Ulcerative Colitis Pain Location and Treatment

For some people, ulcerative colitis (UC) pain is more intense on the left side of the body. However, UC pain can occur throughout the abdomen and in other areas.

Ulcerative colitis (UC) is a condition that causes tiny open sores in the large intestine. These sores can flare up, leading to abdominal cramps and pain. Although pain is common in the abdomen, you may also experience it in your rectum, joints, or skin.

Your physician can help you create a treatment plan to manage pain from UC and reduce flares. This may include medication as well as dietary changes. 

In this article, you will learn about the types and locations of UC pain and when to contact a doctor. This article will also discuss treatment strategies and answer some common questions about UC pain.

UC is a chronic inflammatory disease of the large intestine, or colon. It causes small sores, or ulcers, to form on the colon’s innermost lining. These ulcers produce mucus and pus, resulting in abdominal pain.

UC develops most often in people ages 15–30, but it can start at any age.

The condition is unpredictable. People with UC can enter remission, going weeks, months, or even years without any symptoms.

UC pain primarily occurs in the abdomen. More than 50% of UC patients experience abdominal pain. Pain can range from mild to severe, and usually comes and goes over time. These are known as flares.

UC may affect the entire colon, causing pain in a large part of your abdomen. The pain may be more intense on the left side of the abdomen.

Abdominal pain can be caused by other conditions. Because of this, doctors may use additional methods to diagnose a flare caused by UC. The abdomen extends from the lower chest to the groin, and contains many other organs besides the colon.

The colon by itself is about 5 feet long and makes up a large portion of the abdomen. Although it is one continuous structure, medical professionals have names for different portions according to the direction food waste is moving.

• Ascending colon: This begins in the lower right of the abdomen and continues up to the center right of the abdomen.
• Transverse colon: This moves across the center of the abdomen to the left side.
• Descending colon: This proceeds down the lower left abdomen.
• Sigmoid colon: This is an S-shaped structure that connects with the rectum.
• Rectum: This extends about 6 inches to the anal canal, which is about 1 inch long.

UC affects the colon and rectum, which is the last part of the colon. In fact, the Canadian Society of Intestinal Research states that UC “always begins at the anus” and moves upward as the disease progresses.

If you have mild UC, the inflammation will extend about 8 inches up from the anus. You may only feel pain in your bottom and lower to lower left abdomen.

UC may cause inflammation in other parts of the body that results in pain. These areas include the:

Learn more about other UC symptoms.

Treatment for UC pain typically involves medication along with dietary changes. The goal is to reduce or eliminate pain and achieve remission.

Medications that help reduce or eliminate inflammation can greatly improve pain caused by UC. This is because reducing inflammation can stop the formation of ulcers. These medications include:

• aminosalicylates, which help prevent inflammation
• corticosteroids, which suppress the immune system to prevent it from overreacting 
• immunomodulators, which decrease inflammation 
• biologics, used to stop specific proteins that cause inflammation 
• Janus kinase inhibitors (JAK inhibitors), which can induce and maintain remission

Over-the-counter (OTC) medications such as acetaminophen (Tylenol) can help reduce joint pain. Always talk with your physician first before taking OTC medications.

Other types of medications for managing UC pain include:

• tricyclic antidepressants
• SNRIs
• other neurological medications such as gabapentin (Gralise, Neurontin) and quetiapine (Seroquel)

Learn about antidepressants.

UC may come and go unexpectedly. Because of this, adjusting your diet to help reduce symptoms can be difficult. However, paying attention to what you eat, especially when flares occur, may help to manage symptoms, such as diarrhea.

Keeping a food diary may also help you identify foods or liquids that make symptoms worse. You can share your food diary with your doctor.

To manage flares, your physician may recommend certain dietary changes at different times, according to the Crohn’s and Colitis Foundation. These can include a low-salt, low-fiber, or lactose-free diet.

The following tips may also also help with pain caused by UC:

• Eat frequent, smaller meals.
• Eat bland, soft foods.
• Avoid carbonated drinks to prevent gas.
• Reduce or eliminate caffeine to prevent diarrhea.
• Reduce or eliminate greasy or fried foods to prevent gas and diarrhea.
• Limit your intake of certain high fiber foods, such as seeds, nuts, and raw vegetables.

Learn about the best and worst foods for UC.

Sometimes, surgery can help treat a specific source of UC pain, such as with a colon stricture, or narrowing of the colon. Additionally, your doctor may recommend surgery to remove part or all of the colon. However, this is usually only when medications do not reduce the frequency or intensity of flares and pain.

Contact your healthcare professional promptly if you experience abdominal or rectal pain along with other symptoms of UC. Even if you already have a UC diagnosis, new or ongoing pain may indicate a flare or other condition that should be evaluated.

If you experience persistent diarrhea, severe bleeding in the rectum, or persistent vomiting, seek immediate care by calling 911 or having someone take you to the nearest emergency room.

To diagnose pain that may be due to UC, your doctor will start with a physical examination. This will include listening to sounds in your abdomen and feeling for tenderness or masses.

Your doctor may also recommend tests to confirm the diagnosis. These can help rule out other conditions, such as anemia, infection, irritable bowel syndrome, or Crohn’s disease. Tests may include:

• blood tests
• stool tests
• colonoscopy
• imaging tests such as an MRI scan

Cynthia Taylor Chavoustie, MPAS reviewed the following questions.

UC pain can feel like cramps in the abdomen, which you may experience before or during a bowel movement. Some people may also feel joint pain. This can depend on the degree of colitis but can also occur without ongoing inflammation.

UC pain often comes and goes in an intermittent pattern referred to as flares.

Learn more about UC flares.

UC pain primarily occurs in the abdomen and rectum. It can be more intense on the left side and before or during bowel movements. Inflammation can also lead to joint and skin pain. Treatment for UC pain includes medications and dietary changes to manage flare symptoms.

UC is a chronic condition with no cure. However, periods of remission usually occur and may last weeks or years.

If you suspect your pain is due to UC, contact a healthcare professional for a physical examination. Following a diagnosis, talk with your doctor about creating a treatment plan. This can help reduce or eliminate pain and may lead to remission.