Bowel Urgency in Ulcerative Colitis is Independently Associated with Histologic Inflammation and Stool Form Despite Endoscopic Remission

Background: Bowel urgency (BU) is a distressing symptom in patients with ulcerative colitis (UC), yet its associations with disease activity and patient-reported outcomes remain unclear. This study aimed to provide the first comprehensive evaluation of these relationships. Materials and Methods: Between September 2024 and March 2025, we enrolled 100 patients with UC. Patients were stratified into two groups based on the Urgency Numeric Rating Scale (NRS): bowel urgency–active (BU-A; NRS > 1) and bowel urgency–remission (BU-R; NRS ≤ 1). Clinical parameters including the partial Mayo score, Mayo endoscopic subscore (MES), Nancy Index (NI), Bristol Stool Form Scale (BSFS), and IBD Disk score were evaluated. Logistic regression analyses were performed to identify independent predictors of active BU. Results: 50 patients were in BU-A, and 50 in BU-R. Endoscopic remission (MES=0) occurred in 14% of BU-A and 34% of BU-R; Histological remission (NI = 0) in 10% and 36%, respectively. Stool consistency was predominantly normal (Bristol types 3– 5) in both groups (60% of BU-A, 72% of BU-R); however, type 6– 7 stools were significantly more frequent in the BU-A group (36% vs 6%, P < 0.001). The BU-A group also had significantly higher partial Mayo scores, MES, NI, and total IBD Disk scores (25.3 ± 20.0 vs 12.0 ± 14.9, P < 0.001). In multivariate analysis, higher NI (OR: 1.874; 95% CI: 1.277– 2.750; P < 0.001) and BSFS score (OR: 1.499; 95% CI: 1.052– 2.137; P = 0.025) were independently associated with active BU. Conclusion: Histological inflammation and loose stool form were identified as independent predictors of BU. BU may persist despite endoscopic or histological remission and normal stool form, warranting targeted evaluation beyond traditional marker of disease activity. Plain Language Summary: Summarize the established knowledge on this subjectBowel urgency (BU) is a frequent, distressing symptom of ulcerative colitis (UC) that markedly impairs quality of life.The precise links between BU, objective disease activity, and patient-reported outcomes remain unclear. What are the significant and/or new findings of this study?Active histological inflammation and loose stool form are independent predictors of BU.BU can persist despite simultaneous endoscopic and histological remission and normal stool consistency, revealing a symptom burden not captured by conventional indices.Recognising BU as an independent treatment target supports more personalised, patient-centred management strategies and may translate into measurable gains in quality of life. Keywords: ulcerative colitis, bowel urgency, patient-reported outcomes