Bowel Urgency in Inflammatory Bowel Disease: Prevalence, Psychosocial Burden, and Challenges in Assessment

Abstract

Bowel urgency (BU) is a highly prevalent and distressing symptom in inflammatory bowel disease (IBD), yet its assessment remains inconsistent and insufficiently standardized. Although recent clinical trials and emerging guidelines increasingly recognize its clinical relevance, no standardized, multidimensional instrument specifically designed to assess BU has been established. This narrative review synthesizes current evidence on the prevalence, clinical and psychosocial burden, prognostic role, and measurement of BU. It outlines key priorities for developing a BU-specific patient-reported outcome (PRO). BU is reported by 30–98% of patients and frequently persists despite clinical or endoscopic remission. BU is independently associated with higher risks of hospitalization, corticosteroid use, colectomy, and disease relapse. Reported psychosocial effects included anxiety, avoidance behaviours, reduced physical activity, decreased work productivity, and impaired health-related quality of life. Existing assessment tools do not fully capture the complexity of BU: traditional disease activity indices overlook urgency, numeric rating scales assess severity alone, and behavioral measures focus on secondary coping strategies. Evidence from trials of JAK inhibitors, S1P modulators, and IL-23 inhibitors supports BU as a sensitive and early marker of treatment response. In conclusion, BU is a prevalent, burdensome, and prognostically relevant symptom in IBD. Current assessment instruments are limited and fail to encompass the emotional, behavioral, and functional dimensions of BU. A multidimensional BU-specific PRO is needed to enhance clinical evaluation, support patient-centered care, and refine outcome assessment in therapeutic trials.