a picture of your colon and rectum. You may have tests including a magnetic resonance imaging (MRI) scan or computed tomography (CT) scan.
• Endoscopic tests: An endoscope is a thin, flexible tube with a tiny camera. Specialized doctors can insert the endoscope through your anus to check the health of your rectum and colon. Common endoscopic tests include colonoscopy and sigmoidoscopy.

Who diagnoses ulcerative colitis?

If you have symptoms of ulcerative colitis, your regular healthcare provider will probably refer you to a specialist. A gastroenterologist — a doctor who specializes in the digestive system — should oversee the care of adults. For younger people, a pediatric gastroenterologist who specializes in children should manage the care.

Management and Treatment

How is ulcerative colitis treated?

There’s no cure for ulcerative colitis, but treatments can calm the inflammation, help you feel better and get you back to your daily activities. Treatment also depends on the severity and the individual, so treatment is crafted for each person’s needs. Usually, healthcare providers manage the disease with medications. If your tests reveal infections are causing problems, your healthcare provider will treat those underlying conditions and see if that helps.

The goal of medication is to induce and maintain remission, as well as to improve the quality of life for people with ulcerative colitis. Healthcare providers use several types of medications to calm inflammation in your large intestine. Reducing the swelling and irritation lets the tissue heal. It can also relieve your symptoms so you have less pain and less diarrhea. For children, teenagers and adults, your provider may recommend:

• Aminosalicylates: For mild to moderate ulcerative colitis, your healthcare provider may prescribe sulfasalazine (Azulfidine®). Let your provider know if you’re allergic to sulfa. They can prescribe a sulfa-free aminosalicylate instead, such as mesalamine (Canasa®, Delzicol®, Asacol® HD, Pentasa®, Lialda®, Apriso®). The medications come in both pill form and enema or suppository form, which can better reach the inflammation low down in your colon or rectum.
• Corticosteroids: If you have a severe form of ulcerative colitis, you may need a corticosteroid such as prednisone (Deltasone®) or budesonide (Entocort® EC, Uceris®). Because corticosteroids have serious side effects, healthcare providers only recommend them for short-term use. Other medications are used to help maintain remission.
• Immunomodulators: Your healthcare provider may recommend an immunomodulator. These medicines include 6-mercaptopurine (Purixan®, Purinethol®), azathioprine (Azasan® and Imuran®) or methotrexate (Trexall®). These medications help calm an overactive immune system.
• Biologics: Biologics treat moderate to severe ulcerative colitis by targeting parts of your immune system to quiet it down. Medications like infliximab (Remicade®), adalimumab (Humira®), golimumab (Simponi®), certolizumab pegol (Cimzia ®), vedolizumab (Entyvio®) and ustekinumab (Stelara®) are biologics.
• Janus kinase (JAK) inhibitors: Drugs like tofacitinib (Xeljanz®) stop one of your body’s enzymes (chemicals) from triggering inflammation.

Children and young teenagers are prescribed the same medications. In addition to medications, some providers recommend that children take vitamins to get the nutrients they need for health and growth that they may not have gotten through food due to the effects of the disease on their bowels. Ask your healthcare provider for specific advice about the need for vitamin supplementation for your child.

You might need surgery that removes your colon and rectum to:

• Avoid medication side effects.
• Prevent or treat colon cancer (people with ulcerative colitis are at greater risk).
• Eliminate life-threatening complications such as bleeding.

Can I get surgery for my ulcerative colitis?

Surgery is an option if medications aren’t working or you have complications, such as bleeding or abnormal growths. You might develop precancerous lesions, or growths that can turn into colorectal cancer. A healthcare provider can remove these lesions with surgery (a colectomy) or during a colonoscopy.

Research shows that about 30% of people with ulcerative colitis need surgery sometime during their life. About 20% of children with ulcerative colitis will need surgery during their childhood years.

There are two kinds of surgery for ulcerative colitis:

Proctocolectomy and ileoanal pouch

The proctocolectomy and ileoanal pouch (also called J-pouch surgery) is the most common procedure for ulcerative colitis. This procedure typically requires more than one surgery, and there are several ways to do it. First, your surgeon does a proctocolectomy — a procedure that removes your colon and rectum. Then, the surgeon forms an ileoanal pouch (a bag made from a part of your small intestine) to create a new rectum. While your body and newly made pouch are healing, your surgeon may perform a temporary ileostomy at the same time. This creates an opening (stoma) in your lower belly. Your small intestines attach to the stoma, which looks like a small piece of pink skin on your belly.

After you heal, waste from your small intestines comes out through the stoma and into an attached bag called an ostomy bag. The small bag lies flat on the outside of your body, below your beltline. You’ll need to wear the bag at all times to collect waste. You’ll have to change the bag frequently throughout the day.

Your medical team will teach you how to care for the stoma and empty the attached bag. You can also use a fabric cover for the pouch so even when you’re undressed, the waste isn’t visible. With proper care, the pouch doesn’t smell and isn’t noticeable under clothes.

Once you and the ileoanal pouch have healed, your surgeon will discuss taking down the ileostomy.

Your new ileoanal pouch still collects stool. That allows waste to exit your body through your anus as it would normally. Afterward, because you have less space in your large intestine to store poop, you’ll have frequent bowel movements (on average four to eight times a day once your body has adjusted). But you should feel a lot better when you recover from the surgery. The pain and cramping from ulcerative colitis should be gone.

Proctocolectomy and ileostomy

If an ileoanal pouch won’t work for you, your healthcare team might recommend a permanent ileostomy (without an ileoanal pouch). Your surgeon does a proctocolectomy to remove your colon and rectum. The second part of this surgery, done at the same time, is to perform a permanent ileostomy (as described above).

Prevention

What causes ulcerative colitis flare-ups?

When you’re in remission from ulcerative colitis, you’ll want to do everything you can to prevent a flare-up. Things that may cause a flare-up include:

• Emotional stress: Get at least seven hours of sleep a night, exercise regularly and find healthy ways to relieve stress, such as meditation.
• NSAID use: For pain relief or a fever, use acetaminophen (Tylenol®) instead of NSAIDs like Motrin® and Advil®.
• Antibiotics: Let your healthcare provider know if antibiotics trigger your symptoms.

What role do diet and nutrition play in ulcerative colitis?

Diet doesn’t cause the development of ulcerative colitis, nor can any special diet cure the disease. However, the foods you or your child eat may play a role in managing symptoms and lengthening the time between flare-ups.

Some foods may make symptoms worse and should be avoided, especially during flare-ups. Foods that trigger symptoms are different from person to person. To narrow down what foods affect you, keep track of what you eat each day and how you feel afterward (a food journal).

Problem foods often include:

• Greasy foods.
• High-sugar foods and drinks.
• Carbonated beverages.
• High-fiber foods.
• Alcohol.

In addition to the problem foods listed above, infants, children and teenagers can also experience issues with:

Keep a careful eye on your child’s diet and nutrition. Their appetite may decrease during a flare-up and they might not eat enough to stay healthy and grow. The inflammation caused by ulcerative colitis may keep their digestive tract from absorbing enough nutrients. This can also affect your child’s health. For these reasons, you may have to increase the number of calories your child consumes.

It’s best to work with your provider and nutritionist to come up with a personalized diet plan if you or your child has ulcerative colitis.

Outlook / Prognosis

What can I expect if I have a diagnosis of ulcerative colitis?

Ulcerative colitis is a lifelong condition that can have mild to severe symptoms. For most people, the symptoms come and go. Some people have just one episode and recover. A few others develop a nonstop form that rapidly advances. In up to 30% of people, the disease spreads from their rectum to their colon. When both your rectum and colon are affected, ulcerative symptoms can be worse and happen more often.

You may be able to manage the disease with medications. But surgery to remove your colon and rectum is the only “cure.” About 30% of people with ulcerative colitis need surgery.

Living With

When should I call my doctor about my ulcerative colitis?

Call your healthcare provider immediately if you have:

• Heavy, persistent diarrhea.
• Blood leaking from your anus with clots of blood in your stool.
• Constant pain and a high fever.

What is the best diet for ulcerative colitis?

There’s no single diet that works best for ulcerative colitis. If the disease damages the lining of your colon, your body might not absorb enough nutrients from food. Your healthcare provider may recommend supplemental nutrition or vitamins. It’s best to work with your provider and nutritionist to come up with a personalized diet plan.

How often do I need a colonoscopy?

Especially when you have symptoms or are just starting or changing medications, your doctor may want to periodically look at the inside of your rectum and colon to make sure the treatments are working and your lining is healing. How often this is needed is different for each person.

Ulcerative colitis also increases your chance of developing colon cancer. To look for early cancer signs, your healthcare provider may have you come in for a colonoscopy (a procedure to check the health of the colon) every one to three years.

How does pediatric ulcerative colitis affect my child’s mental/emotional health?

Like many conditions, ulcerative colitis can have a negative psychological effect, especially on children. They can experience physical, emotional, social and family problems. Because of the medications and/or general stress from the situation, your child may experience:

• Mood swings.
• Teasing from classmates.
• Anger, embarrassment and frustration.
• Worry about appearance and physical stamina.
• Vulnerability because their body doesn’t function normally.
• Poor concentration.
• Misunderstandings with friends and family.

Children need mutual support from all family members. It’s helpful for the entire family to learn about the disease and try to be empathetic. Seek out a psychiatrist and therapist to help your child manage such challenges of ulcerative colitis.

Does ulcerative colitis make you immunocompromised?

Ulcerative colitis doesn’t make you immunocompromised. Some of the medicines that treat it may change the way your immune system responds. This change is different for each medication. Some of these changes may increase the risk of certain infections or other issues. A discussion with your healthcare team before starting a medication is the best way to understand these risks and ways to prevent them.

What should I ask my doctor?

If you have ulcerative colitis, you may want to ask your healthcare provider:

• How much of my large intestine is affected?
• What risks or side effects can I expect from the medication?
• Should I change my diet?
• Will ulcerative colitis affect my ability to get pregnant?
• What can I do at home to manage my symptoms?
• What are my surgical options?

What should I ask my doctor on behalf of my child or teenager?

Ask your healthcare provider the following questions in addition to the ones listed above:

• What vitamins should my child take?
• Will my other children have pediatric ulcerative colitis?
• Is my child at risk for other conditions?
• Can you recommend a psychiatrist or therapist to help my child with emotional issues related to pediatric ulcerative colitis?
• Is my child growing at a normal rate?
• What can I do to help my child cope at school?

A note from Cleveland Clinic

When you have ulcerative colitis, it’s essential to work closely with your healthcare team. Take your medications as prescribed, even when you don’t have symptoms. Skipping medications you’re supposed to take can lead to flare-ups and make the disease harder to manage. Your best shot at managing ulcerative colitis is to follow your treatment plan and talk to your healthcare provider regularly.

Resources

Cleveland Clinic Podcasts

Visit our Butts & Guts Podcasts page to learn more about digestive conditions and treatment options from Cleveland Clinic experts.

Common Changes in Ulcerative Colitis Stool

Brittany Poulson, MDA, RDN, CDCES, is a registered dietitian and certified diabetes care and education specialist.

Published on October 27, 2021

Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York.

Table of Contents
Table of Contents

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.

A Word From Verywell

Managing UC flare-ups and the stool changes that go along with them can be challenging and frustrating. The hardships that come with planning your life around UC are not always easy.

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.

Frequently Asked Questions

How often do you have diarrhea with ulcerative colitis?

• Remission: Normal bowel function with no blood or urgency
• Mild UC: Four or fewer loose bowel movements per day
• Moderate UC: Four or more bowel movements daily with urgency
• Severe UC: Six or more bloody stools daily
• Fulminant UC: More than 10 bloody bowel movements per day

What causes mucus in UC bowel movements?

In UC, the lining of the large intestine (colon) becomes inflamed and develops ulcers, or sores. These ulcers can bleed and may also produce pus and mucus. When there is a large volume of mucus, it can be passed along with the stool.

Do certain foods trigger ulcerative colitis symptoms?

• 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.

Is it normal to have blood in colitis stool?

It is common to have bloody stool with ulcerative colitis. When chronic inflammation damages the lining of your colon, ulcers can develop. The ulcers may bleed, leading to blood being passed in your stool. This might show up as bright red, pink, maroon, or sometimes even black stools.

11 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Eligibility.com. The most googled medical symptoms by state.
2. Lichtenstein GR, Hanauer SB, Sandborn WJ. Emerging treatment options in mild to moderate ulcerative colitis. Gastroenterol Hepatol (N Y). 2015;11(3 Suppl 1):1-16.
3. Cleveland Clinic. Ulcerative colitis.
4. Crohn’s & Colitis Foundation. Causes of flares.
5. Liverani E, Scaioli E, Digby RJ, Bellanova M, Belluzzi A. How to predict clinical relapse in inflammatory bowel disease patients. World J Gastroenterol. 2016;22(3):1017–1033. doi:10.3748/wjg.v22.i3.1017
6. Crohn’s and Colitis Canada. Bleeding and blood in the stool.
7. Johns Hopkins Medicine. Ulcerative colitis: introduction.
8. American Gastroenterological Association. Overview of ulcerative colitis.
9. Feuerstein JD, Isaacs KL, Schneider Y, et al. AGA clinical practice guidelines on the management of moderate to severe ulcerative colitis. Gastroenterol. 2020;158(5):1450-1461. doi:10.1053/j.gastro.2020.01.006
10. National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for ulcerative colitis.
11. Keshteli AH, Madsen KL, Dieleman LA. Diet in the pathogenesis and management of ulcerative colitis; a review of randomized controlled dietary interventions. Nutrients. 2019;11(7):1498. doi:10.3390/nu11071498

By Brittany Poulson, MDA, RDN, CD, CDCES
Brittany Poulson, MDA, RDN, CDCES, is a registered dietitian and certified diabetes care and education specialist.

Ulcerative colitis stool: A visual guide

Ulcerative colitis is a long-term inflammatory bowel disease that can affect the texture, composition, and frequency of stools.

In people with ulcerative colitis (UC), the large intestine, or colon, becomes inflamed and develops small, pus-producing ulcers. These ulcers can also develop in the rectum.

The type of stool symptoms people experience will depend on the location of inflammation and ulceration within the colon.

This article outlines the various stool symptoms of UC, along with the possible treatment options

Doctors may use a Bristol Stool Chart to help a person recognize healthy bowel movements or identify possible problems.

The stool changes that occur in UC are due to inflammation. Over time, inflammation can damage the lining of the large intestine.

People with UC may experience painful abdominal cramps and a frequent need to empty the bowels.

According to the Crohn’s and Colitis Foundation (CFF), a person with UC may also experience the following symptoms:

• diarrhea
• stools containing mucus or blood
• pain in the abdomen

According to another organization, 75 percent of people with an inflammatory bowel disease (IBD) have also experienced bowel incontinence — the unintended passing of stools, or “having an accident.”

Also, some people with IBD experience constipation instead of diarrhea.

Learn more about the common stool changes below:

Diarrhea

Diarrhea occurs when intestinal damage becomes so extensive that the colon loses its ability to absorb water from waste.

When waste retains too much water, it results in loose stools.

Blood in stools

Often, the ulcers that form within the lining of the colon can bleed, resulting in bloody stools.

A person who regularly loses a lot of blood in their stools may develop anemia.

Constipation

Share on Pinterest Ulcerative colitis may cause severe stomach cramps.

Although the majority of people with UC will have loose stools, some may also experience constipation.

However, constipation is more common among people with proctitis, in which inflammation and ulceration affect only the rectum.

Symptoms of constipation include:

• reduced frequency of bowel movements
• harder stools
• difficulty passing stools
• bloating
• cramping
• feeling that the bowels are not empty even after a bowel movement

Bowel incontinence

Most people with UC tend to experience bowel incontinence during a flare-up of the disease.

However, around 1 in 10 people with IBD who experience bowel incontinence will do so during a period of disease remission.

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 have surgery to remove all or part of the large intestine.

In “pouch surgery,” the surgeon replaces the colon with an internal pouch. Some people who undergo this procedure may develop bowel incontinence.

Severe constipation

A buildup of stools can irritate the lining of the rectum, causing an overproduction of mucus.

If the rectum constantly contains stools, the muscles of the anus relax, allowing the mucus to leak out.

The following treatments for UC reduce inflammation that leads to stool symptoms:

• Aminosalicylates, which are drugs that target inflammation in the lining of the colon.
• Corticosteroids, which are powerful, fast-acting anti-inflammatories used to treat UC flare-ups.
• Immunomodulators, which are drugs that regulate the immune system.
• Biologics, which target inflammation in the gut.

Treating diarrhea

Antidiarrheal drugs can increase the risk of a complication called megacolon, in which digestive gases become trapped in the colon, causing it to swell. In some cases, this can be fatal.

The safest way to treat diarrhea is to make dietary changes. Many people with UC experience diarrhea after eating specific foods.

Keeping a food diary along with a daily record of stool symptoms can help people identify and eliminate these trigger foods.

Reducing blood in stools

A recent study suggests that a prebiotic supplement may help reduce bloody stools and other symptoms of UC.

Participants taking the prebiotics supplement experienced significantly decreased abdominal pain and cramping. They also reported reduced nausea, vomiting, diarrhea, and blood in stools, although these effects were not statistically significant.

The study was small, so more research is needed to determine the best way to reduce blood in stools.

If a person frequently has bloody stools, a doctor may prescribe iron supplements to help prevent anemia.

Treating constipation

Share on Pinterest Keeping a food diary can help identify the cause of the symptoms.

The International Foundation for Gastrointestinal Disorders (IFFGG) recommend the following treatments for mild constipation:

• drinking plenty of fluids
• eating fibrous foods, such as uncooked fruits and vegetables
• eating whole-grain bread and cereals

However, many people with UC find that fibrous foods and whole grains trigger other symptoms, so keeping a food diary can help people identify which foods cause which symptoms.

Other methods for relieving constipation include:

• Squatting while having a bowel movement: Sitting with the knees higher than the hips when using the toilet can help align the rectum, making stools easier to pass.
• Exercising: Exercise helps speed up the movement of stools through the colon.
• Taking laxatives: Doctors may recommend osmotic laxatives for people with IBD. These increase water availability in the colon, which helps to soften stools.

However, people with UC should talk to a doctor before taking laxatives, as these medications can increase wind and stomach cramps.

Managing bowel incontinence

Many people who experience bowel incontinence find it difficult to discuss the issue with a doctor.

However, a doctor may be able to identify the underlying cause of a leaky bowel and can offer advice on how to control and manage this symptom.

Some suggestions for managing bowel incontinence include:

Bowel retraining

People who experience a sense of urgency may benefit from delaying bowel movements. This technique is called bowel retraining.

Although bowel retraining may be difficult at first. Over time, however, it will help build up strength and control over the rectum and sphincter muscles.

Pelvic floor exercises

The pelvic floor muscles support the pelvic organs, which include the bladder and bowel, as well as the uterus in women.

Pelvic floor exercises can help strengthen the muscles around the anus, reducing incontinence. To find the pelvic floor muscles, imagine stopping a urine stream or practice while urinating.

To perform pelvic floor exercises, contract and hold the pelvic floor muscles for a count of 3, and then relax the muscles, while slowly counting to 3. Avoid pushing out the muscle during the relaxation stage.

Repeat this 15 times to complete one set of exercises. Aim to complete three sets each day.

People with UC may experience uncomfortable, inconvenient, and sometimes distressing stool symptoms. These can greatly affect a person’s quality of life.

However, there is a range of treatments that can help those with UC to experience fewer and less severe symptoms.

A person should discuss the options with their doctor to establish the most effective treatment plan.

Last medically reviewed on October 24, 2018

• Ulcerative Colitis
• Crohn’s / IBD
• GastroIntestinal / Gastroenterology