Ulcerative colitis (UC) involves inflammation of the lining of the large intestine. People with UC tend to have pain in the left side of the abdomen or in the rectum. The severity and frequency of pain depend on the extent of the inflammation.

UC is one of the most common forms of inflammatory bowel disease (IBD). As a result of inflammation, tiny sores called ulcers form on the inner lining of the colon. These ulcers may lead to bleeding and the discharge of mucus.

A person with UC might experience abdominal pain and diarrhea and might notice blood in their stool.

The specific location of pain varies depending on the type of UC a person has and the extent of inflammation in the colon. However, UC tends to affect the left side of the abdomen, whereas Crohn’s disease, another common type of IBD, typically affects the right side.

In this article, we discuss the symptoms of UC, including the most likely locations of pain. We also look at the causes, diagnosis, and treatment of the condition. Additionally, this article includes personal insights from Daisy Warner, who lives with UC.

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UC is one of the most common types of IBD, with an incidence of 9–20 cases per 100,000 people per year. It is most prevalent in North America and northern Europe and is more likely to affect adults than children.

Risk factors

The risk factors for developing UC include:

  • Age: UC can occur at any age but is more common among people ages 15–30 and 50–70 years.
  • Ethnicity: People of Jewish descent have a higher risk of UC.
  • Family history: People who have a parent, sibling, or child with UC are more likely to develop it.

Causes

The exact cause of UC is still unclear. However, some factors may contribute to its development, including:

Visit our IBD hub to learn more about UC and similar conditions.

Pain is a common symptom of UC. According to the Crohn’s & Colitis Foundation, 33% of people with UC experience chronic abdominal pain. Therefore, pain management is an important part of the treatment plan.

UC most commonly causes pain in two areas: the rectum and the lower left side of the abdomen. Doctors associate the areas of inflammation with a certain type of UC.

The severity of symptoms can vary over time. People often experience periods of mild or no symptoms, known as remission, alternating with periods of more severe symptoms, known as flare-ups.

Daisy’s story: My UC pain is persistent and concentrated in my lower abdomen

I’ve found that sometimes it’s really hard to distinguish between menstrual cramps and UC pain.
The pain feels like a cramp, but the difference is that I often don’t find relief from UC pain. It feels like a continuous pain that is concentrated in the middle of the stomach, just below the belly button.

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Rectal pain

Rectal pain in UC is often associated with proctitis, which is acute or chronic rectal inflammation.

Common symptoms of ulcerative proctitis include:

  • a constant urge to pass stool
  • diarrhea or constipation
  • cramping or pain in the rectum or the left side of the abdomen while having a bowel movement
  • the passing of blood in the stool
  • mucus in the stool

Left-sided pain

Whether a person experiences pain in the left side of the abdomen depends on the type of UC they have. This symptom may occur in left-sided colitis and proctosigmoiditis.

In people with left-sided colitis, the inflammation begins in the rectum and extends into the colon as far as the bend by the spleen. This results in pain on the left side of the abdomen.

Proctosigmoiditis is similar to left-sided UC, but it affects the rectum and the lower part of the colon, which is known as the sigmoid colon.

Proctosigmoiditis causes symptoms similar to those of left-sided UC, including:

  • bloody stool
  • diarrhea
  • fatigue
  • mucus in the stool

Daisy’s story: My pain is worse on the left side

My pain is often worse in the left of my stomach, and I think that is common for other people with UC.

In my most recent colonoscopy, they found pseudopolyps in the left side. The active disease there had healed, which left scar tissue.

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Learn more about the different types of UC.

Vs. Crohn’s

Crohn’s disease, another common form of IBD, causes pain in a different location than UC. People with Crohn’s disease tend to experience pain in the lower right part of the abdomen.

Learn more about the differences between Crohn’s disease and UC.

People with UC might also experience musculoskeletal symptoms. Pain can be present on both sides of the body, above and below the waist, and in the axial area, which includes the chest, the neck, and the middle and lower spine.

In a 2020 study, people with UC reported more chronic pain in their lower back and hip region than people without the disease. Higher UC disease activity correlated with more pain in all affected body regions.

Chronic UC can affect the peripheral joints and the axial skeleton, leading to pain in other parts of the body, such as the:

  • knee
  • ankle
  • lower leg
  • foot

Daisy’s story: My symptoms affect my joints, mouth, and more

I have pain in my stomach and lower back, leading toward my tailbone.

I also experience joint pain in my fingers and knees, which is why I take calcium and vitamin D supplements. Sometimes I also have skin issues, like breakouts, and I can also have eye issues like itchiness. I can also have painful ulcers and mouth soreness.

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The location of pain will determine the tests that doctors use to diagnose UC. Here are two common options:

  • Colonoscopy: A doctor uses a colonoscopy — a type of endoscopy — to view the lining of the rectum and the entire colon. This procedure can help them diagnose all types of UC based on the area of inflammation.
  • Flexible sigmoidoscopy: This type of endoscopy is particularly useful in diagnosing proctosigmoiditis. It allows doctors to examine the lower rectum and the sigmoid colon.

Other diagnostic tests

Other tests that doctors may use to aid in diagnosis include:

  • Blood tests: Blood tests can be useful to check for signs of UC and other complications. They can help a doctor identify any signs of anemia or inflammation.
  • Stool tests: Doctors use these to check for signs of inflammation that can indicate UC or an infection.
  • Biopsy: This procedure involves analyzing a small portion of tissue from the lining of the rectum and colon.

Learn more about the diagnosis of UC.

There are various treatment options for UC, and the best approach for a person will depend on the severity of their symptoms. Over-the-counter medications can sometimes help relieve the pain that UC can cause, but severe cases require stronger pain relievers.

Daisy’s story: I took Pentasa and steroids for my UC, but I eventually stopped

In the beginning, I took Pentasa (mesalamine). I also took steroid medication, but that didn’t really help in managing my symptoms.

That’s when my mum started researching dietary changes. I was slowly weaned off the steroids but continued to take the Pentasa. Over time, that was slowly reduced too.

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Medications

Medications that a doctor may prescribe to treat UC include:

Doctors may prescribe any of these types of medication for proctitis and moderate cases of left-sided colitis. In more severe cases, a combination of medication types may be necessary.

People who experience certain complications or do not respond to medications may need to undergo surgery.

Learn more about the treatments for UC.

Natural remedies

Some people may also find natural remedies such as the following helpful in treating and preventing UC:

  • Probiotics: The intestines and stomach are home to a significant number of good bacteria that keep harmful bacteria in check. Any imbalance between the two can result in diarrhea and other digestive problems. Probiotics aim to help restore the good bacteria. They are unlikely to cause any side effects in people who are in generally good health.
  • Aloe vera: People worldwide use this tropical medicinal plant in a variety of ways. Aloe vera juice has anti-inflammatory properties and may help treat UC.
  • Curcumin: This is a chemical present in turmeric. It originates from ginger root and can help reduce inflammation.
  • Omega-3 fatty acids: Omega-3 fatty acid supplements can help treat UC due to their anti-inflammatory properties.

Daisy’s story: I make homemade probiotic yogurt and take supplements

I make my own yogurt, and I feel like it makes such a difference. Obviously, this could be the placebo effect, but I think it also shows the power of the good bacteria in your gut.

I also take supplements: calcium, zinc, magnesium, and turmeric, which is a natural anti-inflammatory.

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Learn more about other natural remedies for UC.

Dietary changes

A person can also adjust their diet to try to avoid foods that may result in a UC flare-up. Adjustments that may help include:

Daisy’s story: I follow a specific diet, avoid triggers, and eat snacks

Diet is the biggest thing for me. I follow the SCD diet and avoid gluten, dairy, grains, and really sugary things. I also don’t consume caffeine and avoid spicy foods.

If I’ve had a large meal, that affects me. I used to get very hungry within an hour of eating, so I solved that by having more snacks and small meals, and I find that helps me absorb my food better.

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Learn more about what foods to eat and avoid with UC.

Below, we answer some of the questions that people often ask about UC.

What are the first symptoms a person may experience?

The first symptom of UC is often diarrhea, which may begin slowly or suddenly. Some people also experience abdominal pain and an increased urge to pass stool.

What does the pain feel like?

The intensity of abdominal pain varies from person to person. The abdominal pain feels like a sensation of squeezing and releasing, which people may refer to as cramping. Other parts of the body might hurt as well.

How long does UC pain last?

UC pain varies from person to person. A flare-up can last a few days to weeks in mild cases. A remission period often follows and tends to last at least a few months but can be as long as a few years. However, in severe cases, symptoms may never go away.

Does UC hurt all the time?

UC pain occurs during flare-ups and should be absent or mild during periods of remission. The extent of the pain and the duration and frequency of flare-ups will depend on the severity of the disease.

Ulcerative colitis (UC) is a type of inflammatory bowel disease. The symptoms can vary depending on the severity of the disease. Identifying the location of pain helps doctors diagnose UC and determine the type.

Pain in the left side of the abdomen and rectal pain typically indicate UC. Over-the-counter medications can help treat pain in some cases, but prescription-strength pain relievers or surgery may be necessary to relieve more severe symptoms.

Various medications and natural remedies are available to treat UC. A doctor can advise a person on the best treatment methods for them. A person will need to continue the treatment for the prescribed duration to prevent the relapse of symptoms.