Pancolitis - Complications of ulcerative colitis

If you have ulcerative colitis, you could develop further problems.

Some of the main complications of ulcerative colitis are described below.

Osteoporosis

People with ulcerative colitis are at an increased risk of developing osteoporosis, when the bones become weak and are more likely to fracture.

This is not directly caused by ulcerative colitis, but can develop as a side effect of the prolonged use of corticosteroid medication. It can also be caused by the dietary changes someone with the condition may take – such as avoiding dairy products, if they believe it could be triggering their symptoms.

If you are thought to be at risk of osteoporosis, the health of your bones will be regularly monitored. You may also be advised to take medication or supplements of vitamin D and calcium to strengthen your bones.

Poor growth and development

Ulcerative colitis, and some of the treatments for it, can affect growth and delay puberty.

Children and young people with ulcerative colitis should have their height and body weight measured regularly by healthcare professionals. This should be checked against average measurements for their age.

These checks should be carried out every 3-12 months, depending on the person's age, the treatment they are having and the severity of their symptoms.

If there are problems with your child's growth or development, they may be referred to a paediatrician (a specialist in treating children and young people).

Primary sclerosing cholangitis

Primary sclerosing cholangitis (PSC), where the bile ducts become progressively inflamed and damaged over time, is a common complication of ulcerative colitis. Bile ducts are small tubes used to transport bile (digestive juice) out of the liver and into the digestive system.

PSC does not usually cause symptoms until it's at an advanced stage. Symptoms can include:

fatigue (extreme tiredness)
diarrhoea
itchy skin
weight loss
chills
a high temperature (fever)
yellowing of the skin and the whites of the eyes (jaundice)

There is currently no specific treatment for PSC, although medications can be used to relieve some of the symptoms, such as itchy skin. In more severe cases, a liver transplant may be required.

Toxic megacolon

Toxic megacolon is a rare and serious complication of severe ulcerative colitis, where inflammation in the colon causes gas to become trapped, resulting in the colon becoming swollen.

This is potentially very dangerous as it can send the body into shock (causing a sudden drop in blood pressure), the colon could rupture (split), or cause infection in the blood (septicaemia).

The symptoms of a toxic megacolon include:

abdominal (tummy) pain
a high temperature (fever)
a rapid heart rate

Toxic megacolon can be treated with fluids, antibiotics and steroids given intravenously (directly into a vein). A tube will also need to be inserted into your rectum and colon so the gas can be drawn out. In more severe cases, surgical removal of the colon (known as a colectomy) may be needed.

Treating symptoms of ulcerative colitis before they become severe can help prevent toxic megacolon.

Bowel cancer

People who have ulcerative colitis have an increased risk of developing bowel cancer (cancer of the colon, rectum or bowel), especially if the condition is severe or extensive. The longer you have ulcerative colitis, the greater the risk.

People with ulcerative colitis are often unaware they have bowel cancer as the initial symptoms of this type of cancer are similar. These include blood in the stools, diarrhoea and abdominal pain.

Therefore, you will usually have regular check-ups to look for signs of bowel cancer from about 10 years after your symptoms first develop.

Check-ups will involve examining your bowel with a colonoscope – which is a long, flexible tube containing a camera – that is inserted into your rectum. The frequency of the colonoscopy examinations will increase the longer you live with the condition, and will also depend on factors such as how severe your ulcerative colitis is and if you have a family history of bowel cancer.

To reduce the risk of bowel cancer, make sure you eat a healthy, balanced diet including plenty of fresh fruit and vegetables. It is also important to take regular exercise, maintain a healthy weight and avoid alcohol and smoking.

Taking aminosalicylates as prescribed should also help reduce your risk of bowel cancer.

Read more about preventing bowel cancer.

Blood: Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Deficiency: If you have a deficiency it means you are lacking in a particular substance needed by the body.
Immune: The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.
Inflammation: Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Joints: Joints are the connection point between two bones that allow movement.
Liver: The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.
Pain: Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Ulcerated: An ulcer is a sore break in the skin, or on the inside lining of the body.