The predominant symptom of ulcerative colitis is diarrhea, sometimes associated with blood in the stool. Frequent bowel movements are common, as a result of irritability of the inflamed rectum. In severe cases, people may have eight or more bloody bowel movements a day. Other symptoms include abdominal or rectal pain, fever, and weight loss. In some cases, anemia and weakness may result from blood loss.
About 50 to 60 percent of patients have mild disease, marked mainly by diarrhea and some bleeding. These cases usually respond well to drug therapy. Moderate disease occurs in about 30 percent of people with UC and is characterized by bloody diarrhea, cramps, abdominal tenderness, and urgency to defecate; sometimes these symptoms are accompanied by anorexia and weight loss, fever, or mild anemia. Only about 10 percent of UC patients have severe cases of the disease. The symptoms involve six or more bloody bowel movements per day, abdominal pain and tenderness, fever, anemia, an elevated white cell count, and a low level of albumin, a protein in the blood. People who suffer severe UC may develop life-threatening complications, such as severe hemorrhage, or a condition called "toxic megacolon," where the colon swells and may damage other organs.
Sometimes, people with ulcerative colitis experience symptoms that affect other systems of their body, known as extra-intestinal symptoms.
Symptoms of arthritis may occur in as many as 26 percent of patients with ulcerative colitis. Arthritic symptoms may show up even before inflammatory bowel disease is diagnosed. About 12 to 23 percent of patients with ulcerative colitis have peripheral arthritis, or pain and swelling that affects the large, weight-bearing joints such as the knees and ankles. If UC worsens or becomes exacerbated, arthritis signs and symptoms often accompany the change in condition. Spondylitis, or inflammation of the vertebrae, occurs in about 3 percent of UC patients who also have arthritis complications.
Nineteen percent of patients with ulcerative pancolitis (UC that involves the entire colon) experience dermatological disorders. These can include a skin condition called erythema nodosum, in which small, tender, red nodules appear under the skin, accompanied by fever and transitory arthritic symptoms. Another possible skin disorder is pyoderma gangrenosum. Thought to be an immune reaction, this condition causes soft, red nodules on top of the skin that ulcerate, turning purple-red around the edges. Pyoderma gangrenosum (and especially erythema nodosum) do occur alone and associated with other conditions that do not include UC. However, because pyoderma gangrenosum is so commonly associated with UC, evaluation of the bowel is usually undertaken even in the absence of symptoms (as in primary sclerosing cholangitis). Psoriasis, a common skin disease appearing as reddish, silvery-scaly skin, can accompany UC.
About 5 percent of patients with extensive ulcerative colitis also develop eye-related manifestations of the disease. These may include uveitis, or inflammation of all or part of the uvea (the iris, ciliar body, and choroids); episcleritis, inflammation of the outermost layers of the eye; and keratoconjunctivitis, a condition characterized by dryness of the cornea due to lack of tears. Symptoms of these ocular complications are often headache, abnormal sensitivity to light, blurred vision, burning, and increased secretions from the eyes. Note that the majority of patients that have these ocular conditions do not have UC, however.
In most cases, when these systemic symptoms occur, they can be effectively treated with standard medications. Only in rare cases is removal of the colon necessary to control severe systemic complications associated with ulcerative colitis.
Last reviewed on 6/4/09
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