Early Signs of Ulcerative Colitis: 5 to Know

1. Blood in Your Stool

Blood in the stool is an important early symptom of ulcerative colitis, says Adam Pont, MD, a gastroenterologist in private practice in New York City. According to research, bloody diarrhea is the most common symptom that prompts people with UC to seek medical attention for the condition. In general, blood in the stool is abnormal and needs medical attention to assess the cause.

Along with blood, some people notice mucus in their stool. Passing the mucus that acts as a protective lining in your gastrointestinal tract can be normal if you’re not experiencing inflammation or seeing blood alongside it. But passing blood is typically caused by the effects of inflammation in the colon and rectum. “Ulcerative colitis causes inflammation and swelling of the bowel wall,” says Dr. Fearn.

2. Loose, Watery Stools

Diarrhea with or without visible blood is another common early symptom of ulcerative colitis. “One of the signs we look for is bloody diarrhea — where the blood is mixed in with the unformed stool, indicating a larger section of bowel is significantly inflamed,” says Fearn.

Passing loose, watery stools three or more times per day qualifies as diarrhea, but any loose stools that aren’t usual for you also counts. Diarrhea in UC happens because inflammation affects the colon in ways that prevent fluid absorption while letting extra fluid in, making stools themselves more liquid.

3. Cramping and Abdominal Pain

Cramping and abdominal pain with ulcerative colitis are typically due to irritation of the muscles in your colon wall, says Dr. Alexis, and over 70 percent of people with an IBD report abdominal pain.

This inflammation also triggers the stretch receptors of bowel nerves, which sense the presence of stool in the colon and can cause waves of cramping pain, says Fearn. At first, cramping and tenderness may feel mild and easily be passed off as gas or a pulled muscle. But if it continues, your healthcare provider may want to test for another cause, such as IBD.

4. Bloating

Bloating happens when gas gets trapped in your stomach and intestines, and it’s common in ulcerative colitis. Excess gas can build up because UC-related inflammation makes it difficult for your body to digest certain foods, like sugars and starches.

When these undigested foods get to your large intestine, bacteria break them down and create gas as a by-product. Besides poor digestion, excess gas and bloating in UC can also occur due to constipation, unbalanced gut bacteria (microbiome), heightened intestinal sensitivity, and food intolerances.

5. Bowel Habit Changes

Bowel movements follow a broad schedule that looks different for everyone. Some people poop every day, while others go only three times per week. But when you have ulcerative colitis, bowel movements can feel unpredictable and urgent.

“In healthy adults, the rectum can expand to hold just over 1 cup of stool,” says Alexis. “In ulcerative colitis, inflammation causes the rectum to become stiff and less able to accommodate stool over time, which leads to a more urgent need to pass stools and, in some cases, fecal incontinence.”

According to one research review, international surveys reveal that over 80 percent of people with UC report bowel urgency. Urgency is more common in people with active inflammation, but it can occur even when symptoms such as increased frequency and rectal bleeding have resolved.

Besides a more pressing need to visit the bathroom, UC can cause tenesmus, which describes feeling like you need to poop even when you don’t. This happens in up to 30 percent of people with UC or Crohn’s disease because the swelling in the large intestine irritates nerves that tell the brain you need to have a bowel movement.

“Even though ulcerative colitis is probably not the most common cause of any of these symptoms, you should definitely speak to your doctor should you experience any of them,” says Dr. Pont.

The Takeaway

Early signs of ulcerative colitis can be subtle and easily blamed on other causes, but early detection and treatment can protect against future complications.
The first symptoms of ulcerative colitis can include blood in the stool, diarrhea, abdominal pain or cramping, bloating, and bowel habit changes.
If you experience these symptoms, tell your healthcare provider, who can assess the likely cause and refer you to a gastroenterologist.

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1. Blood in Your Stool

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