Bowel Urgency in Ulcerative Colitis: Current Perspectives and Future Directions

Am J Gastroenterol. 2023 Nov 1;118(11):19401953.doi:10.14309/ajg.0000000000002404. Epub 2023 Jun 12.


Marla Dubinsky 1Alison Potts Bleakman 2Remo Panaccione 3Toshifumi Hibi 4Stefan Schreiber 5David Rubin 6Axel Dignass 7Isabel Redondo 2Theresa Hunter Gibble 2Cem Kayhan 2Simon Travis 8


Author information

1Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Icahn School of Medicine at Mount Sinai, Icahn School of Medicine, New York, New York, USA.

2Eli Lilly and Company, Indianapolis, Indiana, USA.

3Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada.

4Center for Advanced IBD Research and Treatment, Kitasato Institute Hospital, Kitasato University, Tokyo, Japan.

5Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany.

6The University of Chicago Medicine Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA.

7Department of Medicine I, Agaplesion Markus Hospital, Goethe University, Frankfurt/Main, Germany.

8Experimental Medicine Division, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom .


Bowel urgency (BU), the sudden or immediate need for a bowel movement, is one of the most common and disruptive symptoms experienced by patients with ulcerative colitis (UC). Distinct from the separate symptom of increased stool frequency, BU has a substantial negative impact on quality of life and psychosocial functioning. Among patients with UC, BU is one of the top reasons for treatment dissatisfaction and one of the symptoms patients most want improved. Patients may not discuss BU often due to embarrassment, and healthcare providers may not address the symptom adequately due to the lack of awareness of validated tools and/or knowledge of the importance of assessing BU. The mechanism of BU in UC is multifactorial and includes inflammatory changes in the rectum that may be linked to hypersensitivity and reduced compliance of the rectum. Responsive and reliable patient-reported outcome measures of BU are needed to provide evidence of treatment benefits in clinical trials and facilitate communication in clinical practice. This review discusses the pathophysiology and clinical importance of BU in UC and its impact on the quality of life and psychosocial functioning. Patient-reported outcome measures developed to assess the severity of BU in UC are discussed alongside overviews of treatment options and clinical guidelines. Implications for the future management of UC from the perspective of BU are also explored.

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