Assessment of Bowel Urgency in Ulcerative Colitis: Current Measures and Future Directions

Bowel urgency (BU), a burdensome ulcerative colitis (UC) symptom, impacts quality of life. It is associated with higher levels of disease severity, corticosteroid use, hospitalization, and colectomy. Despite its prevalence and clinical significance, BU is underassessed in clinical practice and infrequently included as a clinical trial end point. This review evaluates the strengths and limitations of available patient-reported outcome (PRO) measures assessing BU in UC to inform future directions for its assessment. A literature review was conducted using PubMed, Google Scholar, and Embase to identify publications through October 31, 2024, using the key terms "ulcerative colitis assessment" and "bowel urgency." Publications assessing BU in UC using PRO scales developed according to Food and Drug Administration guidance were included. Five tools met the inclusion criteria. The Urgency Numeric Rating Scale provides a simple and time-efficient tool for clinical use, while multi-item tools such as the Symptoms and Impacts Questionnaire for Ulcerative Colitis and the Ulcerative Colitis-Symptom Questionnaire include comprehensive symptom tracking but impose greater burdens for clinical practice. Diary-based tools, including the Ulcerative Colitis-Patient-Reported Outcomes/Signs and Symptoms Diary and Patient-Reported Outcomes-Ulcerative Colitis Diary, allow detailed symptom monitoring in clinical trials but are less practical for routine clinical use. Some dimensions of BU are missing from the tools reviewed. Incorporating validated BU measurement into routine clinical care and research is essential for advancing patient-centered, comprehensive disease management and improving outcomes in patients with UC.