Bowel urgency is common in adults with ulcerative colitis (UC), especially among those without diarrhea or rectal bleeding, and is associated with disease-related disability, according to a study published recently in Gastro Hep Advances.
Chung Sang Tse, M.D., from the University of Pennsylvania in Philadelphia, and colleagues hypothesized that bowel urgency is associated with disease-related disability and influenced by psychosocial factors in a study involving 241 adults with UC. Baseline disease symptoms and psychosocial factors associated with disability were assessed using cross-sectional data from the Addressing Disability Effectively with Psychosocial Telemedicine trial.
Overall, 48 percent of patients had moderate-to-severe bowel urgency; among those without diarrhea or rectal bleeding, 75 percent experienced bowel urgency. The researchers found a strong correlation between bowel urgency and disability (ρ = 0.597), with negative illness perceptions, lower self-efficacy, and more health-related social needs mediating the association. Forty percent of the variance in disability was explained by gastrointestinal symptoms; psychosocial factors accounted for an additional 19 percent.
“Psychotherapists who treat patients with inflammatory bowel disease should be aware of the link between fecal urgency and inflammatory bowel disease-related disability, especially as fecal urgency may underlie or exacerbate social anxiety and behavioral avoidance,” the authors write.
Several authors disclosed ties to the biopharmaceutical and nutritional industries.
Traditional ulcerative colitis assessments focus heavily on endoscopic findings and clinical remission. Symptoms like bowel urgency — a sudden, strong need to pass stool that is difficult to delay — can significantly affect daily functioning even when inflammation appears controlled. The fear of accidental leakage may cause patients to be hypervigilant, embarrassed, and panicked, significantly increasing the risk of anxiety and depression. It can also lead patients to avoid travel, meetings, social gatherings, or physical exercise for fear that a sudden, uncontrollable urge will strike. Bowel urgency can also cause physical complications such as rushing or straining, which can lead to skin irritation around the anal area from frequent moisture or leakage.
The findings reinforce the value of incorporating patient-reported outcome measures in routine care. Clinicians may need to evaluate urgency separately from stool frequency and rectal bleeding, especially since more than 80 percent of patients with UC can experience bowel urgency even in the absence of diarrhea or visible bleeding.
While UC was once considered more common among white patients, incidence and prevalence have risen among Black patients. Research suggests that Black patients often experience delays in diagnosis, reduced access to gastroenterology specialists, and disparities in advanced treatment use.
When symptoms like bowel urgency interfere with a patient’s work, social activities, and quality of life, they can have an outsized impact, especially when care barriers already exist.
Although the study didn’t specifically focus on racial differences, its findings highlight the importance of routinely discussing bowel urgency with all patients, including groups historically underrepresented in inflammatory bowel disease (IBD) research.
The latest findings suggest clinicians may need to consider bowel urgency when defining treatment success for patients with UC, expanding symptom management beyond mucosal healing alone. Persistent urgency could signal ongoing disease burden even when other clinical measures improve. Future therapeutic approaches and clinical trials may increasingly incorporate urgency as a meaningful endpoint.
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