The Signs and Symptoms of Ulcerative Colitis

You don’t want to ignore this type of chronic stomach distress.

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Each year, 38,000 Americans are diagnosed with ulcerative colitis (UC), according to the Crohn’s and Colitis Foundation of America. UC is a type of inflammatory bowel disease that causes inflammation and ulcers in the large intestine (i.e. the colon).

Inflammation in the body is hard to picture and seems abstract, but it causes noticeable symptoms. The immune system mistakes the colon as a foreign invader and attacks, just like it would a flu virus or cancer cell. The inflammatory attacks on the colon affects the integrity of the colon lining and can lead to the following symptoms:

  • Loose and bloody stool
  • Frequent diarrhea
  • Ulcers (open sores in the colon and rectal lining)
  • Abdominal pain
  • Weight loss
  • Loss of appetite
  • Fatigue
  • Delayed growth

Symptoms vary greatly among different individuals.  “Some patients may have just mild symptoms … and go on for years,” says Sergey Khaitov, MD, surgeon at Mount Sinai Beth Israel. “Some patients may have such severe disease they may require emergency surgery within days after the disease started.”

One factor that may influence symptom presentation is what part of the colon is affected. UC might affect only the bottom of the colon, which causes primarily bowel symptoms, or it could affect the entire colon, which may cause weight loss and severe bleeding.

Like all inflammatory conditions, UC can cause inflammation in other parts of the body as well. People with UC are at an increased risk of developing inflammatory conditions in the joints, eyes, and skin, according to UpToDate from Wolters Kluwer.

Complications of Ulcerative Colitis

UC typically begins mild but progresses over time. “Ulcerative colitis may lead to a variety of complications, which are not always related directly to the intestines, but to the presence of chronic inflammation in the body,” says Dr. Khaitov.

If inflammation is unable to be controlled, complications may occur, such as:

  • Eye infections: This inflammation of the eye is called uveitis.

  • Skin inflammation: Those with UC are at an increased risk in developing inflammatory conditions of the skin, such as psoriasis.

  • Joint inflammation: Having UC increases the risk of rheumatoid arthritis and ankylosing spondylitis.

  • Rectal bleeding and anemia: Ulcers, or open sores in the colon and rectum, leak mucus and blood through the stool. The problem with rectal bleeding is it could lead to anemia, or low red blood cell count.

  • Osteoporosis and osteopenia: Corticosteroids can help treat UC, but they may also affect bone density and can increase the risk of fractures.

  • Dehydration and malnutrition: Frequent diarrhea can increase the risk of dehydration, and inflammation in the colon can inhibit absorption of nutrients. Stomach pain and fear of symptoms may also cause a loss of appetite that increases the risk of malnutrition or unintended weight loss.

  • Toxic megacolon: Typically, UC only affects the innermost lining of the colon. However, if the inflammation spreads to deeper tissue layers, the colon becomes swollen and is no longer functional. Although rare, megacolon is a serious and life-threatening complication that requires surgery.

  • Colon cancer: “Sometimes, in rare situations, [UC] may lead to development of cancer in the colon and rectum,” says Dr. Khaitov.

Symptoms of UC occur in a pattern of flare-ups and remissions (a period of no symptoms). The good news is that each year, nearly half of people with UC are in remission, according to the Crohn’s and Colitis Foundation.

“Gastroenterologists will provide patients with medications to induce and maintain remission of the disease to keep the patient with no symptoms,” says Dr. Khaitov. Learn more about treatment of UC here.