Ulcerative colitis is a chronic disease in which the body's immune system mistakenly attacks the lining of the colon or large intestine. This causes inflammation and leads to the growth of open sores or ulcers.
Constipation is a common problem that has many different causes, including low-fiber diets, a lack of physical activity, certain medications, and health conditions.
Ulcerative colitis is most often associated with diarrhea and bloody, frequent stools.
However, for some individuals with ulcerative colitis, constipation is also a problem.
Many people think they need to have at least one bowel movement each day, and a failure to do so means they are constipated. However, the normal frequency for bowel movements ranges from three a day to three a week.
Constipation is when a person has fewer than three bowel movements a week. These movements may be difficult or painful to pass and produce hard, dry stools.
The most common form of ulcerative colitis is distal ulcerative colitis, which only affects the left side of the colon. Distal ulcerative colitis affects 80 percent of people who are newly diagnosed with the condition.
Some people with ulcerative colitis on the left side of their bowel can become constipated on the right side. This is called proximal constipation.
There are many ways to treat constipation in people with ulcerative colitis, depending on the severity of the symptoms and a person's lifestyle.
1. Dietary changes
The first form of treatment for constipation is usually making dietary changes. These changes include:
- Adopting a high-fiber diet. A person should consume 22–34 grams (g) of dietary fiber a day. Easy steps to do this include switching white bread for whole grain.
- Drinking about 2 liters of water a day. Drinking more than 2 liters has not been shown to be any more helpful, so people should not force themselves to drink more.
- Eating a nutrient-rich, plant-based diet. This means including plenty of fresh fruit and vegetables.
2. Keeping track of bowel movements
Tracking bowel movements can help a person find out if their condition is getting better or worse.
It can also help to eat high-fiber foods at a regular time each day, such as for breakfast, and to attempt 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
- not delaying bowel movements
Regular exercise can ease the symptoms of constipation. A lack of physical activity can slow down digestion.
Low-impact exercises can include walking to work, swimming regularly, or doing yoga.
4. Over-the-counter laxatives
If diet, hydration, and exercise do not ease symptoms, some people with ulcerative colitis constipation may find relief by taking over-the-counter laxatives.
- calcium polycarbophil
Laxatives of any kind, including over-the-counter medications, should always be used carefully. A person should be sure to drink plenty of fluids.
5. Other medications
There is a range of other medications and prescription laxatives that may help a person with constipation find relief.
- Magnesium: A low dose can 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 at relieving constipation as lactulose and usually costs less.
- Polyethylene glycol (PEG): This is usually used to clean out the digestive tract before a colonoscopy. However, once- or twice-daily doses of 17 g can relieve chronic constipation.
- Anthraquinones: These are stimulant laxatives that activate the digestive system and can promote bowel movements rather rapidly, usually in 6–8 hours. They may cause cramps, however. Types include senna.
- Diphenylmethane derivatives: These are similar to anthraquinones and can help people with temporary constipation. Types include bisacodyl.
- Castor oil: This oil can stimulate the intestines, but it may cause cramping.
- Stool softeners
Having a support system that understands the experience of living with ulcerative colitis is important. IBD Healthline is a free app for people that have faced a UC diagnosis. The app is available on the AppStore and Google Play. Download here: https://go.onelink.me/LOC7/c0a0025f.
Other conditions that may cause constipation include:
Irritable bowel syndrome (IBS)
Ulcerative colitis is a kind of inflammatory bowel disease or IBD. It is not the same as irritable bowel syndrome or IBS, which is not caused by an immune system response.
However, some of the IBS symptoms can be similar to IBD. Constipation can develop on its own or alternate with diarrhea. Ongoing abdominal pain is a common IBS symptom.
The key difference between IBS and IBD is inflammation. IBD causes inflammation, whereas IBS does not. This inflammation can cause serious damage to the colon.
Unlike ulcerative colitis, which 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, from the mouth to the anus.
It commonly affects the small intestine. Constipation can signal that the disease is getting worse and may be due to a stricture or narrowing of the intestine, also known as an obstruction.
Celiac disease is an inflammatory response to gluten in the diet and causes injury to the lining of the small intestine. When products that contain gluten, such as bread or pasta, are removed from the diet, a person's symptoms eventually disappear.
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
- loss of appetite
- unexplained weight loss
Although the specific cause of ulcerative colitis has yet to be identified, it is widely thought to be an autoimmune disease, caused by a combination of genetic and environmental factors.
In fact, 10–20 percent of people with the condition have family members who also suffer from inflammatory bowel disease.
Many people with ulcerative colitis find that the disease starts slowly, with the symptoms getting worse over time.
With treatment, the symptoms of ulcerative colitis frequently go away for an extended time. This is called remission, and it can last for weeks, months, or even years.
For people with ulcerative colitis, constipation may be a recurring problem. However, treating the condition with medication and nutritional guidance can help people stay symptom-free for as long as possible and improve their overall quality of life.