This common symptom of ulcerative colitis (UC) can have a large impact on day-to-day life. Addressing underlying inflammation can help a person manage urgency and other UC symptoms

Bowel urgency is a sudden, urgent, or immediate need to have a bowel movement. It is separate from incontinence, but it can similarly lead to bowel accidents. It often occurs alongside other symptoms, such as abdominal pain, cramping, and fatigue.

Bowel urgency is common in people with UC. Studies have shown that more than 80% of people with UC experience bowel urgency and that it occurs at higher rates in people with active disease.

Here, experts discuss the link between bowel urgency and UC, including steps people can take to help relieve symptoms and improve quality of life with this form of inflammatory bowel disease (IBD).

“In UC, we think of bowel urgency as primarily being driven by inflammation,” explained Megan Lutz, MD, a gastroenterologist and assistant professor of medicine at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin.

Inflammation can have many effects in the colon that can lead to urgency.

“This inflammation can make the rectum more sensitive, which can trigger the sudden need to have a bowel movement,” added Danielle Gaffen, MS, RDN, LD, an IBD registered dietitian nutritionist. “The damage caused by inflammation can also result in a buildup of scar tissue in the large intestine and rectum, altering normal bowel function.”

Lutz said these effects are more common in people with UC than in those with other forms of IBD. This is because UC affects the rectum, which plays an important role in holding in stool.

“When the rectum is inflamed, we can see urgency, diarrhea, and blood in the stool,” she said.

“Common symptoms like diarrhea and increased stool frequency during a flare can also exacerbate bowel urgency,” Gaffen added.

“I always ask my patients about bowel urgency because it can have a huge impact on quality of life,” said Lutz. “It can make people nervous to leave the house because they are fearful they may find themselves running to the bathroom or not be able to control a bowel movement.”

“Many individuals may avoid school, work, or social situations due to the fear of having an urgent need to use the bathroom,” Gaffen noted. “This avoidance can lead to feelings of embarrassment and low self-esteem, and the fear of bowel urgency can make it difficult to maintain social relationships and participate in normal daily activities.”

In a 2022 study involving more than 600 people with UC, those who experienced bowel urgency were more than twice as likely to report feelings of anxiety or social impairment as those who did not. Those with bowel urgency were also more than three times as likely to report feelings of depression.

These rates were even higher in people who experienced bowel incontinence.

Gaffen added that the need for frequent bathroom breaks can disrupt routines and reduce productivity, creating additional challenges at work, school, and home.

“In UC, the first step in treating bowel urgency is treating inflammation,” Lutz explained. “If we can control inflammation, this typically improves urgency significantly.”

In some studies of medications used to control inflammation in UC, researchers have specifically focused on the effects of treatment on bowel urgency symptoms and have seen an improvement.

For instance, in two 2023 studies on upadacitinib (Rinvoq) in UC, the percentage of participants without bowel urgency increased from 8% to 35.8% after 2 weeks of treatment. And up to two-thirds of participants reported no bowel urgency with long-term treatment (up to 52 weeks).

Participants also experienced improvements in bowel urgency in two 2023 studies on the effects of mirikizumab (Omvoh) for UC treatment.

“At times, urgency may persist even when the inflammation is controlled,” added Lutz. “In this case, we may need to look at other treatments, such as modifying diet or working with a physical therapist to help strengthen the muscles that help control a bowel movement.”

“Dietary changes, when combined with other UC treatments, can significantly improve symptom management and quality of life,” explained Gaffen. “By tailoring diet to one’s individual needs and working with one’s healthcare team, one can better control bowel urgency and other symptoms of UC.”

“Working with a dietitian who specializes in IBD can help people with IBD choose the best foods for their unique needs, ensuring that their diet complements your medical treatments,” Gaffen emphasized.

For her clients with UC and bowel urgency, Gaffen suggests eating small meals or snacks every 3 to 4 hours.

“Avoid skipping meals,” she said.

She also recommends choosing a variety of foods to support a balanced diet.

“This helps in maintaining overall health and supporting the body’s needs during flares and remission,” she said.

“Keep in mind that tolerance for certain foods varies among individuals with IBD,” Gaffen added. “Also, food choices may change depending on whether IBD is in a flare or remission state.”

In general, she suggested that people with UC may need to avoid common inflammatory triggers, such as:

  • foods or beverages high in fats or sugars
  • ultra-processed foods
  • fried foods
  • lactose
  • caffeine
  • alcohol

These can worsen diarrhea and increase the likelihood of bowel urgency, she said.

Research suggests that bowel urgency is one of the main reasons people with UC may be unhappy with their current treatment plan. However, many people do not discuss these symptoms due to embarrassment.

“I have found that at times patients are hesitant to bring up this symptom, but if you are experiencing bowel urgency, tell your healthcare provider,” Lutz emphasized.

“If bowel urgency is significantly affecting daily activities, such as work, school, or social interactions, it is important to discuss these impacts with a healthcare professional,” Gaffen agreed. “Quality of life considerations are crucial, and medical care can help manage and mitigate these symptoms. Early intervention can prevent complications and help manage the condition more effectively.”

“There are many potential causes for urgency in addition to UC, and typically there is a great deal that can be done to make this better,” added Lutz.

Gaffen emphasized that people who are experiencing bowel urgency, with or without a UC diagnosis, should talk with a healthcare professional if the urgency lasts for more than a few days and does not improve.

“Persistent symptoms may indicate an underlying condition that requires medical attention,” she said.

She recommended that people “seek immediate medical care if bowel urgency is accompanied by other symptoms,” such as:

  • severe abdominal pain
  • blood in the stool
  • fever
  • unintended weight loss

“These symptoms can indicate a more serious condition that needs prompt evaluation,” she added.

Bowel urgency is a common symptom in UC that can significantly affect a person’s physical, emotional, and social health. Treatments for UC can help improve this symptom but may not provide complete relief. People can take additional steps, such as dietary changes, to manage bowel urgency in UC.

It is important for people with UC to communicate with their healthcare team about their symptoms, even if they feel embarrassed. If a healthcare professional does not ask about bowel urgency, make sure to bring it up.