For people living with ulcerative colitis (UC), a form of inflammatory bowel disease (IBD), changes in stool are not just an uncomfortable topic—they’re a vital early warning system. Monitoring bowel movements can help you detect a flare before it escalates, allowing for quicker treatment adjustments. This is because UC directly affects the digestive tract, and the nature of your stool is a clear indicator of inflammation.
Understanding Normal vs. UC-Affected Stool
Before discussing flares, it’s important to define what “normal” stool looks like. For those without UC, bowel movements typically range from three times a week to three times a day, with well-formed, easily passable stools (types 3 or 4 on the Bristol Stool Chart).
However, in UC, even during remission, your “normal” may differ. The key is to recognize your baseline and then identify deviations. Any significant change from your usual pattern should be noted.
What to Look For During a UC Flare
During a UC flare, inflammation increases, and this directly impacts stool characteristics. Here’s what to watch for:
- Increased Frequency: You may experience more frequent bowel movements than usual.
- Blood or Mucus: The presence of blood (even small amounts) or excessive mucus is a clear sign of inflammation.
- Urgency: A sudden, strong urge to defecate, sometimes difficult to control, is a common symptom.
These changes are often the first signals that inflammation is returning after a period of remission. Ignoring these signs can lead to a worsening flare.
Consistency Changes
One of the most common indicators of a flare is diarrhea or loose stools. Instead of formed stools, you may pass mushy or completely liquid stool (types 5–7 on the Bristol Stool Chart). This is often accompanied by cramping.
Blood in the Stool
Blood in the stool, known as hematochezia when it’s fresh and bright red, is a sign of active UC. No amount of blood is considered normal, even if it’s only on toilet paper. Darker blood may indicate inflammation higher in the colon.
Mucus and Pus
Inflamed colons produce excess mucus, which may appear as clear, white, or yellowish strands. Yellow or green mucus, or pus, can suggest an infection.
Tenesmus
Tenesmus is the persistent feeling of needing to defecate, even when there’s little or nothing to pass. It signals chronic inflammation in the lower bowel and suggests the disease is not fully controlled.
Other Red Flags
Beyond stool changes, be aware of these additional warning signs:
- Rising urgency or a sudden need to use the bathroom.
- Nocturnal bowel movements.
- Foul-smelling stools, which may indicate malabsorption or infection.
- Abdominal pain or cramping.
- Fatigue and fever.
- Weight loss or loss of appetite.
When to Seek Emergency Care
Not every flare requires the emergency room, but certain symptoms demand immediate medical attention:
- Frequent diarrhea with fever, chills, or dehydration (dizziness, dry mouth).
- Large amounts of bright red or dark maroon stool.
- Severe abdominal pain.
- Signs of toxic megacolon (bloating, rapid heart rate, worsening pain).
These symptoms can be life-threatening and require urgent evaluation.
The Bottom Line
Changes in stool are one of the most reliable ways to detect a UC flare. Tracking your bowel movements, even if it’s uncomfortable, can help you stay ahead of the disease and work with your healthcare team to manage it effectively.
Ignoring these signs can lead to more severe complications, so vigilance is key.
