Not Just a Pain in the Ass: Here's Where Ulcerative Colitis Pain Can Happen

UC is a chronic condition and one of the more common IBDs (other IBDs include Crohn’s disease, which shares a few symptoms with UC).

While UC can be managed, there’s currently no cure. It’s a complex condition broadly characterized by persistent inflammation of the lower intestine. Small ulcers develop due to the inflammation that cause (among other symptoms) significant pain and discomfort. Sometimes the pain is continuous, others it’s mild unless there’s a flare-up.

Estimates are that between 600,00 and 900,000 in the US live with Ulcerative Colitis. You’re not born with UC. It normally develops between ages 15-30, but can appear at any point in life. Some people’s UC gradually develops, while others are hit with full force almost overnight.

UC can lead to complications pretty quick, some of which are fatal, so it can’t be left untreated.

Pain is the main symptom of UC. Folks with UC commonly report experiencing aches, cramps, burning sensations, and other chronic discomforts in key areas. The location and severity of UC pain depend on which part of the large intestine is inflamed and ulcerated.

Left-side pain (aka left side colitis)

Pain in the left abdominal region for peeps with left-sided colitis. This is ulcerative colitis that inflames the length of GI tract, from the rectum all the way up the colon to the bend near the spleen. Since this bit of intestine is on your left side, that’s where the pain is.

Rectal pain (aka ulcerative proctitis)

Ulcerative colitis can cause proctitis – the fancy name for acute and/or chronic rectal inflammation. If the inflammation from UC doesn’t reach the colon the pain can feel acutely concentrated at your rectum, especially when you poop.

The severity depends on the level of inflammation and ulceration though, so it’s not an either/or. The rectal pain can be intense enough to be easily distinguishable from the left-side colon-based discomfort.

Associated pain

Everything in the body is connected, so pain in other non-digestive regions isn’t unheard of with UC. According to research pains in the hips, lower back, and feet are experienced by some peeps managing UC. General musculoskeletal discomfort is also pretty common.

One risky complication of UC is cerebralvenous thrombosis (CVT), which causes severe migraines and can be fatal (so if your UC flares come with headaches, speak to your doc ASAP). This extremely rare condition happens because UC creates chronic inflammation in the body, which increases the risk of creating blood clots.

Science hasn’t pinpointed a main cause of UC. It’s not a contagious disease, but there are a number of factors that possibly lead to developing it. Some of the known catalysts for UC are:

• Genetics. It’s been proven that UC has a genetic/hereditary factor, with 10 to 25 percent of folk with UC belonging to a family that includes at least one other person with Ulcerative Colitis or a similar IBD (like Crohn’s disease).
• Immune system issues. General medical consensus is that UC is partly an autoimmune condition. TL;DR- your immune system goes OTT and attacks your own body, which makes the large intestine inflammation happen.
• Environmental factors. There’s no direct “environmental factor = instant UC” link, but stuff like smoking, air pollution, and alcohol are all known to increase risk of developing Ulcerative Colitis (as well as nearly all the other bad health things, let’s be real).
• Composition of bacteria in the gut. Some studies suggest reduced amounts of specific gut bacteria and secondary bile acid may be a causal factor in UC. These findings are pretty recent though, so more research is needed.

Ulcerative Colitis Risk factors

Anyone can develop ulcerative colitis. UC onsets are most common between ages 15-30 but can occur any time, and gender doesn’t appear to be a factor in risk level (although IBDs tend to be more commonplace among female-bodied peeps in the US). Despite UC lacking a target market, there are certain factors that make some lower intestines more at risk from UC than others.

• Smoking. Smoking = bad for you. You can add Ulcerative Colitis to the list of conditions it increases your risk of developing.
• Alcohol. There’s some evidence that prolonged/excess alcohol consumption might increase risk of IBDs. More research is needed into UC specifically, but if proved true would track with alcohol’s habit of being linked to health problems.
• Environmental Pollutants. Pollutants and toxins in the environment, such as air pollution or chemicals in some water supplies, increase UC risk. Research has shown this time and time again.
• Hereditary Risks. Probably the highest risk with UC is having close family members with UC. Genetics determine autoimmune response, gut bacteria, how we process alcohol and toxins – basically everything else that’s a UC risk/causal factor. If your family member has a UC-making DNA helix your chances of doing so too are, for obvious reasons, higher.

While there isn’t a cure for ulcerative colitis yet, there are ways to treat the inflammation and discomfort. In most UC cases the pain is at its worst during a flare-up, and some peeps are completely pain-free outside of these times. Pain treatment involves a mix of reducing the risk of painful flare-ups and the discomfort experienced during them.

Some treatments are medical interventions, while others are lifestyle and self-management techniques. Here are some effective options:

• Dietary changes. Diet is an essential part of treating all IBD and UC is no exception. UC diets can be complex and quite restricting sadly, but they do work. They generally include keeping processed, greasy, fatty, or sugary foods to a minimum, cutting out gas-making veg, and putting a kibosh on the caffeine and alcohol. Keeping a food diary helps!
• OTC medications. There’s a lot of over-the-counter pain relief that’s fine to take, but the ones to avoid are nonsteroidal anti-inflammatory drugs (NSAIDs). They can cause flare-ups and make your pain worse, the exact opposite reason you took them in the first place. Some common NSAIDs include ibuprofen, aspirin, and naproxen. Household pain-stopper acetaminophen (Tylenol) is A-OK though.
• Stress management. Stress and the digestive system are linked, and for UC this means stress can be a flare-up trigger. On the flip side, that means taking practical steps to chill TF out can also reduce UC pain. More research is needed to scientifically confirm or figure which stress-busters work best, but anecdotally many peeps with UC report that yoga or mindfulness exercises have a positive impact on their pain levels.
• Anti-inflammatory medications. Since inflammation is UC’s M.O., it makes sense that anti-inflammatory meds reduce the pain it causes. These aren’t available OTC and will be prescribed by your doc. Some common types of anti-inflammatory medications for ulcerative colitis include corticosteroids like prednisone or hydrocortisone, or aminosalicylates like mesalamine or sulfasalazine.
• Immunosuppressant medications. Immunosuppressants do their thing by forcing your immune system to chill out and stop triggering painful inflammation for no damn reason. They’re only meant for short-term use since they can damage the liver and pancreas, as well as a number of other side effects. Chances are your doc won’t prescribe these unless they have to, normally if you don’t respond well to other treatments. Some examples include azathioprine, mercaptopurine, and cyclosporine. Immunosuppressants sound scary, but thousands of people take them every day with no issues.

Chronic pain in the rectum and/or lower left abdomen is the defining symptom of UC, so pain management is integral to treating the condition.

There are a number of ways to treat UC pain. Some OTC meds work, as do lifestyle changes like a UC-friendly diet or stress reduction. In more severe cases your doc may prescribe anti-inflammatory or immunosuppressant medications.

UC has a number of possible causes and there’s sadly no cure. However our understanding increases every year, and recent developments such as framing UC as a deficiency/misbalance of bacteria in the gut could lead to more ways of treating UC pain getting discovered in the near future.