Ulcerative colitis stool: Appearance, symptoms, and treatment

In people with ulcerative colitis (UC), the large intestine, or colon, becomes inflamed and develops small, pus-producing ulcers. These ulcers can also develop in the rectum.

The type of stool symptoms people experience will depend on the location of inflammation and ulceration within the colon.

This article outlines the various stool symptoms of UC, along with the possible treatment options

Appearance

Doctors may use a Bristol Stool Chart to help a person recognize healthy bowel movements or identify possible problems.

The stool changes that occur in UC are due to inflammation. Over time, inflammation can damage the lining of the large intestine.

Although the majority of people with UC will have loose stools, some may also experience constipation.

However, constipation is more common among people with proctitis, in which inflammation and ulceration affect only the rectum.

Symptoms of constipation include:

• reduced frequency of bowel movements
• harder stools
• difficulty passing stools
• bloating
• cramping
• feeling that the bowels are not empty even after a bowel movement

Bowel incontinence

Most people with UC tend to experience bowel incontinence during a flare-up of the disease.

However, around 1 in 10 people with IBD who experience bowel incontinence will do so during a period of disease remission.

The following factors may cause bowel incontinence:

Increased sensitivity of the rectum

As the rectum becomes inflamed, it will also become more sensitive. Heightened sensitivity in the rectum can cause it to become more active, pushing out stools as soon as they arrive.

IBD surgery

People with severe UC may have surgery to remove all or part of the large intestine.

In “pouch surgery,” the surgeon replaces the colon with an internal pouch. Some people who undergo this procedure may develop bowel incontinence.

Severe constipation

A buildup of stools can irritate the lining of the rectum, causing an overproduction of mucus.

If the rectum constantly contains stools, the muscles of the anus relax, allowing the mucus to leak out.

The International Foundation for Gastrointestinal Disorders (IFFGG) recommend the following treatments for mild constipation:

• drinking plenty of fluids
• eating fibrous foods, such as uncooked fruits and vegetables
• eating whole-grain bread and cereals

However, many people with UC find that fibrous foods and whole grains trigger other symptoms, so keeping a food diary can help people identify which foods cause which symptoms.

Other methods for relieving constipation include:

• Squatting while having a bowel movement: Sitting with the knees higher than the hips when using the toilet can help align the rectum, making stools easier to pass.
• Exercising: Exercise helps speed up the movement of stools through the colon.
• Taking laxatives: Doctors may recommend osmotic laxatives for people with IBD. These increase water availability in the colon, which helps to soften stools.

However, people with UC should talk to a doctor before taking laxatives, as these medications can increase wind and stomach cramps.

Managing bowel incontinence

Many people who experience bowel incontinence find it difficult to discuss the issue with a doctor.

However, a doctor may be able to identify the underlying cause of a leaky bowel and can offer advice on how to control and manage this symptom.

Some suggestions for managing bowel incontinence include:

Bowel retraining

People who experience a sense of urgency may benefit from delaying bowel movements. This technique is called bowel retraining.

Although bowel retraining may be difficult at first. Over time, however, it will help build up strength and control over the rectum and sphincter muscles.

Pelvic floor exercises

The pelvic floor muscles support the pelvic organs, which include the bladder and bowel, as well as the uterus in women.

Pelvic floor exercises can help strengthen the muscles around the anus, reducing incontinence. To find the pelvic floor muscles, imagine stopping a urine stream or practice while urinating.

To perform pelvic floor exercises, contract and hold the pelvic floor muscles for a count of 3, and then relax the muscles, while slowly counting to 3. Avoid pushing out the muscle during the relaxation stage.

Repeat this 15 times to complete one set of exercises. Aim to complete three sets each day.

Summary

People with UC may experience uncomfortable, inconvenient, and sometimes distressing stool symptoms. These can greatly affect a person’s quality of life.

However, there is a range of treatments that can help those with UC to experience fewer and less severe symptoms.

A person should discuss the options with their doctor to establish the most effective treatment plan.

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