When you are living with persistent rectal bleeding, long-term stomach pain, or a bathroom routine that suddenly feels unpredictable, you shouldn’t have to settle for “probably hemorrhoids.” If you have noticed blood when you wipe or a sharp urgency that makes leaving home stressful, these symptoms deserve a clear answer—not a “wait and see” approach.
For many, a colonoscopy is the vital turning point that moves you from guesswork to a definitive ulcerative colitis (UC) diagnosis.1 Beyond identifying inflammatory bowel disease, colonoscopies are the gold standard for colon cancer screening, allowing doctors to find and remove precancerous polyps before they become a threat.
Unfortunately, when digestive symptoms are repeatedly dismissed, the issue isn’t just discomfort; it is a delay in care that can lead to long-term complications. This medical bias matters for everyone, but it is especially critical for Black and Brown communities. Research shows that Black Americans face a higher burden of colorectal cancer and are more likely to experience delays in receiving a GI referral or specialist care.2
If your symptoms keep coming back, it is time to stop the “trial and error” treatment. This guide will help you understand why a colonoscopy is essential for ulcerative colitis and how to advocate for the testing you need when your pain has been minimized.
What a Colonoscopy is, in Plain Language
A colonoscopy is a procedure where a clinician uses a thin, flexible tube with a small camera to examine the inside lining of your colon (large intestine) and rectum.3 It’s typically done with sedation, meaning most people do not remember the procedure or feel pain during it.3
What makes a colonoscopy especially powerful is that it’s not only a “look.” It’s also an opportunity to act. During the exam, a clinician can remove polyps (small growths that can become cancer over time) and take small tissue samples called biopsies.3
That ability to identify problems early, and sometimes prevent them entirely, is why colonoscopy remains one of the most important tests in digestive health.3
Colonoscopy can help evaluate or diagnose conditions such as colorectal cancer, polyps, unexplained bleeding, chronic diarrhea, inflammatory bowel disease such as ulcerative colitis (UC), and other causes of ongoing abdominal symptoms.3
Why Ulcerative Colitis Needs More Than “Trial And Error” Treatment
Ulcerative colitis is a chronic inflammatory condition where the immune system triggers ongoing inflammation and irritation in the lining of the colon and rectum.4 Over time, that inflammation can lead to ulcers, bleeding, pain, urgency, and frequent diarrhea.4
UC is not the same as Irritable Bowel Syndrome (IBS). IBS can be painful and disruptive, but it does not cause visible inflammation or ulcers in the colon. UC does, and that difference matters because the treatments are different and the risks are different.4
People with UC often describe symptoms like frequent loose stools, urgency, blood or mucus in the stool, and abdominal cramping that flares and calms in cycles.4 Some people also experience fatigue, appetite changes, and weight loss. Symptoms can look “mild” on the outside while significant inflammation is happening internally.4
Here’s the key point: to diagnose UC, clinicians generally need to see the colon and confirm inflammation with biopsies. In other words, a colonoscopy with tissue sampling is central to diagnosis and to guiding treatment decisions.4
Without that confirmation, people can spend months or years cycling through the wrong explanations, and the condition can continue quietly progressing.4
Why A Colonoscopy Is Often The Turning Point For UC Care
A colonoscopy helps answer the questions that symptoms alone cannot. It shows where inflammation is located, how extensive it is, and whether the pattern fits UC versus other conditions. It also allows biopsies to be examined by a pathologist, which helps confirm diagnosis and rule out other causes of colitis.3
This is not only about naming the condition. It’s about making treatment precise. UC treatment is often long-term, and the goal is not just symptom relief. The goal is healing inflammation, reducing flares, preventing complications, and protecting quality of life. Getting the diagnosis right early makes every step after that safer.3
Why Black And Brown Communities Face Higher Stakes When Care Is Delayed
Digestive symptoms are easy for healthcare systems to minimize, and that problem does not land equally across communities.2
We know that colorectal cancer disparities are real, with Black Americans experiencing a higher burden and higher mortality overall.2 Research also shows disparities can appear even in younger age groups, which is one reason national screening guidance shifted to begin at age 45 for average-risk adults.2
When it comes to inflammatory bowel disease like UC, emerging research continues to document disparities in access to specialty care and outcomes, including delayed diagnosis and worse outcomes for Black people with IBD.2
Add in the very real experiences of medical bias, shorter visits, fewer referrals, and higher likelihood of being uninsured or underinsured, and you get a system where symptoms can be brushed aside until they become emergencies.2
When It’s Time To Push For Answers
Not every stomach ache needs a colonoscopy. But ongoing or escalating symptoms deserve an evaluation that matches the seriousness of what you’re living with.2
If you have persistent diarrhea, recurring abdominal pain, blood in the stool, unexplained weight loss, or symptoms that keep returning after “simple fixes,” it is reasonable to ask for a GI referral and to discuss whether colonoscopy is appropriate.
UC is often suspected when symptoms like blood in stool, increased stool frequency, and urgency appear, and guidelines emphasize confirming diagnosis with colonoscopy and biopsies.4
How to Advocate for a Colonoscopy When Your Pain Is Dismissed
Advocacy works best when it’s specific. Instead of trying to “convince” someone you’re suffering, your goal is to help the clinician document why further testing is medically necessary.5
1) Describe the pattern, not just the pain
When people feel dismissed, it’s often because symptoms are presented as a single moment rather than a pattern over time. You do not need dramatic language. You need clarity.
You can say: “I’ve had abdominal pain and diarrhea for __ weeks/months. It happens __ days per week. I’m waking up at night with symptoms, and I’ve noticed blood/mucus in my stool. This is affecting my ability to work and function. I need to be evaluated for inflammatory bowel disease, including ulcerative colitis”.
That wording signals duration, frequency, and functional impact, which are details clinicians and insurers take seriously.
2) Name the conditions you’re worried about and ask for the right next step
You’re allowed to ask for the test that matches the concern.5
Try: “I understand there are different causes of GI symptoms, but because this has persisted and I’m seeing blood, I want to rule out ulcerative colitis and other serious causes. What is the plan to evaluate this, and do I need a GI referral and colonoscopy”?
This keeps the conversation anchored to evaluation, not reassurance.
3) Ask what is being ruled out and how
If the response is “let’s wait,” make the next question about safety.5
You can say: “What diagnoses are we considering right now, and what would make you change course? If symptoms continue, what’s the timeline for imaging or colonoscopy”?
Watchful waiting without a timeline is how people get lost in the system.
4) If you’re offered only symptom meds, ask what confirms the diagnosis
Medications can help while you’re awaiting answers, but they should not replace diagnosis when red flags exist.5
Try: “I’m open to symptom relief, but I want to make sure we’re not treating blindly. What test confirms UC, and when do we schedule it”?
UC diagnosis typically involves endoscopic evaluation with biopsies, so it’s appropriate to ask directly for that pathway.
5) If you meet resistance, request documentation and escalation
This is one of the most effective strategies when you feel dismissed.5
You can say calmly: “I hear you. If we’re not pursuing a GI referral or colonoscopy today, please document in my chart that I requested further evaluation due to persistent symptoms, including blood/pain/diarrhea, and that we decided not to pursue it at this time. Also, what is the next step if symptoms do not improve within two weeks”?
Documentation changes accountability.
6) If insurance is the barrier, ask for the “medical necessity” language
For many people, the obstacle is not the doctor’s opinion. It’s prior authorization, coverage rules, or referral requirements.5
Ask: “Is there a prior authorization process for colonoscopy, and will your office submit documentation of medical necessity based on my symptoms and duration”?
If your plan requires a specialist referral, ask for it directly and request that it be marked as urgent if symptoms include bleeding or weight loss.
A Note on Screening vs Diagnostic Colonoscopy
It also helps to understand the language insurance companies use. A colonoscopy done because you have symptoms like bleeding or persistent pain is often considered a diagnostic colonoscopy.6 A colonoscopy done as routine prevention at a certain age is screening.6
Coverage rules can differ depending on how the procedure is coded. If you are navigating insurance barriers, asking whether your case is being submitted as diagnostic versus screening can clarify next steps.6
Separately, national guidance recommends colorectal cancer screening starting at age 45 for average-risk adults, and earlier for some higher-risk groups.6
A Call to Action for the NOWINCLUDED Community
If your gut symptoms have been minimized, you’re not alone, and you’re not “too sensitive”. You deserve care that matches what your body is telling you.
In the NOWINCLUDED app, tell us what you’re navigating right now. Are you trying to get a GI referral? Are you being told it’s “just stress” or “just hemorrhoids”?
Your story can help someone else realize they’re not overreacting, they’re advocating for the right test at the right time.
References
- Crohn’s & Colitis Foundation. (2024, April 12). Preparing for Your Colonoscopy. Retrieved from Crohn’s & Colitis Foundation: https://www.crohnscolitisfoundation.org/blog/preparing-your-colonoscopy
- Moazzami, B., Zabala, Z. E., Chandradevan, R., & Sifuentes, H. (2025). Racial disparity in inflammatory bowel disease-related complications: a nationwide cohort study. Annals of Gastroenterology. doi:10.20524/aog.2025.0958
- ACS. (2024, February 16). Colonoscopy. Retrieved from American Cancer Society: https://www.cancer.org/cancer/diagnosis-staging/tests/endoscopy/colonoscopy.html
- Crohn’s & Colitis Foundation. (2025). Overview of Ulcerative Colitis. Retrieved from Crohn’s & Colitis Foundation: https://www.crohnscolitisfoundation.org/patientsandcaregivers/what-is-ulcerative-colitis/overview
- Volpe, A. (2023, September 24). How to advocate for yourself at the doctor’s office. Retrieved from VOX: https://www.vox.com/even-better/23880457/advocate-for-yourself-doctors-office-health
- USPSTF. (2021, May 18). Colorectal Cancer: Screening. Retrieved from United States Preventive Services Taskforce: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening
