Ulcerative Colitis Risks and Complications
It's hard enough when you have to cope with the symptoms of ulcerative colitis, a chronic inflammatory bowel disease. But when you add ulcerative colitis complications that often result, the diagnosis can be overwhelming. "The impact on quality of life can be profound, not just from the ulcerative colitis. A third of people we see have other conditions that go beyond the colon," says Dr. Miguel Regueiro, chair of the department of gastroenterology, hepatology and nutrition at Cleveland Clinic. He specializes in treating people with inflammatory bowel disease.
What Is Ulcerative Colitis?
UC is an autoimmune disease. The body mistakenly attacks the lining of the colon (large intestine), which causes inflammation and open sores. "It always starts in the rectum or lower colon," Regueiro notes. "When a colonoscopy for UC is done, the mucosa (top layer) will look all red and is inflamed. You can also get little ulcers throughout the colon."
That inflammation can cause a long list of symptoms, including:
-- Abdominal cramps.
-- Dehydration.
-- Frequent diarrhea accompanied by pain and blood in the stool.
-- Loose bowel movements.
-- Rectal pain and bleeding.
-- Urgency to go to the bathroom.
[See: Foods to Avoid During an Ulcerative Colitis Flare-Up.]
Those gastrointestinal symptoms are the kinds you might expect from an inflammatory bowel disease. But ulcerative colitis can also lead to symptoms you may not recognize as bowel problems, such as:
-- Fever.
-- Joint pain.
-- Mouth sores.
-- Nausea and vomiting.
-- Skin lumps.
-- Unintended weight loss.
Many of those symptoms are linked to ulcerative colitis complications.
Non-life-threatening Ulcerative Colitis Complications
Because UC is an autoimmune or inflammatory condition, you can develop inflammation in other areas of the body. This can manifest as flu-like symptoms (like fatigue or fever) or additional health complications, which can include:
-- Arthritis. "Up to 50% of patients have arthritis as part of their ulcerative colitis," Regueiro says. "That can involve different joints and migrate from one joint to the other."
-- Bone loss. "Osteoporosis is a risk for people who take steroids (to treat inflammation) for long periods of time. We try to avoid prescribing them, although they still have an important short-term role in quieting inflammation when you're adding new medications," explains Dr. Najwa El-Nachef, a gastroenterologist and associate professor of medicine at University of California-San Francisco. The risk for UC-related osteoporosis is 17% to 42%, according to Regueiro.
-- Skin problems. Regueiro says less than 10% of patients develop painful ulcers on the skin, called pyoderma gangrenosum. People with UC may also develop painful red bumps on the skin that look likes hives, called erythema nodosum.
-- Eye inflammation. Less than 5% of patients experience eye-related UC problems: "Two (types of inflammation) are easier to treat, but one called uveitis is more severe and can lead to blindness if untreated," Regueiro warns.
All of these conditions can be concerning and cause discomfort in addition to gastrointestinal symptoms. However, Regueiro points out that treating the underlying UC controls many of these ulcerative colitis complications and their symptoms.
[Read: Foods for Ulcerative Colitis.]
Life-threatening Ulcerative Colitis Complications
There are numerous life-threatening ulcerative colitis complications. They include:
-- Blood clots. People who have ongoing colonic inflammation are at an increased risk for blood clots. "You lose proteins through the colon and that can interfere with the blood's clotting mechanism. The clot would likely be in your leg, with the risk that it could travel to the lung," El-Nachef says. A clot in the lung is called a pulmonary embolism. It can block blood flow to the heart or lungs and even cause sudden death. Regueiro estimates the risk for UC-related blood clots is about 5%.
-- Colon cancer. Long-term inflammation can lead to colon cancer. "The lifelong chance (if you have UC) is about 5%. It's lower than it used to be because we're better at detection and treatment. We don't really know why ulcerative colitis causes colon cancer, but the thought is that when the cells keep repairing themselves, there can be errors in the DNA replication," Regueiro says. A key to catching colon cancer is early detection. "If you've had UC for at least eight years, we put you on a more intense screening protocol and may suggest a colonoscopy every one to two years," El-Nachef says.
-- Liver disease. "Primary sclerosing cholangitis is a rare liver problem related to UC that is difficult to treat and can lead to cirrhosis and the need for a liver transplant," Regueiro says. He estimates the risk for people with UC is about 4.5%.
-- Severe bleeding or dehydration. Either complication requires hospitalization and may be seen in severe cases.
-- Toxic megacolon. When the colon is severely damaged and inflamed, it can stop working, blow up like a balloon and "pop" or perforate. "If you have a perforation in the GI tract, that's a life-threatening emergency. Bacteria will be going to parts of the body that are supposed to be sterile," El-Nachef says. "The treatment for this would be emergency surgery and would include the removal of the colon." The percentage of people with UC who develop toxic megacolon, notes Regueiro, is about 3%.
Controlling Ulcerative Colitis Complications
Warding off the complications and risks of ulcerative colitis requires medication to control the condition. The main types of medications used today are anti-inflammatories, such as corticosteroids and aminosalicylates, and a newer class of medications called biologics. The biologics target certain molecules and interfere with your immune system response. "In the clinical research trials the response rates vary between 40 and 60%," Regueiro says. "However, in clinical practice I'd say about 70 to 80% of patients have a response and improvement with biologics."
But older medications are still prescribed, especially a class of drugs called immunomodulators. They suppress the immune system by working on DNA in the immune cells. "These are not as effective as the newer agents such as biologics and small molecule therapies, but sometimes we combine them with biologics to prevent patients from developing antibodies to the biologics," El-Nachef says.
Other types of medications that can be used to treat UC include:
-- Antibiotics. These are used to help control infection.
-- Antidiarrheals. These can help control severe diarrhea, but may increase the risk for toxic megacolon and should only be used in close consultation with your doctor.
A combination of medications is often necessary to control ulcerative colitis. But doctors are glad to have so many different kinds of drugs to treat the condition. It was only a few decades ago when there were precious few UC drugs in existence. "People can have a normal life again," El-Nachef says. "It's amazing to see people so sick in hospital and (after taking medications) you see them a few months later and they're back to work."
[See: How Often Should I Poop, and Other Toilet Topics.]
When Medication Doesn't Work
"About a third of patients do not respond to medication," Regueiro notes. "They need surgery (called a proctocolectomy) to remove the colon." This procedure can cure ulcerative colitis.
After colon removal, doctors connect the small intestine to the anus. "Normal bowel function can be reduced to three to seven bowel movements per day. For UC patients with 20 to 30 bowel movements today, this is actually good," Regueiro says.
But the procedure comes with its own risks and complications, such as inflammation of the connection area (called a J-pouch) that's due to exposure to bacteria.
That's why it's important to monitor your symptoms (such as increased flare ups of diarrhea or bloody stool), whether you've had surgery to remove the colon or even if you're just in the beginning stages of UC.
The earlier you can catch and treat problems, the better chance you'll have for controlling symptoms and warding off ulcerative colitis complications.
Heidi Godman reports on health for U.S. News, with a focus on middle and older age. Her work has appeared in dozens of publications, including the Harvard Health Letter (where she serves as executive editor), the Chicago Tribune, Baltimore Sun, Orlando Sentinel and Cleveland Clinic Heart Advisor.
Heidi spent more than 20 years as a TV news anchor and health reporter at ABC affiliate WWSB and more than five years as the host of a daily health talk radio show on WSRQ-FM. Heidi has interviewed surgeons in operating rooms, scientists in laboratories and patients in all phases of treatment. She's earned numerous awards for outstanding health reporting and was the first TV broadcaster in the nation to be named a journalism fellow of the American Academy of Neurology. Heidi graduated from West Virginia University with a degree in journalism.
Connect with Heidi on Linkedin or email her at health@heidigodman.com.
