Ulcerative Colitis Symptoms and Diagnosis

Ulcerative colitis symptoms tend to come and go, with periods of remission between flare-ups.

Remission can last for months or years, which can make it difficult to know whether a treatment helped or a spontaneous remission occurred. (1)

Ulcerative colitis may progress over time, affecting greater areas of the colon.

In general, the more of the colon that's affected, the more serious the disease and the worse its symptoms and complications. (2)

What Are the Symptoms of Ulcerative Colitis?

The most common symptoms of ulcerative colitis are abdominal pain and diarrhea that may contain blood, pus, or both.

The disease and these symptoms typically come on gradually. (2)

As the disease progresses, other symptoms may include:

• Rectal pain, bleeding, or both
• Loss of appetite
• Weight loss
• Urgency to defecate
• Inability to defecate in spite of urgency
• Severe tiredness
• Fever
• Skin sores
• Joint pain
• Growth failure in children

If you have ulcerative proctitis — which affects only the rectum — your only symptom may be rectal bleeding. This form of the disease tends to be the least severe.

Proctosigmoiditis — which affects the rectum and lower part of the colon — tends to cause bloody diarrhea, abdominal pain, and difficulty defecating despite a strong urge to do so.

Left-sided colitis — which affects the rectum and colon up to an area called the descending colon — often causes bloody diarrhea, abdominal pain of the left side, and unintended weight loss.

If you have pancolitis — which affects the entire colon — you’re likely to experience severe episodes of bloody diarrhea, abdominal pain, fatigue, and major weight loss. (2)

How Is Ulcerative Colitis Diagnosed?

It’s important to see a doctor if you have some combination of the following symptoms:

• Persistent change in bowel habits (such as diarrhea for several weeks)
• Frequent stools
• Abdominal pain
• Blood or mucus in your stool
• Diarrhea that awakens you from sleep
• Unexplained fever lasting more than a day or two (2)

Your doctor will use your history of symptoms, a physical exam, and a number of tests to make a diagnosis.

At first, your doctor will investigate whether you have ulcerative colitis or another condition, such as an infectious form of diarrhea.

The tests used to diagnose ulcerative colitis can also help determine which type of the disease you have, on the basis of what areas of your colon are affected. (1)

Tests that may be used to diagnose ulcerative colitis and rule out other conditions include:

• Blood tests Your doctor may order these to check for anemia and infection.
• Stool analysis This can rule out conditions that may be mistaken for ulcerative colitis, such as infections caused by bacteria or parasites. White blood cells in your stool can be a sign of ulcerative colitis.
• Colonoscopy A colonoscopy is a procedure that uses a flexible tube with a camera to view the inside of your colon and obtain tissue samples for analysis.
• Flexible sigmoidoscopy Similar to a colonoscopy but less extensive, this procedure uses a flexible tube with a light to view just the lower portion of the colon. A definitive diagnosis of ulcerative colitis is generally made using endoscopy — that is, a colonoscopy or a sigmoidoscopy.
• X-ray A type of imaging, X-ray may be used on your abdominal area to look for serious complications.
• Barium enema This is an X-ray in which the colon is filled with liquid barium before images are taken.
• CT scan A computerized tomography scan, or CT scan, is a type of imaging that may be used on your abdomen or pelvis to see how much of the colon is inflamed and whether serious complications have developed. (2)

Ulcerative Colitis Complications

One of the most serious and potentially life-threatening complications of ulcerative colitis is toxic, or fulminant, colitis, also called acute, severe colitis, or toxic megacolon.

It occurs when a section of the colon becomes dilated and immobile, raising the risk of heavy bleeding, perforation, and peritonitis, an infection of the abdominal lining.

Common symptoms include pain, abdominal distension (bloating), fever, and a rapid heart rate.

In many cases, toxic colitis requires surgery to remove all or part of the colon and rectum. (3)

Possible complications of ulcerative colitis include:

• Back pain In some patients, ulcerative colitis is associated with a severe form of arthritis called ankylosing spondylitis, which affects the spine. The condition can lead to severe, chronic back pain.
• Eye problems Occasionally, people affected by UC will experience inflammation in their eyes. This can manifest in symptoms ranging from mild (redness, tearing, a burning sensation) to severe (blurred vision, headache, and eye pain). (4)
• High blood pressure Certain medications for ulcerative colitis, such as corticosteroids, are associated with a risk of high blood pressure. IBD can also increase the risk of blood clots. (5)
• Bowel cancer People with ulcerative colitis have a higher risk of colorectal cancer than the general population, and those with severe ulcerative colitis have the highest risk. But studies have shown that taking maintenance medication to prevent recurrence of active disease may lower your colon cancer risk. (2,6)
• Fertility issues Women who have undergone surgeries to treat their IBD, particularly colectomies with ileostomies or J-pouches for ulcerative colitis, do appear to have decreased fertility rates, according to the Crohn’s & Colitis Foundation. Generally speaking, though, women whose UC is in remission can become pregnant as easily as other women the same age. (7)

Ulcerative colitis is also associated with:

• Bleeding and anemia (inadequate red blood cells)
• Dehydration
• Inflammation of the skin, joints, and eyes
• Perforation colon (a hole in the colon) (2)
• Blood clots
• Canker sores
• Delayed growth and development in children
• Kidney stones
• Liver and gallbladder disease (3)

Signs of an Emergency

Toxic colitis is a life-threatening emergency.

Toxic colitis may occur rapidly and spontaneously for no apparent reason, or as a result of overusing certain kinds of medication, such as antidiarrheal drugs and some pain relievers. (8)

Symptoms of toxic colitis may include:

• Sudden, violent diarrhea
• High fever
• Abdominal pain
• Rebound tenderness (pain as your doctor removes pressure applied to your abdomen)
• Rapid heartbeat
• Altered mental state

Rebound tenderness is a sign of peritonitis, an infection of the lining of the abdomen. (8)

If you have toxic colitis, your doctor will probably hospitalize you for treatment.

In some cases, your doctor may prescribe high-dose, intravenous corticosteroid drugs to control your symptoms.

If this approach fails, your doctor may try other drugs.

In some cases, you will need surgery to remove the diseased portion of your colon. (8)

Can You Die From Ulcerative Colitis?

Ulcerative colitis usually isn’t fatal, according to the Mayo Clinic. But it can cause severe and even life-threatening complications. (2)

This means that ulcerative colitis is considered a serious illness, and you should treat its management and treatment with a similar seriousness.

Getting the right treatments for ulcerative colitis can cause a dramatic reduction in symptoms and possibly lead to lasting remission. (2)

Additional reporting by Jordan M. Davidson