8 complications associated with ulcerative colitis

Ulcerative colitis (UC) can raise your risk for certain health complications. These issues can occur within your digestive system or they can be extraintestinal, meaning they involve other parts of your body. And while some people with UC develop multiple complications, others may not face any at all. Whatever your experience is, it’s important to speak with your GI provider if you notice suspicious symptoms.

Although many of these complications are rare, it’s still key to stay informed about your health. Here are 8 complications associated with ulcerative colitis to keep in mind.

1. Bleeding

Bleeding is familiar to many people living with ulcerative colitis. Ongoing bleeding may lead to iron-deficiency anemia, a condition where your body doesn’t have enough functioning red blood cells.

Since bleeding can be caused by ulcers, hemorrhoids, anal fissures and rarely, colorectal cancer, it’s important to report to your medical team, says Sushila Dalal, MD, a gastroenterologist at University of Chicago Medicine in Illinois. They can pinpoint the source and adjust treatment accordingly.

2. Fulminant colitis and toxic megacolon

A serious issue complicating about 1 in 10 first UC attacks, fulminant colitis is acute, severe inflammation of the colon. Occasionally, it progresses to toxic megacolon, a life-threatening complication where the large intestine stretches and dilates, impeding movement of gas. “It blows up almost like a balloon,” says Dalal, “and that can lead to a perforation in the colon.” Fever, abdominal pain, more than 10 loose stools per day, and continuous bleeding are among the symptoms of fulminant colitis, and should prompt you to seek medical help immediately.

3. Colon cancer

People with UC have a higher colorectal cancer risk than people without UC, especially if colitis affects much of the colon or if they have a liver condition called primary sclerosing cholangitis. To help detect any changes early, Dalal recommends sticking to a regular screening schedule “even if the disease is in remission and the patient’s feeling completely well.” If you haven’t already, talk to your healthcare provider to understand when you should start screenings and how frequently you should have them.

4. Dehydration

Colitis patients may be at higher risk of becoming dehydrated than the general population. Frequent diarrhea is one contributor, as are UC-related surgeries, like the removal of your colon.

Dehydration symptoms include intense thirst, fatigue, and dizziness. To help prevent it, Dalal advises staying consistent with fluid intake and monitoring your urine color. “Make sure urine looks clear—it’s not dark and yellow,” she says, since a darker hue indicates your body is trying to hold on to scarce fluid.

5. Eye problems

Eye issues connected to UC typically won’t threaten your vision, but they can be painful and annoying. Sometimes medications trigger problems, while other times they’re related to UC itself. Uveitis—inflammation of the eye wall that often comes with redness, pain and light sensitivity—is the eye condition most commonly linked to UC. Generally it will subside with your UC, Dalal says, though it may require steroid eye drops. She recommends reporting any new visual symptoms to your healthcare provider, “because they likely will need some further testing.”

6. Arthritis

Arthritis, or joint inflammation, is one of the more common complications with ulcerative colitis. Since it’s usually related to disease activity, says Dalal, “oftentimes, once we heal the colon, the joint pain will improve as well.”

A small percentage of patients may develop ankylosing spondylitis, a serious complication where the vertebrae in the spine can fuse. Physical therapy can be helpful with spinal issues, and doctors may prescribe medication.

7. Osteoporosis

Osteoporosis causes your bones to become weaker and likelier to break. Frequently, it’s related to drugs used to treat UC. “A lot of times our patients need steroids to induce remission,” says Dalal. “We know that steroid use can cause bone loss, and ultimately osteoporosis.” The longer you use steroids, the greater your chances. To help slow or prevent bone loss, your GI provider may prescribe medications or supplements like calcium or vitamin D. They may also perform a bone density test, especially if you’re on steroids for an extended period.

8. Skin conditions

Though several skin conditions are linked to UC, the most common are erythema nodosum (EN) and pyoderma gangrenosum (PG). With EN, you’ll see tender red bumps, usually on the lower leg. Frequently linked to flare-ups, it often resolves with remission. That’s not always the case for PG, which may not mirror disease activity.

Also commonly found on the legs, PG presents with raised purple sores that can lead to ulcers. While treating ulcerative colitis is a good way to address skin issues, medication can help manage associated pain.

The importance of sticking with treatment

Ultimately, the best thing you can do to manage your UC is to follow your treatment plan and talk to your GI provider if any complications arise. “The best thing you can do,” says Dalal, “is to maintain a good remission and make sure the disease is completely controlled.”

Medically reviewed by Jenny Blair, MD