Unexplained abdominal pain can be confusing. Is it bad gas, menstrual cramps, or something more serious? Ulcerative colitis is an inflammatory condition that is often accompanied by abdominal pain. In this article, we’ll dive into what ulcerative colitis pain might feel like, other symptoms to look for, how it is diagnosed, and some potential treatments. 

What Is Ulcerative Colitis?

Ulcerative colitis is a form of inflammatory bowel disease (IBD) that affects the large intestine, or colon. It is not to be confused with irritable bowel syndrome (IBS). The two conditions have some overlapping symptoms but IBS is considered to be a functional disorder, as it causes symptoms without changes to gastrointestinal tissues. Inflammatory bowel disease, on the other hand, involves inflammation and painful ulcers in the digestive tract. The two main inflammatory bowel diseases are ulcerative colitis and Crohn’s disease. 

In ulcerative colitis, small ulcers develop in the mucosal lining, the most superficial layer of the colon. These ulcers can be painful and may result in blood or pus in the stool. In true autoimmune fashion, these sores are generally the result of a protective mechanism in the body overdoing it. (Source)

While the cause of ulcerative colitis remains largely unknown, environmental factors, stress, and diet seem to have a strong link to development of the disease. The modern Western diet is highly implicated in the rise of cases of ulcerative colitis. Overuse of antibiotics or the pain relievers known as nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may also be contributing factors in the development of ulcerative colitis. (Source, Source)

What Does Ulcerative Colitis Pain Feel Like?

Flare-Ups and Remission

Ulcerative colitis symptoms tend to come and go. When symptoms are present, this is considered a “flare-up,” but you may get a break from symptoms for a while during periods of remission. It is certainly possible to have ulcerative colitis and not feel symptomatic all the time. (Source)

Flare-ups may be caused by stress, or may be triggered by certain foods. When you are symptomatic, or experiencing a flare-up, you may start to notice blood in your stool, an urgent need to use the bathroom, and abdominal pain.  

People with ulcerative colitis may also experience periods of remission, when symptoms are minor or absent. Remission is not the same as a cure, but is a period of relief with minimal inflammation and interruption of daily activities. Remission can last for a short period of time or for years. (Source)

Cramping

In general, people living with ulcerative colitis describe the abdominal pain as “crampy,” similar to the waves of pain or pressure associated with diarrhea. The severity will differ from person to person, but it can be severe enough to require medical pain interventions such as antidepressants, opiates, or anticonvulsant drugs. You may experience pain along with an urge to use the bathroom, or more generally throughout the day. (Source)

Where Do You Feel Ulcerative Colitis Pain?

Ulcerative colitis is centralized in the colon. The colon forms an upside-down U shape around the perimeter of your abdominal area, and then ends at the rectum. You may feel pain in these areas, or more centrally in the abdomen, as pain can radiate through interconnected tissues and nerves.

How Long Does Ulcerative Colitis Pain Last?

This will vary from person to person and depends on the severity of your flare-up. Some people only have a few moments of pain, while others don’t get much of a break from pain until a few weeks after implementing healing protocols or starting medication treatment.

Pain is a primary concern when treating ulcerative colitis. New research is suggesting that pain management and psychological support are just as important as symptom management for patients with ulcerative colitis. (Source)

Common Symptoms of Ulcerative Colitis

Digestive Symptoms

• bloody diarrhea that is not easily treated with over-the counter antidiarrheal medications
• frequent need for a bowel movement, often with a sense of urgency
• abdominal pain
• rectal pain

Can Ulcerative Colitis Cause Pain in the Rest of the Body?

Because ulcerative colitis is an inflammatory disease and can result in nutrient deficiencies, many people with ulcerative colitis also experience symptoms elsewhere in the body, such as:

• bone loss
• joint pain or stiffness
• weight loss
• ulcers in the mouth or around the eyes
• extreme fatigue

(Source)

How to Know if Your Symptoms Are Serious

Ulcerative colitis has a wide range of severity. It can be minimally intrusive in your day-to-day life with only occasional discomfort, or it can become quite serious and affect your ability to work, exercise, eat, and enjoy outings.

You are the judge of how disruptive your symptoms are to your life. If you regularly experience bloody diarrhea, abdominal or rectal pain, and a sense of urgency, it’s a good idea to reach out to your health care provider.  Speaking with your provider to identify the root cause of your symptoms, whether ulcerative colitis or another condition, is an important step to take in order to prevent unnecessary worsening of your health. Also, remember, the severity of your symptoms does not foretell your ability to heal and see improvements.

Complications From Ulcerative Colitis

Ulcerative colitis can cause complications which, if left untreated, may become serious. In the short term, a flare-up can lead to severe dehydration and fatigue. The mucosal lining of the colon may be mildly damaged or may become perforated, with a hole allowing air and stool to leak out into the abdomen. A very serious complication is toxic megacolon, an abnormal enlargement of the colon with loss of muscle tone, which can cause severe health problems. (Source)

Ulcerative colitis can cause a loss of appetite as well as frequent diarrhea. Over time, both of these symptoms can contribute to nutrient deficiency, which may lead to complications outside of the digestive tract. Osteoporosis, for example, is a bone disease associated with nutrient deficiency and is a common complication of ulcerative colitis. (Source, Source)

How Is Ulcerative Colitis Diagnosed?

In order to diagnose ulcerative colitis, your health care provider will want to hear about your symptoms and your and your family’s medical histories, and will likely run some tests. Usually, your provider will first rule out other possible diagnoses with minimally invasive tests such as a stool sample or blood tests. 

To truly confirm ulcerative colitis, the tissues of the colon need to be biopsied, with a sample taken from your colon and viewed through a microscope. Your provider will collect these tissue samples during a colonoscopy, in which a flexible tube with an attached camera is inserted through the rectum to capture images and provide valuable information about the health of your colon. 

It can take a while to reach a diagnosis for ulcerative colitis. Make sure to maintain clear communication with your health care provider if you have concerns, and stick with it! You may need to rule out a variety of other possibilities before you get the answers you are looking for.  (Source)

How Is Ulcerative Colitis Treated?

Treatment for ulcerative colitis is based on the severity of the disease and the degree to which the patient’s regular life is interrupted. Some people are able to manage their symptoms and continue on with their lives as usual. But for others, their symptoms can make it difficult to go about their day-to-day activities. They may also struggle with nutrient deficiency because their digestive tract is compromised, and may not get sufficient rest because of the persistent urge to use the bathroom. For these patients, a more aggressive treatment option is likely to be selected.

Medications for Ulcerative Colitis

The following primary categories of medication are typically used.

• 5-aminosalicylates (5-ASAs) work to limit the inflammation response within the digestive tract. 
• Corticosteroids also limit the inflammatory response in the body and can be used instead of or in addition to 5-ASAs.  
• Immunosuppressants lessen the immune response that is overreacting and causing damage.

(Source, Source)

Each of these types of medications has its own drawbacks. 5-ASA drugs can cause an upset stomach, among other acute side effects. Corticosteroids are associated with some longer term side effects such as the development of osteoporosis. And immunosuppressants may decrease your ability to respond to viruses or other infections. In serious cases, surgery may be needed to remove the damaged portions of the colon. (Source)

Lifestyle Choices for Ulcerative Colitis

None of the treatments will cure ulcerative colitis. Finding the right solution is really about finding a way to live your life with the fewest negative trade-offs. Depending on the severity of ulcerative colitis, it may be possible to manage it naturally. Lifestyle and diet changes can also go a long way in decreasing symptoms and putting ulcerative colitis into remission. 

Because ulcerative colitis is an inflammatory disease, the primary focus will be on avoiding foods that tend to be triggers for inflammation while increasing the intake of anti-inflammatory foods. Maximizing quality sleep, learning to manage stress and getting sufficient exercise also help to reduce inflammation in the body and can have a positive effect on symptoms of ulcerative colitis. 

The Bottom Line What Ulcerative Colitis Pain Feels Like

Ulcerative colitis pain may be mild or severe, occasional or nearly constant, and may or may not be accompanied by other symptoms such as fatigue and diarrhea. Complications from ulcerative colitis may be severe enough to affect other parts of the body as well. It can be challenging to get to an ulcerative colitis diagnosis, as symptoms may overlap or be confused with other conditions, and may require invasive testing procedures.

The great news about ulcerative colitis is that, like many autoimmune disorders, it can be managed to a fairly high degree of comfort to get you back to your normal life. Over time, you will learn about your personal triggers for a flare-up, and how to make yourself as comfortable as possible if one does occur. Be gentle with yourself, and as always, reach out for support from your health care provider, the WellTheory team, or people around you who may have had experience managing ulcerative colitis.