Gas, constipation, bloating — if you have ulcerative colitis (UC), you may not want to share the details of unpleasant digestive symptoms with anyone. However, to start feeling better, you may need to start talking more, specifically with your doctor, who can adjust your treatment as needed and recommend ways to relieve your symptoms.
Even if your UC is well managed, you may still experience certain unpleasant digestive symptoms. “There is often superimposed irritable bowel syndrome” — or IBS for short — “even after treating underlying inflammation” in UC, says Chris Damman, MD, a gastroenterologist and clinical associate professor of medicine at the University of Washington Medical Center in Seattle and editor-in-chief of Gut Bites MD, a blog that provides evidence-based tips for gut health.
For any given symptom, it’s essential to know if it’s related to underlying inflammation or if it’s happening despite having your UC under control, Dr. Damman says. That often means you’ll need to undergo specific tests, including stool tests and potentially a colonoscopy, to look for signs of disease activity if you’re experiencing new or worsening symptoms.
Here, we’ve rounded up some of the most common potentially embarrassing or disruptive symptoms you might be experiencing, along with doctor-recommended tips for finding relief.
1. Abdominal Cramps
Some medications, such as a recent course of antibiotics or nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin) or naproxen (Aleve, Midol), can also trigger abdominal pain, Dr. Vaughn says.
2. Rectal Bleeding
Problem Rectal bleeding may be detected on your toilet paper or as blood in your stool. It can look bright red when it’s fresh or seem dark and tarry if the blood has been inside you for a while. While fresh blood is often indicative of hemorrhoids or an anal fissue, in people with UC, bleeding can come from ulcers that have formed on the lining of your rectum or colon.
Solution Stay calm. While it needs to be looked at ASAP, it probably looks worse than it actually is. If hemorrhoids are the cause, the bleeding will typically be minimal. Vaughan suggests that the following can help treat hemorrhoids:
- Sitz baths
- Soluble fiber supplements
- Medications such as steroid creams or suppositories
If the bleeding occurs due to an uptick in inflammation in your rectum or colon, you and your doctor may need to adjust your treatment plan.
For hemorrhoids, a soluble fiber supplement can help you hit a sweet spot where your stool isn’t too soft or hard, making it easier to pass without much effort, says Damman. “It’s the straining and pressure that causes hemorrhoids,” he says. “It’s almost like a balloon — you’re squeezing it and then an area pops out.”
Until you figure out what’s behind your bleeding, consider wearing a sanitary pad or incontinence underwear if it’s happening outside of bowel movements. But don’t hesitate to have a doctor examine any bleeding, especially since there could be a serious underlying condition like colorectal cancer.
3. Irregular Periods
Problem Several UC-related issues can lead to irregular menstrual periods, including inadequate nutrition, stress, and the inflammation itself, which can lead your body to shut down some of its regular hormone function.
Irregular periods include successive periods fewer than 21 or more than 35 days apart, missing three or more periods in a row, or an unusually heavy or light menstrual flow.
Solution Treating your UC will often help correct an irregular menstrual cycle, Vaughn says. This is especially true if the cause of your irregular periods is active colitis or anemia related to blood loss, or even the stress that active disease often causes.
Before making the assumption that irregular periods are linked to your UC, Vaughn recommends talking with your gynecologist to rule any separate underlying issues.
4. Nausea
Solution If you’re feeling slightly nauseous on occasion, try taking an over-the-counter antacid or consuming foods or drinks with ginger in them. Peppermint and other types of mint may also ease nausea, Vaughn says. If you’re throwing up more than every now and then, ask your doctor if you should start a short-term liquid diet to help prevent dehydration. If your vomiting is severe, ask your doctor about taking prescription medication to help limit your nausea.
5. Sudden Diarrhea
Problem During periods of active disease, people with UC often experience diarrhea that can include blood, cramping, and urgency. But diarrhea can also happen in people with concomitant IBS when UC is well-controlled.
Solution “The name of the game is treating the underlying cause,” whether that’s active inflammation, a food intolerance, or an infection, says Damman. For some people, he says, diarrhea happens when you can’t properly digest or absorb a food component, such as FODMAPs.
In a pinch — and only as a short-term fix — you can use an over-the-counter antidiarrheal medication with loperamide (Imodium). To reduce diarrhea over the long term, Vaughn suggests eating more gut-soothing foods — such as rice, bananas, and toast, and avoiding some fibrous foods like fruit and vegetable skins, which are tougher to digest.
6. Flatulence
Problem Many people with UC experience bloating and gas on a regular basis, even if their disease is under control. Potential causes include difficulty digesting certain foods and changes in your gut bacteria.
Solution Reevaluate what you eat. Although gas is normal, it can also be bothersome and often occurs due to diet, says Vaughn. Try cutting out gas-producing foods such as beans and cruciferous vegetables like broccoli, he says. However, foods that cause flatulence can vary significantly from person to person, so keeping a food diary can be helpful, Damman says.
Another tip: Take an over-the-counter gas-reducing product before or after meals. If you’re worried about the smell associated with flatulence, you can try using underwear or a pad designed to absorb these smells, or odor-absorbing cushions and other products.
7. Constipation
Problem Symptoms of constipation, the slowed movement of stool in your lower gut, occur in about one-third to one-half of all people with UC. Doctors don’t fully understand the causes of this. However, it may be related to the effect of chronic inflammation on your nervous system. Constipation can lead to pain, straining, and scant bowel movements (fewer than three per week).
Solution Ruling out underlying inflammation in your rectum (proctitis) as a cause of your constipation is crucial, Damman says. If this isn’t the culprit, then you can move on to other solutions to keep things moving. Try the following to relieve constipation:
- Drinking more fluids
- Adding dried fruit such as prunes to your diet
- Getting regular physical activity
- Taking a fiber supplement in coordination with your doctor
If you take a fiber supplement — which isn’t an effective solution for everyone — be sure to drink plenty of water. Otherwise, fiber supplements can absorb liquid in your gut and make constipation worse.
If your constipation persists despite taking some of the steps listed above, you may benefit from taking a laxative like polyethylene glycol (MiraLax), says Damman. But, he says, “Talk to your doctor first.”
The Takeaway
- Ulcerative colitis (UC) symptoms can be uncomfortable and may include sudden diarrhea, constipation, bloating, rectal bleeding, irregular periods, nausea, and cramps.
- Over-the-counter medications, diet changes, or other lifestyle adjustments may help relieve some of these symptoms, such as constipation, diarrhea, or bloating.
- Carrying a personal hygiene kit or wearing extra odor-absorbing padding may also help in case of potentially sensitive bathroom incidents.
- Speak to a doctor before taking laxatives. Working with your UC care team to control the underlying condition is the best way to reduce flares and relieve symptoms.
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