Symptoms of ulcerative colitis


The symptoms of ulcerative colitis initially appear unspecific.
The main symptom is bloody, slimy diarrhea (Diarrhea), which torments patients even at night. The diarrhea can be very severe, up to 30 times a day, or hardly at all if, for example, only the anus is affected (proctitis). It is not uncommon for symptoms of fecal incontinence to occur in the episode.

Overview of the other symptoms

In addition, there may be colicky (cramp-like) abdominal pain, which depending on the infestation of the intestine in the various quadrants of the abdomen (abdomen) may occur. General symptoms such as weight loss, loss of appetite and nausea often accompany the event.
In rare cases, vomiting of blood occurs. In the acute episode, it is not uncommon for a general inflammatory reaction to appear, which is associated with fever, an increase in the inflammation values ​​and the inflammatory cells (leukocytes) in the blood. Some patients complain of pain during and after a bowel movement (tenesmen). Flatulence (meteorism), which can develop particularly as a result of a temporary sugar intolerance, is a symptom of ulcerative colitis that accompanies relapses. The loss of blood and proteins (proteins) can lead to anemia or protein deficiency (hypoproteinemia).

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Due to the inflammation of the intestinal mucosa of the large intestine, ulcerative colitis often injures the mucous membrane and leads to the formation of ulcers.
As a result, affected patients suffer from bloody diarrhea, which occurs several times a day and which can also be slimy or purulent, in the acute episode. Diarrhea is technically known as diarrhea. In addition to the constant feeling of having to defecate, there is never a feeling of complete emptying of the bowel. Before and during weaning, there are typically cramp-like abdominal pain in the lower abdomen (tenesmen). These pains are often localized on the left side.
Flatulence or fecal incontinence can also occur in patients with ulcerative colitis. Since hardly any nutrients can be absorbed in an acute episode due to the frequent daily and numerous diarrhea, there is often severe weight loss and a feeling of exhaustion. The feeling of weakness can also be caused by loss of blood through the stool and the resulting anemia. In addition to diarrhea, patients often suffer from nausea and a lack of appetite or even loss of appetite in the acute episode.


Although a typical main symptom of ulcerative coltitis is bloody, slimy diarrhea, the complication can be constipation.
Even if the inflammation of the bowel in ulcerative colitis affects only the inner layers of the intestinal lining, the inflammation, the formation of ulcers or polyps can narrow the intestinal passage. Due to this constriction, the food pulp can collect behind the narrowed intestinal passage and cause a blockage. In such a case, the intestinal wall expands and inflates, the inflammation can intensify and, in extreme cases, the intestinal wall can even break through.
In order to avoid these and similar complications of inflammatory bowel disease, an early diagnosis is particularly important. In the case of frequent diarrhea and severe abdominal pain or sudden changes in bowel movements, it is therefore advisable to consult a doctor and have the symptoms clarified by a doctor.

Also read our topic: Colon polyps


Flatulence can be an expression of an existing inflammatory bowel disease.
For example, an inflammatory constriction in the intestine can cause the intestine to expand through this constriction and in this way lead to pain and gas. In addition to these reasons, food intolerance, irregular consumption of meals (e.g. too few and too large meals during the day), late evening meals, drinking large amounts of fluids with meals, certain food combinations, stress or a weak liver can lead to flatulence.
In such cases, it can be helpful to document ingestion and occurrence of winds and to look for individual causes. Particularly in the case of inflammatory bowel diseases such as ulcerative colitis or Crohn's disease, additional stress on the already sensitive intestinal mucosa due to certain eating habits should be avoided.

Find out about the similar bowel disease to clarify your symptoms: Symptoms of Crohn's Disease


Although nausea is not a major symptom of ulcerative colitis, it is still not uncommon.
Nausea often occurs in combination with loss of appetite and leads to the fact that the patients, who can already absorb little nutrients from the intestine in the acute phase of the illness, also lose weight and feel tired and exhausted. In children and especially in the case of longer relapses and / or inadequate therapy, this can also cause growth retardation or growth disorders.


An ulcerative colitis flare-up often results in a fever.
Like weight loss, diarrhea, nausea, abdominal pain, tiredness and general malaise, fever is also a very unspecific disease symptom that, especially in this combination, can quickly be mistaken for a food intolerance or a gastrointestinal infection. If these "infections" occur repeatedly, a possible chronic bowel disease should always be considered and this should be clarified by a doctor.

Possible comorbidities

A whole range of diseases carries the risk of co-occurring (associated) with ulcerative colitis. These include:

  • Joints and spine: ankylosing spondylitis / ankylosing spondylitis / rheumatoid arthritis / chronic polyarthritis / sacroiliitis
  • Liver and biliary tract: primary sclerosing cholangitis, fatty degeneration of the liver
  • Skin symptoms: pyoderma gangrenosum (large skin ulcers), erythema nodosum (inflammation of the subcutaneous tissue)
  • Eye: uveitis iritis (inflammation of the iris), episcleritis (inflammation of the dermis)

You may also be interested in this topic: Causes of ulcerative colitis

Joint pain

The most common non-bowel associated symptom is joint pain in patients with ulcerative colitis.
In this chronic inflammatory bowel disease, antibodies are held responsible for this, which are deposited in the joints and there can cause painful joint inflammation (medical: arthritis). This joint pain can occur in the axial skeleton (axial arthritis) or affect the small joints of the limbs in the periphery. Examples of an affection of the axillary skeleton are ankylosing spondylitis or an inflammatory change in the lower spine, the so-called sacroiliitis. The joint pain can be associated with a flare-up or occur independently of a flare-up.

Back pain

The inflammatory bowel disease ulcerative colitis can also cause problems outside the intestine and cause back pain, for example.
This mostly deep back pain, which is mostly in the lumbar spine area, can either be associated with the inflammation or as a so-called extraintestinal manifestation of inflammatory bowel disease (frequently used abbreviation: IBD). Extraintestinal manifestation means that the symptoms are caused by the disease, but not localized directly in the intestine.

Symptoms on the skin

In addition to the main symptoms, ulcerative colitis is not uncommon for symptoms on the skin.
The possible skin changes (erythema nodosum, pyoderma gangrenosum and pyostomatitis vegetans) mainly occur in the context of an acute attack. The most common skin complication, erythema nodosum, is inflammation of the subcutaneous fatty tissue, which is more common in women and mainly appears on the extensor sides of the lower legs. Very painful, reddish lumps form on the skin.

The less common pyoderma gangrenosum (occurring in about 5% of patients with ulcerative colitis) also manifests itself on the extensor sides of the lower extremities. There are extremely painful, focal changes in the skin. At the beginning there are only vesicles, nodules and pus vesicles, which can develop into deep ulcers with central tissue death. In the mouth area, pyostomatitis vegetans can develop in patients with ulcerative colitis. In this case, numerous pus vesicles and small ulcers (aphthae) develop on the oral mucosa.

Read more on the topic:

  • Pyoderma gangrenosum
  • Canker sores

Symptoms around the eyes

Inflammation of the eyes may also occur in patients with ulcerative colitis.
For example, the iris (called iritis) can become inflamed with or without the involvement of the ciliary body (iridocyclitis). In such a case, patients suffer from dull pain in the area of ​​the eyes and / or forehead, often have watery eyes, see less clearly and are extremely sensitive to light.
If the connective tissue (between the dermis and the conjunctiva) becomes inflamed, the eye is tender and there is sector-shaped reddening, this is called episcleritis. Inflammation of the middle skin of the eye (uveitis) can also occur.

Also read: Conjunctivitis

Symptoms during the episode

Ulcerative colitis is one of the relapsing diseases.
This means that symptoms are not permanent, only permanent "In bursts“Occur.

There are phases in which the patient is completely symptom-free, but then again and again an episode occurs, whereby a distinction is made in ulcerative colitis between a light, moderate and severe episode.

In the slight episode, the general condition of the person concerned is not impaired and there is no fever and the bloody, slimy diarrhea occurs "just“Up to 5 times a day.

In the case of a moderate attack, there may be a slight fever, diarrhea occurs up to 8 times a day and is accompanied by cramp-like (lower) abdominal pain.

The severe relapse is characterized by slimy, bloody stool evacuations that occur more than 8 times a day, a high fever of over 38 ° C, an accelerated heart rate (Tachycardia), a tenderness in the abdomen and a severely impaired general condition.

Read more about this under

  • Ulcerative colitis flare-up
  • Blood in your stool and stomach pain

Symptoms in Children

The peak of ulcerative colitis is between the ages of 15 and 40, so it is not uncommon for children to be affected by this disease.

In children, it is particularly serious because the classically occurring severe, frequent diarrhea leads to one Weight loss and one Insufficient supply and about that with children too Growth lag being able to lead.

It is therefore particularly important for young patients to strive for a balanced, high-calorie diet, especially between the individual attacks.

How can you relieve symptoms?

Physical rest, relaxation and the avoidance of stress are of great importance in the acute episode.
In order to alleviate the symptoms of the disease, to keep relapses as short as possible, and especially to minimize serious damage to the intestinal mucosa and thus reduce the risk of colon cancer, treatment should always be given as promptly and correctly as possible in the acute episode of ulcerative colitis.

Anti-inflammatory drugs are used, which, depending on the initial situation and the affected region, can be administered orally or locally with the help of foam, enema or in the form of suppositories. If necessary, the therapy must be expanded to include cortisone or the use of immunosuppressants. Whether the use of antibiotics and / or probiotics, microorganisms that support the intestinal flora and function, are helpful in shortening acute disease flare-ups or preventing further ones.
The ingestion of linseed soaked in water is said to help with diarrhea by binding the water in the intestine and giving the intestinal mucous membrane a protective film. Moderate endurance training should also reduce inflammatory activity. In traditional Chinese medicine, Aryuveda from India or, for example, through special massage techniques, there are approaches to improve colitis symptoms. Stress regulation techniques such as meditation, autogenic training and yoga should also be helpful. In addition, special diets should also lead to an improvement.

Read more about this: Treatment of ulcerative colitis