Understanding Changes in Your Stool and Ulcerative Colitis

Monitoring bowel health and stool patterns is crucial for everyone, but particularly important for individuals living with ulcerative colitis (UC). Paying close attention to changes in stool – including frequency, consistency, the presence of blood, urgency, and nighttime symptoms – and promptly sharing these details with your gastroenterology team can be a powerful strategy for managing the condition and staying ahead of flares.

What Changes Should Prompt a Call to Your Doctor?

According to Alan Moss, MD, chief scientific officer at the Crohn’s & Colitis Foundation and a professor of gastroenterology at Boston University’s Chobanian & Avedisian School of Medicine, “No amount of visible blood, persistent diarrhea, or significant change from your ‘usual’ is too minor to mention.”

Consistency

Diarrhea or loose stools are among the most common signs of a UC flare. Stool may deviate from a formed consistency, becoming mushy or completely liquid, often corresponding to Bristol Stool Chart types 5 to 7. During a flare, bowel movements are typically loose or watery and accompanied by a greater sense of urgency than usual, potentially occurring multiple times a day. These stool changes are often accompanied by stomach cramping, which serves as a “strong signal” to contact your gastroenterology team.

Blood in the Stool

The presence of fresh blood in the stool, known as hematochezia, is a symptom of active ulcerative colitis that should not be ignored. Supriya Rao, MD, a gastroenterologist and spokesperson for the American Gastroenterological Association, emphasizes, “There is no amount of blood that is considered normal in UC, even if it’s just on toilet paper.”

• Bright red blood typically indicates active inflammation in the rectum or lower colon.
• Darker blood may suggest more extensive disease higher up in the digestive tract.
• Blood can be mixed throughout the stool, coating it, or appear only on toilet paper after wiping.

Even small amounts of blood, especially if persistent or increasing, should be discussed with your doctor. Heavier bleeding, clots, or maroon-colored stool can indicate more extensive bleeding and require urgent medical attention.

Mucus and Pus

The colon naturally produces mucus to protect its lining. However, inflammation can lead to an overproduction of mucus, which may appear as clear, white, or yellowish jellylike strands in the toilet or on the stool. The presence of yellow or green mucus or pus can also indicate an infection.

Tenesmus

Tenesmus is the painful sensation of needing to have a bowel movement, even when the bowel is empty or there’s little to pass. It affects up to 30% of people with IBD and signals chronic inflammation in the lower bowel. Dr. Rao notes that tenesmus usually indicates the disease is not fully controlled.

Other Red Flags to Watch For

Other important warning signs, as highlighted by Dr. Moss, include:

• Rising urgency or a sudden, overwhelming need to find a bathroom
• Nocturnal bowel movements or waking up at night to defecate
• Changes in stool odor, including foul-smelling stools, which can indicate malabsorption or infection (such as Clostridioides difficile)
• Abdominal pain or sudden cramping
• Rectal pain
• Fatigue and fever (even low-grade)
• Weight loss and loss of appetite
• Symptoms outside of the gut, such as joint pain, skin rashes, or eye irritation

By being vigilant about these changes and maintaining open communication with your healthcare team, individuals with UC can proactively manage their condition and improve their quality of life.