When you have ulcerative colitis (UC), bowel issues can develop suddenly or turn into a chronic issue, and one of those difficulties is constipation.
Although diarrhea is a more common issue with UC, constipation can become a problem as well, since the condition may create inflammation in the digestive tract that changes how your nervous system operates. Research suggests between one-third and one-half of people with UC deal with constipation at some point, sometimes during active flares.
If you’re constipated you may have fewer than three bowel movements per week, experience difficulty or discomfort when it does happen, and have stool that's hard, lumpy, or dry. You may also find yourself straining, feeling bloated, or feeling like you didn't get everything out.
What Causes Ulcerative Colitis Constipation?
With UC, inflammation is always a concern with any symptoms, and constipation isn't an exception, says Jakob Saidman, MD , a gastroenterology fellow at Northwell Lenox Hill Hospital in New York City.
"Inflammation can lead to disturbances in the enteric nervous system," Dr. Saidman says. That's the complex network of neurons (nerve cells) in the digestive system that controls gastrointestinal functions. These include contracting muscles to move food through the intestines, regulating blood flow, turning on the immune system when threats are detected, and ensuring that digestive waste gets eliminated. Studies have also shown altered rectal sensation in people with UC, which can contribute to constipation as well.
When this system is disrupted — a situation that can happen more easily with UC — it's like a traffic jam where the signals are mixed up.
"Most often, this creates diarrhea, but it can result in a slow down as well," says Saidman. "However, UC patients may also have constipation for other reasons that are similar to the general population." Those can include:
Even stress can play a role here, since it can affect the enteric nervous system and lead to digestive changes, Saidman says.
How to Manage Ulcerative Colitis Constipation
Although constipation can be uncomfortable, the good news is that there are some ways to manage it. Here's what gastroenterologists recommend as a starting point.
1. Do a Medication Review
Because many types of medication — including some prescribed for UC — can cause constipation, it's helpful to have a conversation with your gastroenterologist or a pharmacist about what could be a possible culprit, says Saidman.
For example, an anti-inflammatory drug class called 5-aminosalicylates (5-ASAs) can help reduce flare intensity and frequency, but they may also lead to constipation for some people, he adds. The most commonly used 5-ASA drug for UC is mesalamine. Also, anti-diarrheal medications may be a factor if they're doing the job a little too well.
Other drugs that aren't for UC but that you may be taking for other conditions might play a role, too, such as:
GLP-1 drugs such as semaglutide (Ozempic) or tirzepatide (Zepbound)
Pain relief meds like opioids and narcotics
Sometimes, one of these meds won't cause a problem on its own, but they may become an issue when taken in combination. That's why doing a medication review is useful, says Saidman.
2. Focus on Fiber
The role of dietary fiber in digestive health isn't just hype. While eating too much fiber can lead to constipation in rare cases, that's much less of an issue than getting too little, says Saidman.
Whether you have UC or not, research suggests dietary fiber can increase stool frequency for those with constipation.
The recommended daily fiber intake for adults is 21 to 38 grams (g), with women typically needing around 21 to 25 g while men usually need 30 to 38 g. Dietary fiber softens your stool and also makes it larger and heavier — this might seem like a drawback, but bulky stool is easier to pass, and that lowers constipation overall.
3. Get More Exercise
Another way to reduce inflammation, improve blood flow in the digestive system, support that enteric nervous system, and reduce stress is to move more often, says Saidman.
"Any type of exercise stimulates the intestinal muscles, and that can have a meaningful effect on moving stool and reducing constipation," he says.
Research suggests exercise can prevent constipation because of its benefits on gut health. That's because it can help to boost peristalsis, which means food doesn't take as long to move through your digestive tract.
4. Train Your Brain
While strategies that get your digestive motor running are helpful, it's crucial to include your brain in the mix, says Ashkan Farhadi, MD, a gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California. The gut-mind connection is powerful, and it can be harnessed with a bit of training.
"You can condition your bowel by setting it up so you expect to go at the same time every day," he says. "The brain loves consistency and predictability, so if you tell the mind that this is the hour for evacuating the bowels, it will do that, and it learns quickly."
For example, let's say you want to have a bowel movement at 7 a.m. every day. Dr. Farhadi suggests sitting on the toilet at that time for 15 minutes, without straining or even trying to poop. Do this every day, even though nothing might happen at first. The point is that every day, you're telling your brain that this is your bowel's "deliver the shipment" time.
"You'd be amazed that after seven or eight days, your body begins to comply," he says. "Your brain begins to anticipate that this is what you want, at that exact time, and it will deliver."
5. Don't Postpone Bowel Movements
Sometimes, constipation happens because you may have been training your brain in a non-helpful way without realizing it, says Farhadi. For example, it's possible that whenever you've had mild urgency about needing to poop, you put it off to a more convenient time. By then, the bowel's nudging sensation may be gone.
"Postponing your bowel movements until they're at a better time is a good way to develop constipation, whether you have ulcerative colitis or not," he adds. "That's because you've been conditioning both your brain and your bowel to regard urgency as unimportant. You stopped listening to your body's signals, and when that happens, the body may adapt by not sending those signals anymore."
6. Talk to Your Doctor
As with any health challenge related to UC, working with your care team is important. Be sure to let your doctor know if it seems constipation is becoming chronic (lasting several weeks) and is affecting your everyday activities, Saidman says. You should also see a doctor if:
You have blood in your stool.
You're losing weight without trying.
Bowel movements cause you severe pain.
The Takeaway
With UC, constipation can occur because of inflammation, but there may be other factors, such as medication complications, food intolerances or allergies, and stress.
Lifestyle changes such as more fiber and more physical activity every day can ease constipation.
Develop routine bowel movement habits to train your brain as well as your body to poop more predictably.
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
Miller C et al. Constipation in ulcerative colitis: Pathophysiology and practical management. Frontline Gastroenterology. August 2020.
Cleveland NK et al. Ulcerative Colitis Patients Have Reduced Rectal Compliance Compared With Non-Inflammatory Bowel Disease Controls. Gastroenterology. January 2022.
Rojas Rojales PC et al. Nutritional knowledge, fiber intake, body mass index, and sex associated with constipation symptoms in Peruvian adults. Scientific Reports. April 12, 2025.
Dietary Fiber: Essential for a healthy diet. Mayo Clinic. December 2024.
Jiahe Cui et al. Physical activity and constipation: A systematic review of cohort studies. Journal of Global Health. November 2024.
Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.
Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.
She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.
Elizabeth Millard is a freelance writer based in northern Minnesota. She focuses on health, wellness, and fitness, and has written for Runner's World, Bicycling, Self, Women's Health, Men's Health, Prevention, Experience Life, and more. She is an American Council on Exercise–certified personal trainer and a Yoga Alliance-registered yoga teacher. She graduated from Harvard University with a bachelor's degree in English.
