What You Need To Know about Ulcerative Colitis Stool

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that causes inflammation in the lining of the large intestine, which includes your colon and rectum. UC causes a variety of digestive symptoms, including changes to your stool and pooping habits.

UC symptoms tend to come and go, following a cyclical pattern of remission and flare-ups. You may have fewer or milder symptoms during remission when inflammation is well-controlled. During flare-ups, when inflammation worsens, you may notice more changes to how your poop looks and smells as well as how frequently you make bowel movements.

What Does Ulcerative Colitis Poop Look Like?

Everyone's poop can look different, but in general, stool should typically be brown and shaped like a snake or sausage. Your poop may look different if you have ulcerative colitis.

With UC, chronic inflammation disrupts the normal function of the large intestine, leading to changes in the texture and color of your poop. Even the smell might be different than usual.

Texture

With ulcerative colitis, it's common for poop to be looser than usual. Intestinal inflammation impairs the colon's ability to absorb fluids and electrolytes from the waste material that passes through. Excess fluid in the colon leads to loose, watery stools (diarrhea).  

UC might also cause poop to be bulkier than usual. Some people with UC can have malabsorption, when inflammation disrupts the absorption of certain nutrients, such as fats and sugars. With malabsorption, your stools may be bulky. The stool could also appear greasy or oily and float in the toilet bowl.

Color 

While poop is usually some shade of brown, UC stool may have a few different colors in it.

Chronic inflammation can damage intestinal tissues and lead to ulcers, which are open sores on the intestinal lining. When these ulcers bleed, you may notice bright red blood mixed in with your poop. The blood may also be in the toilet bowl or on the toilet paper after wiping.

Mucus production increases in the intestines in response to inflammation, which can cause whitish or yellow-colored, jelly-like mucus mixed in with your poop.

During a flare-up, you may have frequent bouts of diarrhea or bowel movements that almost entirely consist of blood and pus.

Smell 

While all poop has an odor, UC may cause foul-smelling stools during a flare. Several factors can contribute to more pungent-smelling stools with ulcerative colitis, including: 

• Changes in the gut microbiome: An imbalance in the gut microbiome—an ecosystem of bacteria and other microbes that aid digestion and contribute to your digestive and overall health—can lead to unpleasant-smelling stools.
• Malabsorption: Difficulty absorbing certain nutrients can contribute to foul-smelling poop.
• Infection: People with UC are at an increased risk for developing gastrointestinal infections. An intestinal bacterial infection can cause more pungent-smelling stools.

How Does Ulcerative Colitis Affect Your Pooping Habits?

Ulcerative colitis can cause significant changes to your usual bowel habits. How often you go and how badly you need to go are just a couple changes you might experience with UC.

Frequency

Most people without UC poop anywhere from three times a day to three times a week. Someone with UC may poop less or more than that.

People experiencing an ulcerative colitis flare-up can have diarrhea, meaning they have three or more loose bowel movements a day. The stool is looser since UC inflammation makes it difficult for the colon to absorb water from waste products. Loose stools tend to move through the colon more quickly than solid stools. 

The increased frequency of bowel movements can disrupt work, school, and social activities. It can also interfere with sleep if the diarrhea occurs at night.

Some people with UC might have occasional constipation (fewer than three bowel movements a week). In UC, constipation can happen in people with distal ulcerative colitis, meaning the inflammation is limited to the left side of the colon. Left-sided inflammation can slow the movement of stool through the right (proximal) colon.

The infrequent stools can be hard and dry. If you're constipated, you may also find yourself straining during bowel movements or feeling as though you have incomplete bowel movements. 

Urgency 

The sudden and immediate urge to have a bowel movement is one of the most common—and disruptive—symptoms of ulcerative colitis. Bowel movement urgency can occur during either remission or flare-ups, with 84% of people with UC reporting bowel urgency as their most frequent symptom during flares.

In many cases, the urge to poop may come with little to no warning, which can be particularly distressing when engaging in activities outside of your home. For many people with UC, bowel urgency causes anxiety and embarrassment and has a significant impact on daily activities like work and school. 

Fecal Incontinence

When inflammation damages or weakens the anal sphincter muscles responsible for stool control, people with UC may experience fecal incontinence (accidental stool leakage). Sudden urges to have a bowel movement when it is difficult to reach a bathroom on time can also contribute to fecal incontinence. 

About 37% of people with UC report experiencing fecal incontinence, which is most common during flare-ups but can also occur in remission. Experts believe fecal incontinence is widely underreported, with some studies suggesting that up to 73% of people with UC experience stool leakage.

Tenesmus 

Tenesmus is the feeling that you need to poop, even when your bowels are empty. When ulcerative colitis causes inflammation in the rectum, you may have a persistent and painful urge to poop, even after you've just completed a bowel movement.

If you have tenesmus, you may strain hard when attempting to make a bowel movement. However, nothing—or maybe only a small amount of stool—will come out.

Treatment

The unpredictable nature of ulcerative colitis symptoms can significantly impact your quality of life. Frequent diarrhea, bowel movement urgency, fecal incontinence, and other symptoms can cause anxiety, social isolation, and limitations on daily activities.

Fortunately, lifestyle modifications and medical treatments can help reduce intestinal inflammation, providing symptom relief and reducing their impact on your daily life. 

Home Management

Practicing mindful lifestyle habits is important for managing ulcerative colitis. Certain habits can help you minimize the impact of symptoms on your day-to-day life. You can make changes to the following areas: 

• Diet: Making dietary adjustments can help reduce inflammation and manage symptoms of UC. This may involve limiting your intake of foods that worsen symptoms or promote inflammation, such as dairy, sugar, artificial sweeteners, high-fat foods, high-fiber foods, red meat, spicy foods, alcohol, and caffeine. Trigger foods vary from person to person, so keep a food diary to identify which foods trigger your symptoms.
• Hydration: Frequent diarrhea can make you lose fluids and electrolytes more quickly than you can replace them, increasing the risk of dehydration. Drinking fluids throughout the day can help prevent dehydration and support digestion.
• Stress management: Stress can worsen UC symptoms like frequent diarrhea and bowel urgency. Stress is a part of life, especially when living with a chronic condition, but practicing stress-relieving techniques like yoga, meditation, or breathing exercises can help manage stress and control symptoms.
• Be prepared: Poop emergencies are a part of life for many people with UC. Carrying a bag with supplies, such as toilet paper, wet wipes, a spare change of clothes, air freshener, and hand sanitizer, can provide peace of mind when symptoms occur outside your home. 

Medical Treatment

Ulcerative colitis is a chronic condition that requires lifelong treatment. In addition to lifestyle modifications, medications can help reduce inflammation and control UC symptoms. Sometimes, surgery may be needed. With the proper treatment, many people with UC experience remission that can last months or years. 

Treatments for ulcerative colitis include:

• Aminosalicylates: These medications reduce inflammation in the intestinal lining. Your healthcare provider may prescribe aminosalicylates as oral tablets (taken by mouth) or as an enema or suppository (taken rectally). Mesalamine, sold under brand names like Lialda and Canasa, is one example of an aminosalicylate.
• Corticosteroids: These strong anti-inflammatory drugs suppress the immune system to reduce inflammation in people with moderate-to-severe ulcerative colitis. Most healthcare providers prescribe corticosteroids for short-term use to prevent harmful side effects that can develop with long-term steroid use.
• Immunomodulators: These medications suppress the overactive immune response that triggers inflammation. It can take several months for immunomodulators to reduce inflammation. Healthcare providers may prescribe these drugs when other medications are ineffective. 
• Biologics: These are antibodies that block the actions of proteins that cause inflammation in the intestines, helping manage moderate-to-severe UC. 
• Surgery: When medications are ineffective or complications develop, surgery to remove your large intestine may be necessary. 

How Can Poop Help in Making a Diagnosis?

When you visit your healthcare provider with symptoms like bloody stool and frequent diarrhea, the provider may request a stool sample for testing. Stool tests are important in ruling out other causes of your symptoms and diagnosing ulcerative colitis. Depending on your symptoms, your healthcare provider may order: 

• Fecal occult blood test: For this, they will test a stool sample for the presence of blood that is invisible to the naked eye. 
• Calprotectin stool test: This measures the amount of a protein called protectin in your poop. When your intestines are inflamed, neutrophils (white blood cells) move to your intestines and release calprotectin, which mixes into your stool. High levels of calprotectin are a sign of intestinal inflammation. 
• Stool culture test: This detects bacteria overgrowth in your stool to identify bacterial infections, such as C. diff, which is common in people with ulcerative colitis. 

Poop alone can't diagnose UC. Only an imaging procedure, such as a colonoscopy, that looks inside your large intestines and a biopsy taken during the imaging can diagnose UC. A healthcare provider can determine whether imaging and biopsy should be performed for a diagnosis based on your poop symptoms and stool sample test results.

When To See a Healthcare Provider

See a healthcare provider if you develop ongoing symptoms of ulcerative colitis, including: 

• Frequent diarrhea 
• Blood, mucus, or pus in your stool
• Rectal bleeding
• Abdominal pain and cramping
• A feeling of incomplete bowel movements
• Urgency to make a bowel movement

Living with ulcerative colitis means following your treatment plan and maintaining regular check-ups with your healthcare provider to ensure your symptoms are well-controlled. If you've already been diagnosed with UC, see a healthcare provider if you develop new or worsening symptoms or experience any of the following:

• Heavy, persistent diarrhea
• Rectal bleeding with blood clots in your stool
• Ongoing, constant, or severe abdominal pain
• Fever

A Quick Review

Ulcerative colitis can cause significant changes in your stool. Ulcerative colitis can change the texture, color, and smell of your poop. You may notice that your stools are looser, contain blood or mucus, or smell foul. UC can also change your bowel movement habits, including how often or urgently you need to go.

If you notice changes in your poop or bowel habits, see a healthcare provider. They may ask for a stool sample to help determine the cause of your symptoms. If further diagnostic testing confirms you have ulcerative colitis, treatment can reduce intestinal inflammation, helping to get your poop and bowel movements go back to what's regular for you.