Diarrhea and cramps are among the most well-known ulcerative colitis (UC) symptoms. They stem from inflammation and sores called ulcers in the intestines. What you may not realize is ulcerative colitis sores can form in any part of your gastrointestinal (GI) tract, from your mouth to your anus.

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 than a real problem. Others can affect your ability to talk or eat and require your doctor’s help to manage.

Ulcerative colitis mouth ulcers are often associated with the following symptoms:

  • pus-filled sores
  • canker sores
  • dry mouth
  • mouth pain
  • swollen tongue
  • bad breath
  • metallic taste or other unusual taste in the mouth

Swelling and ulcerative colitis sores can appear anywhere in your GI tract, including in your mouth. 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 ulcerative colitis damages the lining of the GI tract. Sores can form anywhere along this route, including 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 should heal once you treat the flare.

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

Dry mouth

Some corticosteroids, antidiarrheal drugs, anti-inflammatory drugs, antibiotics, and anticholinergics used to treat ulcerative colitis can cause dry mouth as a side effect.

Medications that may cause dry mouth include:

  • budesonide (Symbicort)
  • 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 B-12 vitamin deficiency. 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 B-12, or zinc. Research suggests 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 B-12 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 to reduce inflammation in your gastrointestinal tract and get your ulcerative colitis under control.

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

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 aren’t the most common symptoms 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 to relieve these issues.