Managing Severe Bowel Issues: Coping with Ulcerative Colitis Symptoms

Inability to have a bowel movement, but experiencing continuous watery stool?

Hello Doctor, I have ulcerative colitis affecting my sigmoid colon and have been holding a major illness card for 8 years.
I have been on medication and under follow-up for the past 6 years.
I undergo a colonoscopy every year, and during my most recent visit last month, my attending physician mentioned that even the smallest endoscope could not be inserted due to the extensive ulceration, recommending a total colectomy.
I experience bowel movements more than five times a day, and the stools are thin and short due to intestinal atrophy.
As this is an autoimmune disease, I am prone to colds and illnesses.
Although I have gotten used to it, there have been a few instances of similar symptoms that I do not know how to alleviate, which have only occurred occasionally in the past year.
When I have a cold with a fever (around 100.4°F), I experience persistent dull pain in my lower left abdomen, occasionally sharp pain that can last all day.
I also have constant urges to defecate but cannot pass anything, and I cannot release gas, although I can hear my stomach making gurgling sounds as if gas is building up inside.
If I leave the bathroom to sit on a chair or lie down, liquid stool will slowly leak out, requiring me to use sanitary pads.
Whenever I feel the urge to defecate, I rush to the bathroom, and if I'm lucky, I might pass a little liquid stool, which is completely unformed and dark red in color.

At night, I often wake up due to the urge to defecate, rush to the bathroom, but cannot pass anything, and there is a significant rumbling sound in my abdomen.
Sometimes, I wake up and rush to the bathroom, and before I can even take off my pants, a large amount of liquid stool comes out, but when I genuinely try to defecate, I cannot.
This has happened 2-3 times this year, mostly when I am sick with a cold.
Medication has not improved the situation, and it seems to resolve only when I can finally expel the stool forcefully.
I have mentioned this situation to my attending physician, who has prescribed medication, but it seems ineffective, and they suggested further observation.
I would like to ask if there are other ways to alleviate this condition.
Thank you for your help!

Sunny, 20~29 year old female. Ask Date: 2017/07/07

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, Miss.
Your condition is complex; please discuss it further with your attending physician.
If there is severe stenosis, surgery may be necessary.
Changhua Hospital cares about your health.
Chen Shidian.

Reply Date: 2017/07/07

More Info

Managing severe bowel issues, particularly in the context of ulcerative colitis (UC), can be incredibly challenging and distressing. Your symptoms, including frequent bowel movements, urgency, and the presence of blood in your stool, indicate that your condition may be exacerbating, especially given the history of extensive ulceration and the recommendation for total colectomy. Here’s a comprehensive overview of your situation and potential coping strategies.

Understanding Ulcerative Colitis
Ulcerative colitis is a chronic inflammatory bowel disease (IBD) characterized by inflammation and ulceration of the colonic mucosa. It can lead to various symptoms, including abdominal pain, diarrhea (often with blood or mucus), and urgency. The disease is autoimmune in nature, meaning that the body’s immune system mistakenly attacks its own tissues, leading to inflammation.

Prognosis and Treatment Options
1. Prognosis: The prognosis for individuals with ulcerative colitis varies widely. Some patients may experience long periods of remission, while others may have frequent flare-ups. The extent of the disease and the response to treatment play significant roles in determining the long-term outlook. In severe cases, like yours, where extensive ulceration is present, surgical intervention may be necessary.

2. Surgical Considerations: The recommendation for total colectomy is often considered when medical management fails to control symptoms or when there is a risk of complications such as colorectal cancer. While the thought of surgery can be daunting, many patients report significant improvement in quality of life post-surgery. It’s crucial to discuss the potential outcomes and lifestyle changes with your healthcare provider.

Managing Symptoms
Given your current symptoms, here are some strategies that may help alleviate discomfort:
1. Medication Review: It’s essential to have an ongoing dialogue with your healthcare provider regarding your medications. If current treatments are ineffective, you may need to explore alternative medications, including biologics or immunosuppressants, which have shown efficacy in managing UC.

2. Dietary Adjustments: Certain foods can exacerbate symptoms of ulcerative colitis. Keeping a food diary may help identify triggers. Generally, a low-residue diet can help reduce bowel movements and improve stool consistency. Foods that are easier to digest, such as bananas, rice, applesauce, and toast (the BRAT diet), may be beneficial during flare-ups.

3. Hydration: Frequent diarrhea can lead to dehydration. Ensure you are drinking plenty of fluids, and consider electrolyte solutions to replenish lost minerals.

4. Stress Management: Stress can exacerbate UC symptoms. Techniques such as mindfulness, yoga, and meditation may help manage stress levels. Engaging in regular physical activity, as tolerated, can also improve overall well-being.

5. Symptom Tracking: Keeping a detailed log of your symptoms, including bowel habits, pain levels, and any associated factors (like illness or stress), can provide valuable information to your healthcare provider and help tailor your treatment plan.

6. Emergency Plan: Given the urgency and frequency of your symptoms, it may be helpful to have an emergency plan in place. This could include knowing the nearest restroom locations when out and about and carrying extra supplies (like pads) for accidents.

When to Seek Immediate Help
If you experience severe abdominal pain, significant changes in bowel habits, or signs of dehydration (such as dizziness, dry mouth, or reduced urination), it’s crucial to seek medical attention promptly. Additionally, if you notice any signs of infection (fever, chills, or worsening symptoms), contact your healthcare provider.

Conclusion
Living with ulcerative colitis can be a complex journey, especially when faced with severe symptoms and the possibility of surgery. It’s essential to maintain open communication with your healthcare team, explore all treatment options, and implement lifestyle changes that may help manage your symptoms. Remember, you are not alone in this, and support from healthcare professionals, family, and support groups can make a significant difference in coping with this condition.

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