What is Ulcerative Colitis?

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that causes ulcers and long-lasting inflammation in the gastrointestinal tract. Ulcerative colitis affects the innermost lining of your colon, or the large intestine, and the rectum. Symptoms of the disease tend to develop over a period of time rather than appear suddenly. ⁽¹⁾

Ulcerative colitis happens when the immune system suddenly starts attacking bacteria, food, and other substances present in the large intestine. This attack is what causes the inflammation associated with Ulcerative colitis. Over time, inflammation can lead to permanent damage to the lining of the colon.

People with Ulcerative colitis go through periods during which they experience aggravated Ulcerative colitis symptoms. These are known as flare-ups. Flare-ups are typically followed by symptom-free periods, known as remissions. Ulcerative colitis patients alternate between flare-ups and remissions.

Medications help in controlling the body’s immune response and also reduces inflammation in the large intestine before it is able to cause damage and complications. ⁽²⁾ In some people, though, surgery might be needed to remove damaged portions of the colon.

Let us take a look at some of the long term complications of uncontrolled Ulcerative colitis.

Long Term Complications of Uncontrolled Ulcerative Colitis

Long Term Complications:

Severe Bleeding

The most common complication of uncontrolled Ulcerative colitis is severe bleeding. This happens because of the damage caused to the colon. The most common symptom to indicate bleeding is the presence of blood in your stool. In fact, bloody stools are one of the main symptoms of Ulcerative colitis. ⁽³⁾

In some people, the bleeding can be severe enough to lead to anemia, which is a decrease in the number of red blood cells in the body that carry oxygen. Anemia can cause symptoms such as shortness of breath and fatigue.

Toxic Megacolon (Swollen Colon)

A rare but dangerous complication of Ulcerative colitis is toxic megacolon or swollen colon. This happens when there is gas trapped in the large intestine, causing it to swell up. ⁽⁴⁾

The colon can actually become so swollen or enlarged that it bursts open, releasing bacteria and other toxic substances into your bloodstream. If not caught in time, then this bacteria can cause a deadly blood infection known as septicemia. ⁽⁵⁾

Some of the symptoms of toxic megacolon include:

Fever
Severe abdominal pain and swelling
Bloating of the abdomen
Abdominal tenderness
Fast heart rate (tachycardia)
Shock
Painful bowel movements
Bloody or severe diarrhea

Toxic megacolon is considered to be a life-threatening condition, and if you experience any of these symptoms, you must seek immediate medical assistance.

Doctors treat toxic megacolon with medications to prevent infection and to reduce the swelling. If the treatments fail to work, then you might need to undergo a surgery for removing part of or all of your colon.

Hole in the Intestine

Sores and inflammation caused by Ulcerative colitis can weaken the wall of the large intestine to such an extent that it eventually develops a hole. This is known as a perforated colon. ⁽⁶⁾

A perforated colon generally occurs due to toxic megacolon and should be treated as a medical emergency. Seek immediate medical assistance if you experience any of the following symptoms:

Sudden and severe abdominal pain
Nausea and vomiting
Fever
Chills
Swelling and bloating of the abdomen

Bacteria present in your intestine can eventually get out through the hole in the colon and into the stomach. These bacteria can then go on to cause a severe infection known as peritonitis. If such a situation occurs, you will need to undergo surgery to close the hole.

Some of the symptoms of peritonitis include:

Abdominal pain
Abdominal tenderness
Bloating or feeling of feeling in the abdomen
Nausea and vomiting
Fever
Loss of appetite
Low urine output
Diarrhea
Increased thirst
Inability to pass gas or stool
Severe fatigue

High Risk of Colorectal Cancer

The presence of constant inflammation in the intestine can, over a period of time, cause healthy cells to become cancerous. People who have Ulcerative colitis are nearly two times more likely to develop colorectal cancer as compared to people who do not have Ulcerative colitis. ⁽⁷⁾

Even though the overall risk is not that high and most Ulcerative colitis patients do not get colorectal cancer, but the likelihood of getting cancer increases in the long run, especially if you have had Ulcerative colitis for at least eight to ten years.

You are also more likely to develop colorectal cancer if you have a family history of colorectal cancer or if there is severe inflammation present in your colon for a long time.
It is, therefore, important for patients who have had Ulcerative colitis for more than eight years to keep getting regular screenings for colorectal cancer.

You should have a colonoscopy once in every one to two years to keep a close watch on your risk of getting cancer. A colonoscopy makes use of a long and flexible tube to detect and remove any abnormal growth in the lower intestine.

High Risk of Osteoporosis

People with Ulcerative colitis are at a greater risk of developing the bone-weakening disease known as osteoporosis. It has been observed that nearly 60 percent of Ulcerative colitis patients have thinner than healthy bones. ⁽⁸⁾

Severe inflammation of the large intestine or having part of the colon surgically removed is believed to make it more difficult for the body to absorb vitamin D and calcium as it usually should. You need both calcium and vitamin D to keep your bones strong. Inflammation due to UC can further disrupt the process your body utilizes for the rebuilding of new bones.

Additionally, taking corticosteroids (a commonly prescribed medication during Ulcerative colitis treatment) can also lead to osteoporosis. Corticosteroids are medications prescribed during Ulcerative colitis treatment for decreasing inflammation in the colon. However, a known side effect of these medications is that they also weaken your bones.

Having weakened bones also increases the risk of fractures. ⁽⁹⁾ This is why you should be consuming a diet rich in vitamin D and calcium to help your bones. You should also be doing weight-bearing exercises such as dancing or walking up the stairs to strengthen your bones to prevent fractures.

Many doctors often recommend that Ulcerative colitis patients undergo a bone density test. If a bone density test shows that you have weakened bones, then your doctor will recommend that you take bisphosphonates or some other medication to protect and strengthen your bones. You may also need to reduce the use of steroid medications if you are diagnosed with osteoporosis.

Primary Sclerosing Cholangitis (PSC)

PSC is a condition marked by inflammation and scarring of the bile ducts. The bile ducts are tubes that carry digestive fluid bile from the liver to the small intestines. PSC is a common condition observed in people with Ulcerative colitis. ⁽¹⁰⁾

Over time, these scars can make the bile ducts become narrow, causing bile to back up into the liver. In the long term, this can lead to the liver becoming scarred and ultimately damaged enough to require a transplant.

The symptoms of PSC include:

Fatigue
Itching
Pain in the upper part of the abdomen, usually on the right side
Fever and chills
Enlarged liver
Night sweats
Enlarged spleen
Yellow eyes and skin (jaundice)
Weight loss

Conclusion

The symptoms of Ulcerative colitis can come and go, but Ulcerative colitis is a chronic disease. If you want to avoid these complications and lower your risk of developing any other serious condition from Ulcerative colitis, then you should strictly follow the treatment regimen prescribed by your doctor. Do not think that just because the disease has gone into remission, you are cured or that you do not need to take the medications during the remission phase. There is no cure for Ulcerative colitis, and you will need to be on your drugs even when you are in remission. Following a healthy diet and a healthy lifestyle can also help you manage your condition better and also lower the chances of developing any complications.

References:

Information, H., Diseases, D., Colitis, U. and Colitis, U. (2019). Ulcerative Colitis | NIDDK. [online] National Institute of Diabetes and Digestive and Kidney Diseases. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis [Accessed 18 Nov. 2019].
Colitis–Pathophysiology, U., 2003. Inflammatory bowel disease part I: ulcerative colitis–pathophysiology and conventional and alternative treatment options. Alternative medicine review, 8(3), pp.247-283.
Robert, J.H., Sachar, D.B., Aufses Jr, A.H. and Greenstein, A.J., 1990. Management of severe hemorrhage in ulcerative colitis. The American Journal of Surgery, 159(6), pp.550-555.
Binder, S.C., Patterson, J.F. and Glotzer, D.J., 1974. Toxic megacolon in ulcerative colitis. Gastroenterology, 66(5), pp.909-915.
Sheth, S.G. and LaMont, J.T., 1998. Toxic megacolon. The lancet, 351(9101), pp.509-513.
De Dombal, F.T., Watts, J.M., Watkinson, G. and Goligher, J.C., 1965. Intraperitoneal Perforation of the Colon in Ulcerative Colitis [Abridged].
Zhen, Y., Luo, C. and Zhang, H., 2018. Early detection of ulcerative colitis-associated colorectal cancer. Gastroenterology report, 6(2), pp.83-92.
Crohn’s & Colitis Foundation. (2019). What is IBD? | Crohn’s & Colitis Foundation. [online] Available at: http://www.crohnscolitisfoundation.org/resources/bone-loss.html [Accessed 18 Nov. 2019].
Vestergaard, P., 2004. Prevalence and pathogenesis of osteoporosis in patients with inflammatory bowel disease.
Broomé, U., Löfberg, R., Veress, B. and Eriksson, L.S., 1995. Primary sclerosing cholangitis and ulcerative colitis: evidence for increased neoplastic potential. Hepatology, 22(5), pp.1404-1408.

Also Read:

Long Term Complications of Uncontrolled Ulcerative Colitis

What is Ulcerative Colitis?