Ulcerative Colitis With Constipation

Medically Reviewed by Minesh Khatri, MD on May 30, 2022
Written by Keri Wiginton
6 min read

Ulcerative colitis (UC) can send you to the bathroom. A lot. In fact, diarrhea is one of the most common symptoms of UC. But some people have the opposite problem.

If you have UC with constipation, the flow of your stool becomes sluggish. You might poop less than normal and have a mix of other uncomfortable belly and bowel symptoms. Scientists call this proximal constipation or ulcerative colitis-associated constipation syndrome (UCAC).

Constipation isn’t serious for most people, and it can happen for reasons unrelated to UC. But you should tell your doctor about it. You’ll feel a lot better when your bowels are back on track.

You don’t need to have a bowel disorder to get constipated. Diet, exercise, how much water you drink, and medication can all affect the flow of your stool. But scientists think certain things about UC might make constipation more likely in some people.

There’s ongoing research in this area, but some leading theories include:

Right-sided transit delays. Left-sided colitis may slow poop on the right side of your colon. It’s unclear why this happens. But scientists think it’s likely due to a lack of coordination between your colon muscles throughout the day and right after you eat.

Nervous system changes. Chronic inflammation may damage nerve cells that control how often your colon contracts. These injured gut cells may not go back to normal. Some experts think that’s why you can have UC with constipation even after you’ve recovered from a flare.

Mechanical obstructions. These are physical issues that block the flow of your stool. For instance, UC can cause your bowels to narrow. That’s called a stricture. You may need an X-ray, sigmoidoscopy, colonoscopy, or other imaging tests to check for barriers in your colon.

Studies show 30%-50% of people with UC sometimes get symptoms of constipation. It seems more likely to happen in people who:

  • Have left-sided (distal) colitis
  • Have rectal disease
  • Have an active flare
  • Are female

Constipation can happen to anyone. But it seems to occur less often in people with colitis throughout most or all of their large intestine. You may hear this called extensive colitis, pancolitis, or total colitis. If you have this kind of UC, you’re more likely to have frequent diarrhea or fast-moving stool.

There’s no agreed-upon definition for UC with constipation. But a group of experts came up with a set of guidelines to better pinpoint it. In general, you’ll need to have at least two of the following symptoms for at least 3 days a month during the prior 3 months:

  • Bloating
  • Belly pain and cramping
  • Poop that’s difficult or painful to pass
  • Having fewer bowel movements than what's normal for you
  • Lots of extra gas
  • Dry, hard stool
  • A sensation that you can’t get all your stool out (tenesmus)

Constipation may also cause:

  • Small, lumpy stool
  • A sick feeling in your stomach
  • Fatigue

The above symptoms can lead to other health issues, especially if you strain really hard when you poop. You may get:

  • Tears or sores in the lining of your anus (anal fissures)
  • Swollen blood vessels around your anus (hemorrhoids)
  • Hard stool that gets stuck in your rectum (fecal impaction)

There aren’t specific guidelines to manage UC with constipation. But you can take steps to boost your bowel movements, including:

Change your diet. Your doctor might urge you to eat more fruits, vegetables, and whole grains. But keep track of how you feel after you eat plant-based foods. Too much fiber can make your poop bulky. That can be a good thing. But it might worsen constipation in some people with UC.

Always check with your doctor before you make any big changes to your diet. But some things that may help UC with constipation include:

  • Adding soluble fiber (the kind that dissolves in water)
  • Reducing your dietary fiber until symptoms get better
  • Trying a low-FODMAP diet
  • Avoiding dairy foods

Stay hydrated. Extra fluid can soften your stool so it’s easier to pass. You’ve probably heard that you should aim for 8 cups of water a day. But there isn’t a perfect number that works for everyone. Drink when you feel thirsty. And pay attention to the color of your urine. It should be clear or light yellow.

Get moving. Regular physical activity can urge your stool to move along. Talk to your doctor about activities that are safe during or after a flare. Some examples of UC-friendly exercises might include:

  • Fast walking
  • Bicycling
  • Swimming
  • Yoga
  • Elliptical
  • Rowing

Train your bowels. Try to have a bowel movement at the same time every day. It might help if you go within 15 to 45 minutes after a meal. That way you can tap into your gastrocolic reflex. That’s a part of your body that sets off movement in your lower intestine after you eat.

Try biofeedback. This is a kind of therapy to retrain the muscles that help you poop. A pelvic floor therapist or physical therapist can let you know if this kind of treatment might be right for you.

Talk to a mental health professional. Constipation isn’t all in your head. But there’s a strong connection between the gut and brain. And studies show psychological techniques may ease belly and bowel symptoms in people with inflammatory bowel diseases (IBD).

You might want to ask your doctor or therapist about the following:

  • Cognitive behavior therapy
  • Gut-directed hypnotherapy
  • Mindfulness therapy
  • Psychodynamic psychotherapy

If diet and lifestyle changes aren’t enough, your doctor may recommend some other things. They’ll let you know how long it’s safe to use any of these choices, including over-the-counter (OTC) laxatives or supplements.

Stick with the dosing schedule your doctor sets for any of the following:

Osmotic laxatives. These help your stool absorb water from other parts of your body. Fluid-filled poop is softer and easier to pass. Osmotic agents can cause dehydration or a mineral imbalance, especially in older people. Ask your doctor if that’s something you need to worry about.

Common examples of osmotic laxatives include:

  • Polyethylene glycol
  • Oral magnesium hydroxide

Stool softeners. These contain docusate sodium. That’s a chemical that brings water into your stool. You may strain less when you take stool softeners, but they can take a few days to work.

Fiber supplements. You may hear these called bulk-forming laxatives. They’re pills or powders that boost the size of your stool. Like eating more fruits and vegetables, fiber supplements can make UC with constipation worse for some people. Tell your doctor if that happens to you.

Common examples of fiber supplements include:

  • Methylcellulose fiber
  • Calcium polycarbophil
  • Psyllium fiber

Stimulant laxatives. These force your colon to contract. Stimulants are sometimes used for short-term relief if your constipation is really serious or nothing else helps. But they’re not a good choice for chronic constipation.

Talk to your doctor before you use a stimulant laxative. They can cause unwanted side effects like stomach cramps, dehydration, or a mineral imbalance. And if you use them for a long time, you may not be able to poop without them.

Prescription drugs. Let your doctor know if OTC laxatives or supplements don’t help. They might want you to try other kinds of medication for constipation. Some ease belly pain, soften your stool, or help you have more bowel movements.

It’s normal for your bowel habits to change every now and then. But it’s a good idea to seek care anytime your constipation:

  • Lasts longer than 3 weeks
  • Keeps you from doing daily activities
  • Creates black stool
  • Causes weight loss without trying

See your doctor right away if you have ongoing constipation along with symptoms such as:

  • Bloody stools
  • Serious belly pain
  • Throwing up
  • Fever
  • Lower back pain

Tell your doctor about any medications you’re taking. Bring up any other symptoms that are bothering you. They’ll want to rule out any hidden health problems.