If you’re living with ulcerative colitis (UC), mouth problems can start even before more typical symptoms like cramps and diarrhea. Some mouth sores are short-lived and are more of a nuisance. Others can affect your ability to talk or eat.

Diarrhea and cramps are among the most well-known UC symptoms because UC primarily affects the colon and rectum. They stem from inflammation and sores called ulcers in the intestines.

Although it’s not very common, UC can also cause mouth sores. Read on to learn about the common mouth problems that UC or its treatment can cause.

UC swelling and sores can appear anywhere in your GI tract, including in your mouth, but UC-related sores are not typical in other parts of the GI tract outside the colon and rectum.

Ulcerative colitis mouth ulcers can also be a side effect of some ulcerative colitis medications that cause dry mouth and swelling in the mucous membranes.

Vitamin and mineral deficiencies can also lead to ulcerative colitis mouth sores and other problems. Inflammation in your intestines can make it harder for your body to absorb nutrients like B vitamins and iron from food. You can also lose these nutrients when you have diarrhea.

Ulcerative colitis and its treatments can cause the following mouth problems:

Mouth sores

Inflammation from UC typically damages the lining of the colon and rectum. Sores that occur outside these areas are known as extraintestinal manifestations and can include sores in the mouth.

Canker sores (aphthous stomatitis) are painful white or yellow spots that form inside the mouth around the gums, lips, or tongue. You’re more likely to get canker sores during ulcerative colitis flare-ups. They typically heal once you treat the flare.

In addition, pyodermatitis-pyostomatitis vegetans is a rare condition that mainly affects people with ulcerative colitis. Symptoms include a rash in skin folds like the armpits and groin. You may also experience pus-filled sores inside the mouth and throat.

Dry mouth

A dry mouth can be caused by UC. However, some corticosteroids, antidiarrheal drugs, anti-inflammatory drugs, antibiotics, and anticholinergics used to treat ulcerative colitis can also cause dry mouth as a side effect.

However, some medications that may cause dry mouth include:

  • diphenoxylate and atropine (Lomotil)
  • loperamide (Diamode)
  • mesalamine
  • metronidazole (Flagyl)
  • propantheline

Taste changes

Some people with ulcerative colitis report a strange metallic or acidic taste in their mouth. This symptom is more common in people with pancolitis.

This severe inflammatory disease affects the entire colon and is usually caused by ulcerative colitis.

Taste changes may stem from a B12 vitamin deficiency. Experiencing a metallic taste can be a side effect of the drugs sulfasalazine, azathioprine, and metronidazole (Flagyl).

Bad breath

Bad breath (halitosis) often happens if you’ve let your oral hygiene habits lapse. In ulcerative colitis, bad breath may be due to dry mouth.

Saliva washes away dead cells and bacteria in your mouth. Those cells build up when your mouth is dry. This can leave you with an unpleasant breath aroma.

Some people with ulcerative colitis who experience bad breath may have an increased level of sulfate-reducing bacteria in the colon. This leads to higher amounts of the gas hydrogen sulfide, causing bad breath.

Tongue problems

Glossitis is inflammation of the tongue. It’s relatively common in ulcerative colitis. When your tongue is swollen, it may be harder for you to eat and talk.

The condition is usually caused by a deficiency of folate, vitamin B12, or zinc. These deficiencies are relatively common in people with ulcerative colitis.

Inflamed lips

Angular cheilitis causes swollen red patches to form in the corners and outer part of your lips. It sometimes affects people with ulcerative colitis.

The cause in people with ulcerative colitis is often a vitamin B12 or iron deficiency. Long-term treatment with corticosteroid drugs can also result in this symptom.

The first step to relieving ulcerative colitis mouth sores and other mouth problems is reducing inflammation in your gastrointestinal tract and implementing a treatment plan to manage your ulcerative colitis.

Medications like aminosalicylates (5-ASAs), corticosteroids, immunomodulators, and biologics calm the overactive immune system response that causes inflammation and sores. Your doctor can help you find the right drug or drugs to help manage your ulcerative colitis.

An antiseptic mouthwash can help keep your mouth clean while your sores heal. Taking a multivitamin or mineral supplement and eating a balanced diet helps to prevent the nutrient deficiencies that can cause ulcerative colitis mouth ulcers and other mouth problems.

Talk with your doctor if you think a medication you take for ulcerative colitis could be causing these symptoms. Your doctor may recommend alternative treatments less likely to cause mouth sores or suggest other ways to manage this side effect.

Besides ulcerative colitis and medications, causes of oral problems like sores include:

  • mouth trauma
  • a connective tissue disease like scleroderma
  • diabetes
  • certain rare congenital disorders
  • viral or bacterial infections such as herpes simplex and oral lichen planus
  • Behcet’s disease
  • Lupus
  • erythema multiforme (EM)
  • Sjögren disease

While having issues in your mouth doesn’t necessarily mean it’s something serious, it’s worth having it checked out because in some cases it can also be a sign of cancer.

Let your doctor know if you have any new symptoms in your mouth or other parts of your digestive tract. Also, call if your mouth problems affect your ability to eat or talk.

Mouth problems are not the most common symptom of ulcerative colitis. They sometimes appear before more common symptoms such as diarrhea and stomach cramps.

Watch for sores, swelling, pain, and taste changes and report them to your doctor. Changing your treatment or adding a nutritional supplement may help relieve these issues.

Read this article in Spanish.