A narrative review on the frequency, pathophysiology and management of bowel urgency associated with ulcerative colitis.

Bowel urgency (BU) is a distressing symptom among patients with ulcerative colitis (UC), significantly impacting quality of life (QoL). Its pathophysiology is not completely understood. Despite its high prevalence, BU is not consistently assessed in clinical practice and has historically received limited attention as a research and treatment target. The aim of this narrative review was to highlight the clinical relevance of BU and to summarize current treatment approaches. Evidence suggests that mesalazine and budesonide foam may help reduce BU. Among advanced therapies, vedolizumab and Janus kinase inhibitors have demonstrated early improvements in urgency, anti-interleukin-23 antibodies have also shown promising effects. Additionally, the novel S1P receptor modulator etrasimod has been associated with symptomatic relief. Additional alternative therapies are also helpful. Despite these therapeutic options, the management of BU remains challenging. Further research and the development of targeted treatments are warranted to address this unmet clinical need.