What to Know About Bowel Urgency in Ulcerative Colitis

Urgency is the sudden and unexpected need to have a bowel movement. Stool frequency and diarrhea can increase bowel urgency. People with urgency may feel panicked about finding a bathroom and fearful about not making it.

Urgency is associated with bowel incontinence (having an accident). Bowel urgency is much more common during a flare, but people with IBD may also experience urgency while in remission.

Patients consistently rank urgency as a top concern. But there’s a disconnect in how healthcare professionals view this symptom. Healthcare professionals often monitor other symptoms, such as blood in the stool or diarrhea, to assess whether a treatment is working.

According to the Communicating Needs and Features of IBD Experiences (CONFIDE) study published in 2024, healthcare professionals need to give more attention to bowel urgency.

Bowel urgency is not fully understood. The ongoing inflammation during a flare of UC causes changes to the large intestine and rectum. The rectum can become more sensitive, which can trigger the sudden need to have a bowel movement.

Damage from inflammation can cause a buildup of scar tissue through the large intestine and rectum, which changes how the bowel functions. Diarrhea and stool frequency are common during a flare, which can worsen bowel urgency.

A research review from 2020 found that 28.7% of people with UC also have IBS. People with IBS may continue to experience diarrhea and urgency even when their UC is in remission.

Bowel urgency is one of the most common symptoms in UC, with more than 80% of people with UC experiencing bowel urgency. Among people with bowel urgency, around 50% of them experience this symptom on a daily basis. This has a huge impact on a person’s life.

Even during remission, urgency can occur. A 2020 study found that between 35% and 39% of people with UC still experienced urgency even when not experiencing other symptoms.

Bowel urgency can affect your physical and mental health and your social life.

In a survey of 501 people with UC, participants were asked which symptom they most wanted to improve. Bowel urgency was the top answer, with 62.5% of survey respondents choosing this symptom.

In the same survey, 30% of people were hesitant to discuss bowel urgency with their healthcare professional. That means many people aren’t getting the care they need and deserve.

Research suggests that improvements in bowel urgency should be used more often as a measure of remission. People may still experience urgency even as symptoms such as frequency and bloody stools get better. Even when other symptoms improve, bowel urgency is associated with an increased risk of hospitalization and surgery.

The mental health and social impacts of bowel urgency are significant. In a survey of 200 people with IBD, 37% had avoided school or work in the past 3 months due to bowel urgency. Living with UC increases the risk of isolation, anxiety, and depression.

Getting inflammation under control is the most important step in managing urgency. Treatments that ease the inflammation of a UC flare will typically improve bowel urgency too.

Medications that can help to improve bowel urgency include:

• Upadacitinib (Rinvoq): This medication is a Janus kinase (JAK) inhibitor that targets specific immune proteins. It has been shown to improve bowel urgency and induce remission.
• Mirikuzimab (Omvoh): This is a type of monoclonal antibody. A study from 2023 compared mirikuzimab to placebo. Mirikuzimab improved bowel urgency and induced remission in a significant number of patients by week 12 and again at week 52.
• Loperamide (Imodium, others): This medication treats diarrhea and may be especially helpful for patients who also have IBS.
• Tricyclic antidepressants such as amitriptyline, nortriptyline, and desipramine: For people with UC in remission but still experiencing bowel urgency, these medications may help.

The following approaches may also help manage bowel urgency:

• Pelvic floor exercises: Strengthening the muscles in your pelvic floor may be helpful as part of managing urgency. Consider working with a pelvic floor physiotherapist.
• Lower caffeine intake: Caffeine is a stimulant and can increase urgency and diarrhea. Try drinking less coffee and caffeinated drinks to see if this helps.
• Low fiber/low-residue diet: This eating pattern limits high fiber foods. This may help to slow down digestion and reduce urgency. It’s usually intended to be short-term until symptoms subside.
• Low FODMAP diet: There is some evidence that a low FODMAP diet can help to reduce diarrhea, urgency, and incontinence. This diet limits carbohydrates that may cause digestive symptoms in those with IBS.
• Keep a food and symptom journal: Make notes about your food intake, urgency, and any other symptoms. You might start to see some patterns.

It’s important to stay in touch with your healthcare team. If you’re still experiencing bowel urgency despite being in remission, make sure to discuss this with your doctor.

Talk with your doctor about other ways to manage, even if your other symptoms are improving. Ongoing bowel urgency can affect your quality of life.

Bowel urgency is the sudden need to have a bowel movement. It’s a common symptom during a flare of UC and can continue even when you’re getting into remission.

Some medications can help to induce remission and improve bowel urgency. Other approaches may help, too.

If your doctor doesn’t ask you about your bowel urgency, be sure to let them know. You deserve to feel better and get this symptom under control.