Learn how to identify and avoid potentially life-threatening complications of ulcerative colitis.
If you have an IBD like ulcerative colitis, a gastroenterologist can prescribe medication or other forms of treatment for the inflammation and the sores, called ulcers, that occur in the lining of the large intestine and rectum. But this autoimmune disorder can also lead to complications in other parts of the body.
Extraintestinal complications — those that exist outside the intestines — can even overshadow symptoms in your bowels, making ulcerative colitis tricky to diagnose. While it remains unclear why UC complications can arise beyond the intestines, a clinical review article published in July 2015 in Inflammatory Bowel Diseases suggested that a person’s immune system may lose the ability to distinguish between intestinal bacteria that have “leaked” to other parts of the body and bacteria normally present in the joints or the skin.
“It’s easy to forget that ulcerative colitis is not just a disease of the intestines but a systemic or body-wide disorder of the immune system,” says Jessica Philpott, MD, PhD, a gastroenterologist at Cleveland Clinic in Ohio.
The following are five conditions commonly linked to ulcerative colitis, along with some treatment options.
Arthritis, or inflammation of the joints, is the most common complication of ulcerative colitis found outside the bowels. It affects about 25 percent of those with the disease, including both young and elderly patients. The severity of arthritis ranges from peripheral — mild joint pain and swelling with some loss of flexibility — to ankylosing spondylitis, a debilitating form of arthritis characterized by a dramatic loss of flexibility in the lower back.
“No one knows why for sure arthritis is so common in people with UC,” says Dr. Philpott, “but it’s probably due to the fact that systemic inflammation commonly has impact on the joints.”
Range-of-motion exercises and anti-inflammatory drugs can alleviate this condition.
2. Skin Disorders
About 5 percent of people with inflammatory bowel disease experience some type of skin disorder. Canker sores in the mouth; skin tags; tender red bumps on the shins, ankles, and arms; and lesions that evolve into deep, chronic ulcers are among those commonly associated with ulcerative colitis.
A study published in January 2016 in Annals of Internal Medicine found that skin lesions are associated with anti-TNF therapy. The research notes however, that such skin disorders are mild or moderate and either resolve on their own or with topical treatment. For other skin disorders associated with IBD, treatment includes antibiotics, ointments, warm baths, and surgery.
3. Eye Disorders
Uveitis, a type of inflammation in the pigmented part of the eye, is a complication of ulcerative colitis that can progress into glaucoma and vision loss if left untreated. Dryness and tenderness of the eyes are also problems that are common among people with colitis.
Vitamin A supplements and eye drops are generally prescribed to treat these complications, while effective management of ulcerative colitis helps to reduce inflammation in the eyes.
4. Bone Loss
Osteoporosis (bone loss) and osteopenia (low bone density) are ulcerative colitis complications that can occur for a variety of reasons, including:
- Inflammation in the body
- A side effect of certain medications used in treatment (particularly steroids)
- Vitamin deficiencies
Lifestyle measures, including regular weight-bearing exercise and supplements of calcium and vitamin D, can help prevent and treat this condition, as can prescription medication that boosts bone strength and density. Working with your doctor to customize your ulcerative colitis treatment plan can also help protect your bones; for example, lower doses of steroids might make sense for you.
5. Liver Disease
Mild liver problems such as gallstones, scarring in the bile ducts (called primary sclerosing cholangitis), pancreatitis, and fatty liver disease, also known as hepatic steatosis, are also associated with ulcerative colitis.
Medication and surgery are the most effective treatments for these complications.
Ways to Reduce Complications
Early intervention is key to reducing complications and improving outcome. It’s important to maintain proper nutrition and avoid emotional stress, though neither stress nor sensitivity to certain foods causes the disease.
While the cure for ulcerative colitis has yet to be found, when the disease is treated properly, some complications may disappear altogether. Work with your doctor and other members of your healthcare team to get optimal control of your ulcerative colitis as soon as possible.