Ulcerative Colitis is often associated with diarrhea and urgent bowel movements. However, on the flip side, some individuals with Ulcerative Colitis also experience constipation. No matter which symptoms you experience, learn how to prevent and treat your Ulcerative Colitis constipation before it affects your quality of life.
In general, Ulcerative Colitis causes inflammation in the large intestine and the rectum. When the inflammation associated with UC is concentrated in the rectum, you are likely to feel constipated. This happens because the inflammation in the rectum (the body part that connects the large intestine to the anus) makes it difficult to pass stool out of your body. This form of Ulcerative Colitis is called proctitis. For individuals with proctitis, constipation may be accompanied by bleeding and a sense of urgency that are usually experienced with diarrhea. However, because the inflammation associated with proctitis is concentrated to the rectum (and not the entire large intestine) the large intestine can successfully absorb water, which prevents diarrhea.
An Example: distal Ulcerative Colitis and Proximal Constipation
Another specific type of Ulcerative Colitis, known as distal Ulcerative Colitis, causes proximal constipation. For reference, distal means away from the center of the body, or in this case, the end of the large intestine. Proximal means close to the center of the body, or in this case the beginning and middle portions of the large intestine. Distal Ulcerative Colitis is also called left-sided Ulcerative Colitis because it affects only the left side of the colon, which is the distal end. The inflammation on the left-sided distal end of the colon causes constipation in the earlier segments of the colon because the inflammation at the end makes it difficult to pass stool through the earlier segments of the proximal colon...which is located on the right side of the body. Essentially, inflammation on the left side of your body (downstream, distal end) causes constipation on the right side of your body (upside, proximal end).
How to Identify Ulcerative Colitis Constipation
Constipation is defined in a few different ways:
- By Quantity: fewer than three bowel movements a week
- By Bowel Movement Characteristic: Having hard, dry stool that appears like pellets or nuts, and is painful to pass. Slightly less severe constipation can produce sausage-shaped stool that is hard and lumpy. Straining and pushing during a bowel movement is another sign of constipation.
- Association / Trigger with other Gastrointestinal Symptoms: including gas and stomach pain, which may further complicate Ulcerative Colitis.
Additionally, constipation associated with Ulcerative Colitis may cause further complications such as hemorrhoids and fissures. Hemorrhoids may cause bleeding after a bowel movement, pain while passing stool, and soreness or swelling around the anus. Anal fissures are small tears in the skin that may crack and bleed, and cause pain or itchiness.
There are many ways to treat constipation, and oftentimes utilizing multiple strategies together is most effective.
Consuming a high fiber diet is one of the best ways to manage mild to moderate constipation. Adults should consume 20 to 35 grams of fiber per day. Focusing on whole grains, fruits, and vegetables will help you hit this daily fiber goal, while also taking in a lot of beneficial vitamins and minerals. If raw fruits and vegetables are hard on your digestive system, steaming or baking may help improve digestibility. It is important to note that during a Ulcerative Colitis flare, a low fiber diet works best. Following a flare, slowly increasing your fiber intake will help your gut adjust and return to normal.
Fluid is essential to normal bowel movements. Dehydration causes stool to be harder and contributes to constipation. Drinking two liters of water daily can help alleviate constipation and is a great goal to aim for. Limiting intake of caffeine, which is a diuretic and stimulates urination, also helps your body stay hydrated.
A sedentary lifestyle may also play a role in constipation associated with Ulcerative Colitis. Decreased physical activity levels may slow digestion by slowing the contractions of the intestines, which are necessary to pass stool. Regular exercise has been shown to lower the risk of constipation and ease the symptoms associated with constipation. Try to increase daily and weekly physical activity and see how symptoms change. Start slowly and work your way up to the recommended 150 minutes of exercise each week.
Track Bowel Movements
Keeping track of anything helps you manage it. Specifically, tracking bowel movements helps to determine if things are improving or declining. Keeping a log of the frequency, timing, type, and consistency of your bowel movements, as well as any other gastrointestinal symptoms provides valuable insight into your condition and how it evolves over time. This log is also a useful tool to review with your doctor or dietitian.
It is always important to speak with your doctor before taking any type of medication. However, if diet, hydration, and physical activity are not helping alleviate constipation, over-the-counter laxatives, prescription laxatives, and other medications may be recommended by your doctor. Stool-bulking laxities may be used to increase the volume of your stool and make it easier to pass. These laxities must be consumed with water to be effective. Osmotic laxities increase the volume of water in the intestine to soften stool. Laxities may take a few days to induce bowel movement.
As with any Ulcerative Colitis complication, it is important to discuss constipation with your doctor and dietitian, and work on a treatment plan together. If you experience an increase in severity in your constipation or any other symptom reach out to your doctor immediately.
Kaitlyn Willwerth is a Registered Dietitian at OnPoint Nutrition. Kaitlyn's work focuses on providing individualized health and lifestyle coaching and, most importantly, support. She is a Certified LEAP Therapist and has also completed the Monash University 'Low FODMAP Diet for IBS' online training course for health professionals.