People living with ulcerative colitis (UC), a type of inflammatory bowel disease (IBD) that causes ulcers and inflammation in the large intestine, are more likely to develop sacroiliitis. Ulcerative colitis flares may make sacroiliitis symptoms worse.

A person living with UC, a common type of inflammatory bowel disease, has a greater chance of developing sacroiliitis.

Sacroiliitis, inflammation of the joints in the upper pelvis, gets its name from the sacrum (a section near the base of the spine) and the ilium (hip bone).

Though researchers do not fully understand the link between them, they recognize that a person living with UC has a higher chance of developing sacroiliitis.

A person should understand their risks and talk with their doctor if they notice symptoms of sacroiliitis so they can start treatment as soon as possible.

UC is a chronic condition that affects the lining of the large intestine (colon). It causes ulcers, or sores, and inflammation in the large intestine due to an overreaction of the immune system.

Worldwide, UC is the most common form of IBD. In the United States, it accounts for nearly a quarter of a million annual visits to healthcare professionals.

UC can cause several symptoms, including:

  • blood in the stool
  • loose and urgent bowel movements
  • pain and cramping in the abdomen
  • persistent diarrhea

Treatments for UC can include therapeutic and home-based approaches, according to the Crohn’s & Colitis Foundation.

A doctor may recommend:

  • medications, such as anti-inflammatory medication to suppress the colon
  • dietary changes, such as eating soft, bland foods and avoiding spicy or high fiber foods
  • surgery
  • combination therapies, including biologics, other medications, and immunosuppressors

Sacroiliitis refers to inflammation of the sacroiliac joint or joints. The sacroiliac joints, located on either side of the spine, connect the spine to the upper part of the pelvis.

According to the Global Healthy Living Foundation, the sacroiliac joints bear the weight of the upper body when standing or walking.

The pain associated with sacroiliitis can affect several areas, including the:

  • hips
  • groin
  • lower back
  • buttocks

The Global Healthy Living Foundation also notes that pain can increase due to everyday activities, such as:

  • climbing stairs
  • running
  • standing for long periods of time
  • taking longer strides
  • uneven weight distribution

Certain types of arthritis can cause sacroiliitis. Some potential causes include:

  • osteoarthritis
  • psoriatic arthritis
  • ankylosing spondylitis or axial spondyloarthritis

Current treatments for sacroiliitis can include:

  • medications such as NSAIDs and muscle relaxants
  • physical therapy
  • surgery to fuse the bones (typically a last resort)
  • steroid injections
  • radiofrequency ablation (use of radio waves to destroy nerves and relieve pain sensation)

A person living with IBD may also develop musculoskeletal disorders, such as sacroiliitis. These are known as an extraintestinal manifestation of IBD and can occur along with, prior to, or following the diagnosis of IBD.

The exact link remains unclear. Yet, in a 2007 study, people living with UC were three times more likely to develop sacroiliitis than a control group without UC.

In a 2015 study, researchers showed that cases of sacroiliitis in people living with IBD may range from 16% to 46%. A 2020 study found that about 25% of people living with IBD also developed sacroiliitis.

Though arthritis symptoms can occur before or after UC diagnosis, the most severe ones generally occur during worse UC flares, according to the University of Washington.

The severity of arthritis symptoms often corresponds to the severity of UC symptoms. As a result, keeping UC under control with diet, medication, and other therapies may help prevent symptoms of sacroiliitis from occurring.

A person living with UC does not typically experience damaging effects from inflammation. In other words, sacroiliitis usually does not damage their joints.

A person living with UC should talk with their doctor if they notice symptoms associated with sacroiliitis, such as pain in the hips when walking or any other types of arthritis. A primary care physician may refer a person to a rheumatologist for diagnosis.

A person may want to consider a second opinion if their doctor does not refer them to a rheumatologist. Early referrals can help improve treatment outcomes. However, referral rates are low, according to a 2018 study.

If symptoms get worse during treatment or do not improve, a person should talk with a healthcare professional. A doctor can recommend additional therapies that may help improve symptoms of either UC or sacroiliitis.

As a person begins to better manage their UC symptoms, they will often notice an improvement in their sacroiliitis symptoms, too.

Here are some questions people often ask about UC and sacroiliitis.

Can ulcerative colitis make your back hurt?

Inflammatory bowel disease (IBD), such as ulcerative colitis, can involve symptoms outside the intestines. Joint damage and back pain are common examples.

Can bowel inflammation and colitis cause severe lower back pain?

People with IBD, such as colitis, may experience joint inflammation that can lead to warmth, pain, and tenderness. Over time, it can result in joint damage. Symptoms can range from mild to severe.

Why does my back hurt with colitis?

The same underlying immune problems that cause colitis can also lead to back pain and arthritis.

People living with UC may have a much higher rate of developing sacroiliitis or other joint pain than people who do not have UC.

A person living with UC should talk with their doctor if they notice symptoms, such as pain in the lower back, hips, or pelvis. A doctor will likely refer them to a rheumatologist or other specialist for diagnosis of the condition.

Once the rheumatologist or specialist diagnoses the condition, they will help the person with UC develop a treatment plan to address both their UC and sacroiliitis.