Ulcerative colitis is a chronic disease that affects the lining of the large intestine, causing inflammation and ulceration. Diarrhea is common, and constipation can also occur.

These symptoms can cause discomfort and affect a person’s quality of life. However, there are some ways in which people with ulcerative colitis can remedy constipation.

In this article, learn more about the link between ulcerative colitis and constipation and get some tips on how to manage this symptom.

a woman holding her stomach because she is experiencing constipation because of ulcerative colitisShare on Pinterest
In some people, ulcerative colitis causes constipation.

Common symptoms of ulcerative colitis include diarrhea and bloody, frequent stools, but constipation can also affect some individuals.

A person has constipation when they have fewer than three bowel movements a week. These movements may produce hard, dry stools that are difficult or painful to pass.

There are different types of ulcerative colitis, but the most common form is distal ulcerative colitis. This type affects about 80% of people who receive a new diagnosis.

In distal ulcerative colitis, the symptoms only affect the left side of the colon. When a person has ulcerative colitis on the left side, they can experience constipation on the right side — this is called proximal constipation.

Is there a link between stress and constipation? Find out here.

There are many ways to treat constipation in people with ulcerative colitis, depending on the severity of the symptoms and the person’s lifestyle.

1. Dietary changes

Dietary changes are usually the first step in managing this symptom.

These changes include:

A high fiber diet: Current guidelines recommend that adults consume 22.4–33.6 grams (g) of dietary fiber a day, depending on their age and sex. Adding more plant-based foods to the diet and switching from white to whole grain bread are two ways to do this.

Drinking water: Drinking about 2 liters of water a day can help. Exceeding this quantity does not appear to bring additional benefits, so people should not drink more unless they are thirsty.

Eating a nutrient-rich, plant-based diet: This diet should include plenty of fresh fruit and vegetables.

2. Keeping track of bowel movements

Tracking bowel movements can help a person determine whether their condition is getting better or worse.

Other useful practices include eating high fiber foods at a regular time each day, such as for breakfast, and attempting to have a bowel movement at the same time each day.

Tips to help keep bowel movements regular include:

  • tracking bowel movements in a journal, noting the time, frequency, and type
  • striving for regularity in bowel movements but not straining
  • avoiding delaying bowel movements

3. Exercise

Research suggests that regular exercise can ease the symptoms of constipation, especially in older people. However, physical activity is likely to be only one factor among many.

Low impact exercise options include walking to work, swimming, and doing yoga.

4. Over-the-counter laxatives

If diet, hydration, and exercise do not ease symptoms, some people with ulcerative colitis may find relief from constipation by taking over-the-counter (OTC) laxatives.

People should use laxatives of any kind, including OTC medications, with caution. It is best to ask a doctor’s advice before starting to use any laxatives, as they can have some adverse effects.

5. Other medications

A range of other medications and prescription laxatives may help a person with constipation find relief.

These include:

Magnesium: A low dose can usually lead to a bowel movement within 6 hours.

Lactulose: Although it can cause gas and may take longer to work than other options, lactulose can also relieve chronic constipation.

Sorbitol: This artificial sweetener is as effective as lactulose in relieving constipation and usually costs less.

Polyethylene glycol (PEG): Healthcare professionals mainly use PEG to clean out the digestive tract before a colonoscopy. However, one or two daily doses of 17 g can relieve chronic constipation.

Anthraquinones: Senna and other stimulant laxatives activate the digestive system and can usually promote a bowel movement within 6–8 hours. They may cause cramps, however.

Diphenylmethane derivatives: These are similar to anthraquinones and can help people who are experiencing temporary constipation. Types include bisacodyl.

Castor oil: This oil can stimulate the intestines, but it may cause cramping.

Stool softeners: Examples include docusate sodium and mineral oil emollients. These treatments may not be suitable for long-term use. The use of mineral oils, for example, may lead to seepage and reduce the body’s ability to absorb some nutrients.

Enemas: Enemas work by distending and irritating the intestine. They are usually safe to use, but people should administer them with care to avoid damage.

Suppositories: OTC glycerin suppositories are available, but there is little evidence to support their use.

In addition to finding effective treatments, it is important to have the support of people who understand the experience of living with ulcerative colitis.

IBD Healthline is a free app for people who have received a diagnosis of ulcerative colitis. The app is available on the App Store and Google Play. Download it here.

Conditions other than ulcerative colitis that may cause constipation include:

IBS

IBS can cause cramping, bloating, and changes in bowel habits, including constipation. However, it does not involve inflammation, and it does not cause severe damage to the intestines.

Experts do not know why IBS happens, but it does not appear to involve an immune system response.

IBS can cause constipation, diarrhea, or both. Ongoing abdominal pain is also a common IBS symptom.

Get some tips here on coping with IBS.

Crohn’s disease

Ulcerative colitis only attacks the large intestine and the rectum.

Crohn’s disease is another form of IBD that can occur anywhere along the gastrointestinal (GI) tract, which runs from the mouth to the anus. However, it commonly affects the small intestine.

Constipation can signal that the disease is getting worse. It may indicate a stricture or narrowing of the intestine, also known as an obstruction.

There are several types of Crohn’s disease. Learn more here.

Celiac disease

A person with celiac disease has an inflammatory response to gluten in the diet. This response causes injury to the lining of the small intestine. The symptoms eventually disappear if a person removes products that contain gluten, such as bread and pasta, from the diet.

People with ulcerative colitis can learn to manage the symptoms of flare-ups while increasing the length of remissions. Find out how to do this.

A person with ulcerative colitis should have regular checkups with their doctor to discuss changes in their symptoms, including constipation.

Symptoms that require medical treatment include:

  • frequent, bloody stools
  • severe stomach pain
  • abdominal distention
  • persistent vomiting
  • fatigue
  • loss of appetite
  • unexplained weight loss
  • anemia
  • fever

Without treatment, ulcerative colitis can lead to a number of complications. Find out why it is essential to see a doctor if symptoms arise.

Experts have not yet identified exactly what causes ulcerative colitis, but many believe that it is an autoimmune disease that results from a combination of genetic and environmental factors.

It is a long-term, or chronic, condition, and the symptoms can change or worsen over time.

However, treatment is available. Options include:

Aminosalicylates: These help manage inflammation.

Corticosteroids: These help reduce inflammation and regulate the immune system.

Immunomodulators and biologic treatments: These change how the immune system works.

Other medications: Various options can help manage symptoms.

With treatment, symptoms can go away for weeks, months, or even years. This symptom-free period is called remission. However, some people will eventually need surgery.

For people with ulcerative colitis, constipation may be a recurring problem. Following a treatment plan and dietary guidelines can help a person manage the condition and improve their overall quality of life.

Learn more about ulcerative colitis remission here.

Q:

Is it safe to eat high fiber foods with ulcerative colitis, or might they irritate the gut?

A:

People with ulcerative colitis should eat a diet that is rich in fruits and vegetables except during flare-ups. At this time, they should eat a low fiber diet.

Saurabh (Seth) Sethi, M.D., MPH Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.