Ulcerative Colitis: Symptoms, Who Gets It and Possible Complications

Ulcerative colitis (UC) is a chronic disease in which abnormal reactions of the immune system cause inflammation and sores, called ulcers, in the lining of the large intestine — the rectum and colon. It is one of the inflammatory bowel diseases (IBD); Crohn's disease and microscopic colitis are other common types. Research suggests that about 600,000 to 900,000 people in the United States have it.

Who is more likely to get it

UC can begin at any age, but it usually starts between 15 and 30. It tends to run in families: people with a parent, sibling or child who has IBD are more likely to develop it. It is also more common in people of Jewish descent.

Symptoms

The most common symptoms are pain in the abdomen and blood or pus in diarrhea. Others include:

• bleeding from the rectum;
• anemia;
• severe tiredness;
• weight loss and loss of appetite;
• sores on the skin;
• joint pain;
• growth failure in children.

UC can start gradually and worsen over time, or begin suddenly. About half of people with UC have mild symptoms. Most people alternate between flares, when they have symptoms, and remission, when symptoms disappear — sometimes for weeks, sometimes for years. The goal of treatment is to keep people in remission for the long term.

Diagnosis and treatment

Doctors use blood tests, stool tests, colonoscopy or sigmoidoscopy, and imaging tests to diagnose UC. Several types of drugs can help control it. In severe cases, the colon must be removed.

Complications

Over time, UC can lead to:

• anemia, sometimes of more than one kind;
• bone problems such as osteopenia or osteoporosis, from the disease and from the corticosteroids used to treat it;
• growth and development problems in children — slow weight gain, slowed growth, short stature or delayed puberty;
• colorectal cancer — people with long-standing UC affecting a third or more of the colon are at higher risk and need closer screening.

Some complications come on fast, can be life-threatening and need hospital care or emergency surgery:

• fulminant ulcerative colitis, with extremely severe symptoms such as more than 10 bloody bowel movements a day, often with fever, a rapid heart rate and severe anemia;
• perforation, a hole in the wall of the large intestine;
• severe rectal bleeding;
• toxic megacolon, when inflammation reaches the deep layers of the large intestine and it swells and stops working.

Severe UC or its complications can also cause severe anemia and dehydration, which may need blood transfusions or intravenous fluids and electrolytes in hospital.

Sources

• MedlinePlus, U.S. National Library of Medicine, "Ulcerative Colitis," drawing on the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). https://medlineplus.gov/ulcerativecolitis.html
• NIDDK, "Definition & Facts for Ulcerative Colitis," used for the immune cause, how many Americans have it, who is more likely to get it, flares and remission, and complications: https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis/definition-facts
• Rewritten in hubnx's own words.