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Ulcerative Colitis: Warning Signs To Look For

Ulcerative colitis is a type of inflammatory bowel disease that causes chronic inflammation in the digestive tract. This condition typically affects the innermost lining of the colon or the large intestine and rectum. Ulcerative colitis can be mild to severe, but it does put a person at an increased risk of getting colon cancer.1,2

Ulcerative Colitis: Warning Signs To Look For

Ulcerative Colitis: Warning Signs To Look For

One of the first symptoms of ulcerative colitis is generally diarrhea. Stools start becoming progressively looser, and some people also experience a sudden and urgent urge to go to the bathroom, along with abdominal pain and cramps. The onset of diarrhea might be slow, or it can come on suddenly as a symptom. The exact symptoms of ulcerative colitis also depend on the spread and severity of inflammation in the digestive tract.

The most common symptoms of ulcerative colitis are:

Some people with ulcerative colitis also report experiencing:

Symptoms of ulcerative colitis are typically worse early in the morning. The symptoms of ulcerative colitis may also differ from person to person, depending on the exact area of inflammation in the digestive tract. In some cases, signs and symptoms of the condition can continue to be mild or completely absent for several months or even years at a time. However, without treatment, the symptoms are likely to return and vary depending on which part of the large intestine is affected.

The exact causes of ulcerative colitis remain unclear, but it is believed to be caused by a variety of factors, including:

  • Genetics3
  • Environmental factors like air pollution, cigarette smoke, and diet
  • Immune system response

If you have ulcerative colitis, you are already well-aware of the flare-ups that come with symptoms like severe diarrhea, fatigue, abdominal cramping, and bloody stool. Over time, though, people with ulcerative colitis learn how to deal with these flare-ups and manage their condition. However, this does not mean that every symptom should simply be taken as being part of your condition. There are certain warning signs you must be aware of if you have ulcerative colitis.

Serious complications arising from ulcerative colitis is quite rare, they can occur, and if you have ulcerative colitis, you need to be aware of what the symptoms of ulcerative colitis that require emergency medical care look like. As a general rule of thumb, any change in the severity of your ulcerative colitis symptoms should prompt you to call your doctor and let them know. For example, if you notice you are having more than five to six bowel movements each day that includes a lot of blood, along with a fever or low temperature, and a fast heart rate, you must call your doctor at once.4 According to a 2014 review published in the World Journal of Gastrointestinal Pathophysiology, these are considered to be signs of onset for acute severe ulcerative colitis, also known as fulminant colitis.5,6,7

Research shows that nearly 20 percent of all people with ulcerative colitis experience a severe flare. According to a 2016 review, experts believe that it is essential to catch acute severe ulcerative colitis in the early stages so that the person can be hospitalized. They will be administered body fluids and electrolytes and also be given any necessary nutritional support that the doctor deems necessary.8

If acute severe ulcerative colitis is left untreated, it can lead to life-threatening conditions like a perforated bowel, toxic megacolon, and internal hemorrhaging.9

Toxic Megacolon: Potentially Fatal Complication of Ulcerative Colitis

In people with toxic megacolon, a particular portion of the large intestine gets paralyzed and stops working. It can also swell up to many times its normal size. Toxic megacolon is an urgent and potentially life-threatening condition that needs immediate medical attention. If this condition is left untreated, a portion of the large intestine can become severely damaged to the extent that it develops a hole. Perforation of the large intestine could potentially cause severe infection and even death.10,11

Warning signs of toxic megacolon to watch out for include:

  • High fever
  • Worsening abdominal pain – pain might be unbearable
  • Abdominal tenderness
  • Visibly bloated or distended abdomen
  • Dehydration
  • A sudden decrease in the number of daily bowel movements

However, owing to the current therapies for ulcerative colitis, toxic megacolon is not a common condition, but these warning symptoms still require immediate medical attention.

Anytime you experience severe or rapidly worsening abdominal pain along with vomiting, fever, or dehydration, all these should be treated as warning signs that require urgent medical evaluation.12

To prevent toxic megacolon from developing, avoid the following when you have a ulcerative colitis flare-up:

  • Taking non-steroidal anti-inflammatory drugs (NSAIDs)
  • Using narcotics
  • Taking anti-diarrheal medications

Warning Signs that Indicate Hemorrhaging and Perforated Bowel

Bowel perforation happens when there is a hole in the wall of the large intestine. This perforation can be in the form of a tear, cut, or a puncture. The opening allows intestinal material and air to start leaking into the abdominal cavity.

A perforated bowel, or a perforation, is a potentially life-threatening emergency that needs immediate and urgent medical attention along with surgical intervention. Perforation can happen due to toxic megacolon, but in people with ulcerative colitis, it can also be caused by certain types of medications, intestinal infections, inflammation, and long-term irritation of the colon.13

Perforation of the large intestine is considered to be highly dangerous because it can allow the bacteria in from the intestine to travel throughout the body, potentially causing a massive infection and eventual death.

In some cases, perforation can also be followed by heavy rectal bleeding or hemorrhaging.14 When you have ulcerative colitis, you need to be on the lookout for any sudden or dramatic increases in the amount of blood you observe in your stool. While it is a rare occurrence, massive hemorrhaging in a person with ulcerative colitis is a medical emergency that needs immediate and urgent medical care.

Other Warning Signs of Ulcerative Colitis To Watch Out For:

Severe Dehydration

In people with ulcerative colitis, severe dehydration is another medical emergency that can happen from persistent diarrhea. The likelihood of this is even higher if you don’t drink enough fluids to replenish the amount of water lost through diarrhea.

Dehydration is always a big concern for people with ulcerative colitis because the body keeps losing a significant amount of fluid with each bowel movement. Mild cases of dehydration can be treated at home by regularly drinking water or having a rehydration solution. Electrolyte drinks are also a good idea, but only if you clear them with your doctor first.15

Some of the symptoms of severe dehydration include:

Liver Disease

Liver disease is also a common complication with ulcerative colitis. Primary sclerosing cholangitis (PSC) is a type of liver disease that is often associated with ulcerative colitis. However, if PSC is left untreated, it can cause liver scarring (known as cirrhosis) or permanent liver damage.16

Some of the common symptoms of Primary sclerosing cholangitis (PSC) you need to watch out for include:

  • Abdominal pain
  • Extreme tiredness
  • Itchy skin
  • Yellowing of the skin and eyes, a condition known as jaundice
  • Fever and chills from infection of the bile ducts

Another liver-related complication that may occur in people with ulcerative colitis happens from the steroid medications that are used for treating the inflammation. These steroid medications may cause fat to get deposited in the liver. This is known as fatty liver disease.17 Symptoms of fatty liver disease to look for include:

  • Weakness or extreme tiredness
  • Mental confusion
  • Swollen legs and abdomen
  • Jaundice
  • Nausea, weight loss, or loss of appetite
  • Abdominal pain
  • A feeling of fullness, especially in the upper right side of the abdomen

In many cases, though, fatty liver disease does not cause any symptoms and does not require any treatment either. However, if you are overweight, losing some weight can help reverse this condition.

If you have ulcerative colitis, your doctor is likely to run a complete liver function test from time to time to check the overall health of your liver. The first signs of any liver complications typically include jaundice and itchy skin. Jaundice causes yellowing of the whites of the eyes or the skin. If you experience any signs of liver complications, talk to your doctor at once so that the required diagnostic tests can be scheduled.

Colon Cancer

People with ulcerative colitis are at a higher risk of developing colon cancer.18 The risk of colon cancer in people with ulcerative colitis depends on the severity of their condition. According to estimates by the American Cancer Society (ACS), colorectal cancer is now the third most commonly diagnosed cancer in the United States.19

Since the symptoms of colon cancer are very similar to your ulcerative colitis symptoms, it can be challenging to distinguish one condition from the other. To check for any tumors in your large intestine, your doctor is likely to recommend a colonoscopy. A colonoscopy is a procedure in which a flexible tube is inserted into the rectum to get a closer look at the colon.

The warning signs of colon cancer are black, tarry stools, or a sudden change in your bowel activity.20 Colon cancer sometimes also makes your stool become thinner, and there is much more blood present in the stool than you would usually notice in just ulcerative colitis. This is why it is important to let your doctor know if you experience any of these symptoms. Also, see your doctor at the earliest if you experience severe stomach pain, extreme and unexplained fatigue, and unexplained weight loss.

Summing Up

Ulcerative colitis is a chronic and challenging condition to manage. Lifestyle changes and medication can help people manage the disease, though you will always need to be careful and keep an eye out on your symptoms of Ulcerative colitis.

If you feel like your present ulcerative colitis treatment is not working, you should discuss about alternate options with your doctor. Sometimes adjusting the dosage or changing the medication may lead to a better outcome and also help you go into remission.

However, if you do not follow your treatment plan or leave ulcerative colitis untreated, you may be prone to life-threatening situations and complications. This is especially true if the inflammation and ulcers in the colon continue growing untreated.

If you experience any of the listed warning signs and symptoms of Ulcerative colitis, you should seek immediate medical care. Some of these emergency symptoms may include a high fever, severe abdominal pain, heavy rectal bleeding, and severe diarrhea.

Remember that untreated ulcerative colitis can also increase the risk of developing colon cancer, which may further aggravate your symptoms and impair the quality of your life. This is why it is important to follow a healthy lifestyle and keep your medical team updated about any new symptoms as they develop.


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Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:December 4, 2020

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