Monitoring bowel health and your stools is important for everyone, but even more so for people with ulcerative colitis, says Alan Moss, MD, the chief scientific officer at the Crohn’s & Colitis Foundation and a professor of gastroenterology at Boston University’s Chobanian & Avedisian School of Medicine.
“For people living with UC, paying close attention to stool patterns — frequency, consistency, blood, urgency, and nighttime symptoms — and sharing those details early with your gastroenterology team is one of the most powerful ways to stay ahead of flares,” Dr. Moss says.
If you encounter any of the changes below, tell your IBD team. “No amount of visible blood, persistent diarrhea, or significant change from your ‘usual’ is too minor to mention,” he says.
Consistency
One of the most common signs of a UC flare is diarrhea or loose stools, Moss says. Instead of being formed, stool may be mushy or completely liquid, often falling into Bristol Stool Chart types 5 to 7, he says.
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“During a UC flare, bowel movements are usually loose or watery and occur with more urgency than usual,” he says, noting that this may happen multiple times a day rather than as a one-off episode. Stomach cramping often comes along with these stool changes, which are a “strong signal” to call your GI team.
Blood
Fresh blood in the stool, or hematochezia, is a symptom of active ulcerative colitis you shouldn’t brush under the rug, says Supriya Rao, MD, a gastroenterologist and a spokesperson for the American Gastroenterological Association based in Lowell, Massachusetts, where she treats people with IBD or other digestive health issues.
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“There is no amount of blood that is considered normal in UC, even if it’s just on toilet paper,” Dr. Rao says. She notes:
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- Bright red blood usually points to active inflammation in the rectum or lower colon, while darker blood (from higher up) can suggest more extensive disease.
- Blood may be mixed throughout the stool, coating it, or appear only on toilet paper after wiping. Either way, even small amounts can signal active disease and should be discussed with your doctor, especially if it’s persistent or increasing.
Heavier bleeding, clots, or darker maroon stool can signal more extensive bleeding and warrants urgent medical attention, Moss says.
Mucus and Pus
The colon produces mucus to protect its lining, but when it’s inflamed, it can produce too much. In people with UC, this excess mucus may appear as clear, white, or yellowish jellylike strands in the toilet or on the stool.
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Seeing yellow or green mucus or pus in your stool can also point to infection, Rao says.
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Tenesmus
Tenesmus is the painful sensation that you need to go to the bathroom — even though you can’t go or there’s little or nothing to pass. As many as 30 percent of people with IBD experience tenesmus, and it’s a warning sign of chronic inflammation in the lower bowel.
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“Tenesmus usually means the disease is no longer fully controlled,” Rao says.
Other Red Flags to Watch For
According to Moss, other important warning signs include:
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- Rising urgency or a sudden overwhelming need to find a bathroom
- Nocturnal bowel movements or waking up at night to poop
- Odor changes, including foul-smelling stools, which can indicate malabsorption or an infection, such as from the bacteria Clostridioides difficile
- Abdominal pain or sudden cramping
- Rectal pain
- Fatigue and fever (even low-grade fever)
- Weight loss and loss of appetite
And in some people, symptoms outside of the gut, such as joint pain, skin rashes, or eye irritation, may occur.
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