Ulcerative Colitis and Diarrhea: What You Need to Know

Inflammation can make it difficult for the colon to process food and waste. It also interferes with the colon’s ability to absorb water. That’s what leads to the loose, watery stools known as diarrhea.

Diarrhea related to UC may also involve:

• cramps
• abdominal pain
• urgent need to use the bathroom
• increased frequency of bowel movements, including during the night
• feeling that you haven’t completely emptied your bowels

UC can cause ulcers in the lining of the colon and rectum, making bloody diarrhea fairly common.

Frequent diarrhea can lead to other problems, such as weight loss and dehydration.

If you have UC and experiencing diarrhea, you’re not alone.

According to the Crohn’s & Colitis Foundation of America, about 907,000 people are currently living with UC in the United States. Among them:

• 48 percent are in remission
• 30 percent have mild disease activity
• 20 percent have moderate disease activity
• 1 to 2 percent have severe disease

During a flare-up, a person with UC may experience more frequent bowel movements. They may find their stools to be loose and very watery.

According to Crohn’s and Colitis Canada, people who have extensive inflammation of the colon are more likely to have:

• persistent diarrhea and urgency
• rectal bleeding
• abdominal cramping

The diagnosis of UC usually comes before an individual reaches 35 years old. However, there’s another time in life when UC is most frequently diagnosed — at around 60 years old. An estimated 12 percent of those with UC are diagnosed in the decades before and after this age.

Regardless of when the disease is diagnosed, UC can take a significant physical and emotional toll on those living with this chronic condition.

The urgent need to use a bathroom multiple times a day can interfere with your social activities and your ability to work. Diarrhea can be unpredictable, highly inconvenient, and potentially embarrassing. In addition to physical symptoms, people living with UC may experience:

• elevated stress
• anxiety
• depression

Over time, severe UC can become a financial burden due to:

• medications, both over-the-counter and prescription
• doctor visits
• diagnostic procedures
• hospitalizations
• lost earnings

UC causes diarrhea, but there may be other factors involved. Everyone is different, and some people can identify specific triggers for diarrhea, such as:

• side effects of medication
• changes in diet
• infection
• stress
• anxiety

Your doctor may be able to pinpoint some potential triggers. You may also find it helpful to keep a daily journal to track what you eat, your physical activities, and stressful events. In time, you may be able to identify a pattern that leads to diarrhea.

In a given year, 70 percent of people with active disease will have another episode the following year. But only 30 percent of people in remission will have active disease the next year.

Basically, the longer you’re in remission, the less likely you are to have a flare-up the next year. And that means less diarrhea. That’s why it’s so important to find a treatment plan that works for you.

Medications to control UC symptoms include:

• aminosalicylates
• corticosteroids
• immune modifiers
• biologics

There are also medications to help with diarrhea. Antidiarrheal agents help slow movement through the intestines, which helps your body absorb the fluids and nutrients you need. These include:

• loperamide
• diphenoxylate

Fiber supplements may also be helpful in reducing diarrhea, but avoid them if you’re in the middle of a flare-up. Check with your doctor if you’re not sure whether these supplements are suitable for you.

It’s also important to speak with your doctor under the following conditions:

• Before adding any over-the-counter treatments or dietary supplements to your regimen. Some have the potential to interfere with the medications you’re currently taking.
• If you have six or more bloody bowel movements per day. Acute severe UC requires medical intervention.
• If you also have intense abdominal pain or fever.
• If you’re not satisfied with your current treatment plan.

There are a few ways to help manage urgent or frequent bowel movements. For example, you can set regular times to move your bowels. Choose times that are convenient, so you’re not rushed.

You can also practice pelvic floor exercises to strengthen the muscles around the rectum and anus.

A few tweaks to your diet can also help, though not everyone with UC will benefit from the same dietary changes. Keeping a diet journal may help you figure out which foods tend to make diarrhea worse and which ones may be more helpful.

Some items that can contribute to loose stools are:

• dried beans
• raw vegetables
• corn
• cabbage, spinach
• dried fruits
• processed meats
• fried foods
• fructose
• caffeine, alcohol, and carbonated beverages

Foods that may help some people control diarrhea are:

• boiled or mashed potatoes
• bananas
• rice, noodles, pasta
• peanut butter
• white bread
• lean meats

It may also help to eat more frequent, smaller meals throughout the day.

Diarrhea causes your body to lose fluids, sugars, and essential salts. Signs of dehydration include:

• thirst, dry mouth
• dark-colored urine
• less frequent urination
• headache
• lightheadedness
• muscle cramps
• dry skin

Here are things you can do to replace lost fluids and nutrients:

• Drink plenty of water.
• Drink an oral rehydration solution or drinks that contain electrolytes and salts.
• Include foods with sodium and potassium in your daily diet.

According to Crohn’s & Colitis UK, dehydration can eventually lead to kidney stones, liver damage, and muscle and joint damage. Signs of a medical emergency due to dehydration are:

• confusion, disorientation
• blue lips
• rapid breathing, rapid pulse
• inability to wake up

Diarrhea is a common symptom of UC and one that can interfere with daily life. Finding the right treatment for UC can help reduce flare-ups. Medications and lifestyle alterations can help you tackle individual symptoms, such as diarrhea.

If you have frequent or severe diarrhea, it’s worth arranging a visit with your doctor to discuss if you need to make any changes to your treatment plan.