Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that primarily affects the large intestine, including the colon and rectum. It is characterized by inflammation and tiny open sores, or ulcers, on the inner lining of these organs. While UC is commonly associated with symptoms such as diarrhea, abdominal pain, and rectal bleeding, constipation can also occur.
Ulcerative Colitis and Constipation: The Connection
Although diarrhea is a more frequently reported symptom of ulcerative colitis, constipation can affect individuals with this condition. Inflammation in the large intestine can disrupt normal bowel function, leading to constipation. This less common manifestation often occurs when inflammation is confined to the rectum, a condition known as ulcerative proctitis.
Inflammation within the colon can cause the muscles of the bowel wall to spasm or contract abnormally, impeding the passage of stool. This can create a sensation of urgency without the ability to fully evacuate, or make it difficult to pass stool. In some cases, chronic inflammation can also lead to a narrowing of the colon, which further obstructs stool movement.
Specific Reasons for Constipation in UC
Constipation in ulcerative colitis can stem from several factors related to the disease itself or its management. When inflammation affects the rectum (ulcerative proctitis), it can cause rectal pain and a sensation of needing to pass stool, even when the bowel is empty. This inflammation can lead to spasms in the rectal muscles, making it challenging to fully evacuate, resulting in small, hard stools or the inability to pass stool despite urgency. Pain can also cause individuals to delay bowel movements, leading to stool hardening and increased difficulty.
Certain medications used to manage UC or co-occurring conditions can contribute to constipation. For instance, some antidiarrheal medications, if used improperly, can slow down bowel motility. Iron supplements, often prescribed for anemia in UC, are another common cause. Other UC treatments such as antibiotics, corticosteroids, and immunosuppressants can also have constipation as a side effect.
Dietary adjustments made by individuals with UC, often to manage other symptoms, can inadvertently cause constipation. Patients might restrict fiber intake or avoid certain foods they believe trigger flares, which can remove bulk from the stool and make it harder to pass. Additionally, chronic inflammation and intermittent diarrhea can lead to dehydration, contributing to hardened stools that are difficult to pass. Persistent inflammation can also alter the colon’s normal rhythmic contractions (peristalsis), affecting overall gut motility.
Managing Constipation When You Have UC
Managing constipation in ulcerative colitis requires a careful and individualized approach. Adequate hydration is foundational; sufficient fluid intake helps soften stools and promote easier passage.
Dietary considerations also play a role, though these must be approached cautiously to avoid exacerbating other UC symptoms. A healthcare provider or dietitian can help assess the feasibility of gradually introducing soluble fiber, which adds bulk to stool without irritating the bowel and may help normalize stool consistency. Gentle physical activity, as tolerated, can also stimulate bowel movements and improve overall gut function.
Review all current medications with a doctor, including over-the-counter drugs and supplements, to identify any contributing to constipation. Simple adjustments to medication regimens can sometimes alleviate the issue. Prompt medical consultation is recommended for persistent or worsening constipation, especially if accompanied by new symptoms like severe pain, bloody stools, vomiting, fever, or unexplained weight loss. This ensures potential complications are addressed and treatment is adjusted.