Paying close attention to stool patterns – frequency, consistency, the presence of blood, urgency, and nighttime symptoms – is a powerful tool for individuals with ulcerative colitis (UC) to proactively manage their condition, according to Alan Moss, MD, chief scientific officer at the Crohn’s & Colitis Foundation and a professor of gastroenterology at Boston University’s Chobanian & Avedisian School of Medicine.
Dr. Moss emphasizes that sharing these details with a gastroenterology team, even seemingly minor changes, is crucial for staying ahead of potential flares. “No amount of visible blood, persistent diarrhea, or significant change from your ‘usual’ is too minor to mention,” he says.
Changes in stool consistency are often among the first indicators of a UC flare. Instead of formed stools, individuals may experience mushy or completely liquid bowel movements, frequently categorized as Bristol Stool Chart types 5 to 7. These looser stools typically occur with increased urgency and may happen multiple times a day, accompanied by stomach cramping – a “strong signal” to contact a gastroenterologist.
The presence of blood in the stool, known as hematochezia when fresh, is a symptom of active ulcerative colitis that should never be ignored. Supriya Rao, MD, a gastroenterologist and spokesperson for the American Gastroenterological Association, stresses that “There is no amount of blood that is considered normal in UC, even if it’s just on toilet paper.” Bright red blood generally indicates inflammation in the rectum or lower colon, while darker blood may suggest more extensive disease higher in the digestive tract. Blood can appear mixed throughout the stool, coating it, or solely on toilet paper after wiping, and any amount, particularly if persistent or increasing, warrants medical discussion.
Increased mucus production is another sign of inflammation in the colon. While the colon naturally produces mucus to protect its lining, UC can lead to an overproduction, resulting in clear, white, or yellowish jellylike strands appearing in the toilet or on the stool. The presence of yellow or green mucus, or pus, can as well indicate an infection.
Tenesmus – the painful sensation of needing to have a bowel movement even when the bowel is empty or only a small amount is passed – affects as many as 30 percent of people with IBD and signals chronic inflammation in the lower bowel. Dr. Rao notes that tenesmus “usually means the disease is no longer fully controlled.”
Beyond these primary indicators, other warning signs require attention. These include a rising urgency to use the bathroom, nocturnal bowel movements, changes in stool odor (potentially indicating malabsorption or infection, such as Clostridioides difficile), abdominal pain or sudden cramping, rectal pain, fatigue, fever, weight loss, and loss of appetite. Some individuals may also experience symptoms outside of the digestive system, such as joint pain, skin rashes, or eye irritation.
