Ulcerative Colitis Symptoms

Reviewed by: HU Medical Review Board | Last Reviewed: January 2016.

The hallmark symptom of ulcerative colitis is bloody diarrhea.1 Other common symptoms include abdominal pain, urgency, and the feeling of an incomplete bowel movement.1,2 Ulcerative colitis may also cause symptoms outside the intestinal tract. For example, the skin, eyes, joints, and liver can be affected.3

The majority of people with ulcerative colitis say that symptoms affect their ability to enjoy leisure activity (72.6%) and do their job (65.6%).4 In most cases, symptoms start gradually and get progressively worse over several weeks.3 Results of one survey showed that two-thirds of patients experience a flare every few months.4

In some cases, symptoms come on suddenly and severely. Signs that you should get immediate medical care are:2,5

  • Severe pain
  • Frequent bloody diarrhea
  • Abdominal swelling or stretching
  • Fever
  • Rapid heart beat
  • Low blood pressure
  • Decreased urine output

Diarrhea and rectal bleeding

In a postal survey, more than 5,600 people with inflammatory bowel disease answered questions about their symptoms. Nearly 85% of people with ulcerative colitis said they had experienced persistent or recurrent diarrhea, and 87% had had rectal bleeding.4

Ulcerative colitis is a condition of inflammation of the large intestine (colon). This part of the digestive tract normally absorbs water. When inflammation flares up, the colon cannot do its job absorbing water, which leads to diarrhea.6 Blood and mucus are often mixed with diarrhea.7 This is because the small sores (ulcers) that form in the lining of the intestine may bleed. These ulcers are are filled with pus or mucus, which can pass into stool.

Diarrhea is one of the criteria for classifying the severity of ulcerative colitis (Table).1

Table. Severity of ulcerative colitis

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Stools per day

Blood in stools

Yes or No
4 to 6
Yes or No
7 to 10
(severe and sudden)
Two other criteria are part of the classification of ulcerative colitis:
  • Laboratory test for inflammation (erythrocyte sedimentation rate)
  • Signs of toxicity (fever, fast heart beat, blood tests showing increased white blood cells or decreased red blood cells.)

Source: Kornbluth A, et al. Am J Gastroenterol. 2010;105:501-523.

Pain caused by ulcerative colitis

About half of patients with ulcerative colitis report having painful abdominal cramps.4,8 Inflammation has a role in abdominal (belly) pain. Inflammatory signaling chemicals seem to make the nerves in the gut more excitable.8 This means the nerves send more signals to the brain, which may explain some of the pain.

However, between 10% and 33% of people with ulcerative colitis have pain during remission.8 Researchers are trying to understand what causes pain when the inflammation is under control.

Urgency, incontinence, and feeling of incomplete bowel movement

Urgency is a common symptom of ulcerative colitis. Related to that is the feeling of needing to pass stool, even though your bowels are empty.1 The medical term for this condition is tenesmus. This feeling is sometimes described as “incomplete evacuation” or “incomplete bowel emptying.”

Your rectum is the lower part of your large intestine. If everything is working normally, your rectum holds stool. As the rectums stretches, it causes a contraction and the feeling of urgency.9 If the bathroom is not close by, the urgent feeling goes away and the rectum holds stool until you get to the bathroom.

Inflammation in the rectum can cause urgency and tenesmus.10 The rectum loses its ability to stretch and hold stool.11,12 It spasms frequently, which creates a feeling of urgency and can lead to incontinence.11,12

Weight loss and loss of appetite

About half of individuals with ulcerative colitis experience weight loss.4 Loss of appetite is common, due to fear of eating and the symptoms that follow.4,13 Some people have very limited diets in order to manage their symptoms. Healing from inflammation or surgery can increase nutrient needs at a time when it is difficult to eat. Diarrhea can cause significant loss of fluid and blood.

One weight measurement is not enough for evaluating a person’s nutritional status.13 It is important that your health care provider or dietitian tracks changes in your weight over time.

Fatigue and UC

Fatigue is an ongoing and overwhelming sense of tiredness, weakness, or exhaustion.14 Fatigue limits your ability to do physical or mental work. Getting enough sleep and rest do not cure fatigue related to chronic disease.

Seventy percent of patients with ulcerative colitis report feeling fatigued.4 Even during remission, fatigue affects 40% of patients with inflammatory bowel disease.14 Reasons for fatigue include difficulty sleeping, anemia, medications, depression, and the inflammatory process itself.

Inflammation of the joints, skin, eyes, and liver

Between 10% and 30% of people with ulcerative colitis have symptoms outside the intestine.7 The joints, skin, eyes, and liver are commonly affected.

Inflammation can affect joints in the arms and legs (peripheral arthritis) and the spine (axial arthritis). People with inflammatory bowel disease often find that their arthritis is worse in morning and improves through the day.3 Some—but not all—types of colitis-related arthritis get worse during flares. In other cases, the joint pain does not happen at the same time as intestinal inflammation.15

Skin symptoms affect roughly 10% to 20% of people with ulcerative colitis.15 The most common skin symptom is painful red growths under the skin. This condition is called erythema nodosum. The lower legs are most likely to be affected. These growths appear during flares.  Treating the flare improves the growths.

Inflammation can affect the eyes, too. The symptoms depend on the part of the eye that is affected. Symptoms may include pain, redness/pinkness, blurry vision, sensitivity to light, and headaches.15

Up to 50% of people with inflammatory bowel disease are affected in the liver and gallbladder.15 Primary sclerosing cholangitis is a liver disease that often overlaps with inflammatory bowel disease, especially ulcerative colitis.16 This condition causes scarring in the bile ducts. There is no cure for primary sclerosing cholangitis. Other liver conditions related to inflammatory bowel disease are fatty liver disease and autoimmune hepatitis.16