Ulcerative Colitis Symptoms and Concerns in Females

Medically Reviewed By Saurabh Sethi, M.D., MPH
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Ulcerative colitis (UC) poses health concerns for women. They may experience additional symptoms due to their menstrual cycles, as well as vaginal complications and concerns about the effects of UC treatment on fertility and pregnancy. UC is a chronic inflammatory bowel disease (IBD) affecting the lining of the large intestine, also known as the colon. This includes the rectum. Symptoms include:

UC usually becomes apparent between the ages of 30 and 40, and affects all genders equally. Occurences of UC are growing worldwide.

This article discusses UC symptoms in females and health concerns unique to women.

Sex and gender exist on spectrums. This article will use the terms “female” and “women” when discussing people assigned female at birth to reflect language that appears in source materials.

More people search using the term “women,” so this is used throughout the piece to reflect that trend.

Learn more about the difference between sex and gender here.

Symptoms of ulcerative colitis in females 

middle aged woman sitting outdoors with a shawl around her shoulders
Eloisa Ramos/Stocksy United (person appearing is a model and used for illustrative purposes only)

Females who menstruate may notice that UC symptoms are more severe before and during their periods.

UC symptoms include:

  • diarrhea
  • blood, mucus, or pus in the stool
  • rectal bleeding
  • abdominal cramping
  • urge to have a bowel movement even when the bowels are empty
  • urgency when needing to have a bowel movement
  • with severe disease:

On the other hand, UC may increase the likelihood or intensity of premenstrual symptoms, particularly headache and menstrual pain.

In both men and women, UC symptoms sometimes disappear during periods of remission, which can last anywhere from weeks to years.

After a time of UC remission, you may have a return of symptoms during a relapse. Certain treatments can help manage the severity and frequency of flares.

Keep track of your symptoms, when they occur, and how severe they are. If you notice the severity of your symptoms increases at certain times, talk with your medical professional about ways to manage them.

Read Managing the Symptoms of Ulcerative Colitis.

Females with UC face additional challenges beyond gastrointestinal and premenstrual symptoms.

Sexual health

UC may impact your sexual health. According to a 2017 study, 53.6% of women with IBD experienced sexual dysfunction, compared with 28% of women without IBD but with equivalent levels of sexual relationships. The areas most impacted include:

  • desire
  • arousal
  • orgasmic function

In comparison, 16.9% of men with IBD reported erectile dysfunction, compared with 7.4% of men without IBD.

Contributing factors

Anxiety and depression are common in people with UC, and also play a role in sexual dysfunction. In the 2017 study mentioned above, anxiety was a predictor for women reporting sexual dysfunction.

Fatigue is another factor that can affect sexual health. UC can cause fatigue, as can a variety of other situations and conditions, from inadequate sleep or stress.

If you suspect you could have anxiety or depression, consider contacting a counselor or therapist. Some therapists specialize in counseling women who have UC.

Body image and intimacy are concerns for females with ulcerative colitis. According to a 2019 research review, 40% of people with IBD reported that their disease stops them from pursuing intimate relationships. Women who had IBD surgery reported low body image as well.

Consider talking with your partner about your feelings. This may clear up misunderstandings and create deeper intimacy. 

If you have an external pouch, here are some tips:

  • Empty your pouch before sex.
  • Use a deodorizer product in your pouch.
  • Consider wearing a pouch cover or piece of clothing that covers the pouch and that you feel comfortable in during sex.
  • Try different positions for sex if you experience pain or if the pouch is in the way.

Fertility and pregnancy

Most medical treatments to treat ulcerative colitis and IBD do not affect the initiation of conception. However, females with ulcerative colitis may be more likely to choose not to have children due to:

  • apprehension about fertility
  • worries about medication safety during pregnancy
  • fears about how pregnancy will affect their UC 

During a flare-up, a woman may have a harder time getting pregnant. A flare-up during pregnancy carries a slightly higher chance of premature birth, low birth weight, and cesarean delivery. 

If you plan to get pregnant, talk with your gynecologist and the medical professional who treats your condition. They may change the types or amounts of medications you take while you are pregnant or chestfeeding.

For example, methotrexate and thalidomide may cause developmental issues for a fetus, so avoid taking these medications during pregnancy and chestfeeding.

Rectovaginal fistula

A fistula is an atypical opening between two organs or body parts that usually have no connection. Females with UC sometimes develop a fistula between their rectum and vagina, known as a rectovaginal fistula. This can allow fecal matter from the colon to leak into the vaginal area, increasing the risk of infection and other complications.

A rectovaginal fistula also may make it more difficult to deliver a baby vaginally. Rectovaginal fistulas are rare complications, however, affecting only about 0.5–2.2% of females with UC. Treatment may involve surgical repair. 

Anemia

Anemia is a common complication in people with IBD. Several factors may cause this, including a difficulty absorbing iron and gastrointestinal bleeding.

Anemia is a low red blood cell count. Women, in general, may be at higher risk of anemia during childbearing years. Having UC further increases the chance of anemia. 

Being anemic may cause you to feel weak, dizzy, cold, and tired. It may also cause your skin to look paler than usual. Talk with your medical professional if you have symptoms of anemia. They will discuss possible treatment plans with you. 

Osteoporosis

Osteoporosis is a condition of less dense and weakened bones that fracture more easily. Women past menopause tend to be at higher risk of osteoporosis. Females with UC can have an even higher risk because of treatment with steroids and difficulty with nutritional absorption.

Learn about preventing osteoporosis.

Treating ulcerative colitis

The goal when treating UC is to reduce the frequency and severity of flare-ups. The first line of treatment typically includes medications. The severity of your condition determines which medications your physician prescribes.

Severe UC may require surgery to remove a portion of the large intestines. Learn more about UC treatments

Inform your doctor if you are planning a pregnancy or think you could be pregnant.

Additionally, discuss with your doctor any challenges you experience, such as effects on your sexual health or intensity of symptoms, that could relate to UC or its treatment. Together, you may need to adjust your treatment plan.

Close monitoring and management of UC can help minimize its effects on your life.  

Prepare for your next UC appointment with this guide.

Frequently asked questions

Saurabh Sethi, MD, MPH reviewed the following questions.

How do you know if you have ulcerative colitis? 

UC may cause you to have:

  • frequent bloody stools
  • diarrhea
  • abdominal pain
  • unexplained weight loss

Contact a medical professional for an accurate diagnosis if you experience these symptoms. 

How do doctors test for ulcerative colitis?

Medical professionals diagnose UC by performing an endoscopy of your colon. A physical exam and blood and stool tests will be part of a comprehensive evaluation to help rule out other possible causes of symptoms.

Summary

Ulcerative colitis is a chronic inflammatory condition of the colon. It may cause symptoms such as bloody diarrhea, abdominal pain, and unexplained weight loss. Women with ulcerative colitis also face additional challenges related to their menstrual cycles, sexual health, and bone health. 

Speak with your medical professional about your concerns and if you plan to become pregnant. 

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Medical Reviewer: Saurabh Sethi, M.D., MPH
Last Review Date: 2022 Sep 26
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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