Complications of Ulcerative Colitis: What a GI Doctor Wants You to Know

Proper management of UC can help prevent these more serious problems.

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Even if you are experiencing just mild symptoms of ulcerative colitis (UC), and you think they’re “tolerable,” there’s a good reason to take them seriously: UC can be progressive, and actively managing inflammation can help prevent the disease from becoming more serious or having complications.

UC is an inflammatory condition in which the immune system mistakenly attacks the colon. The inflammation caused by these attacks leads to symptoms like abdominal pain, frequent diarrhea, and bloody stools. Learn more about what ulcerative colitis is here.

If treatment for UC is unsuccessful or neglected, however, complications may arise. Here are some of the complications associated with UC, according to Todd B. Linden, MD, gastroenterologist.

Anemia caused by rectal bleeding may occur. The bleeding comes from ulcers in the lining of the colon. Anemia can cause symptoms like fatigue, weakness, and easy bruising and bleeding.

Dehydration is a complication caused by frequent diarrhea from UC. The inflamed lining of the colon may also affect the body’s ability to absorb fluids. Learn more about symptoms of dehydration here.

Malnutrition is a UC complication caused by loss of appetite or poor absorption of nutrients due to inflammation in the intestines.

Osteoporosis and osteopenia are more likely in people with UC for two main reasons. “Many of these patients are on or have been on steroids at some point,” says Dr. Linden. These can have an effect on bone density and increase the risk of fractures.

“In addition, there’s something about just having a chronic inflammatory process in your body, which increases the risk of having osteoporosis,” says Dr. Linden.

Inflammation can spread to other parts of the body, which is known as extraintestinal symptoms. People with one type of inflammatory condition are at an increased risk of developing other types of inflammatory conditions. In particular, people with UC are more likely to experience inflammation in the eyes (e.g. uveitis), the skin (e.g. psoriasis), the liver, and the joints (e.g. rheumatoid arthritis).

A ruptured bowel, or perforated bowel, is a tear in the wall of the GI tract that has been weakened by inflammation or ulceration. Although rare, this complication is dangerous as it allows contents and bacteria of the intestines to leak into the abdomen. This can lead to infections like peritonitis.

Toxic megacolon is a serious and life-threatening complication of UC, but luckily it is rare. This complication is more common among people with pan-ulcerative colitis, meaning it affects the entire length of the colon.

Toxic megacolon occurs when the colon dilates and loses its ability to contract and adequately transport intestinal gas. Symptoms of megacolon include severe stomach distension, a high white blood cell count, high fever, and abdominal pain. It requires emergency surgery to prevent rupture.

Colon cancer is also an increased risk among people with untreated ulcerative colitis. “One of the most important complications of ulcerative colitis, of course, is developing colon cancer, and we really would like to try to avoid that by keeping people on their medications long-term so they stay in complete remission,” says Dr. Linden.

These conditions are more likely to occur when inflammation is persistent, widespread, and severe. This is why consistent treatment—even during periods of remission—is so crucial. “Primarily, the goal of treatment these days is not just to deal with the symptoms, but to really try to get the underlying inflammation to be under control so that the patients don’t have symptoms that need to be treated anymore,” says Dr. Linden.