UC and Your Body

Ulcerative colitis (UC) is a condition that begins in your digestive tract, specifically the lower parts -- the colon and rectum. It’s a type of inflammatory bowel disease (IBD). When you have it, the tissue lining the inside of your large intestine gets irritated and swollen. That causes symptoms such as diarrhea, cramps, and a sudden, urgent need for the toilet.

Although digestive problems are the first symptoms you’ll notice, UC can affect other body parts, too. Those issues can happen because of the symptoms of UC, the inflammation that causes it, or some of the medicines you might take to treat it.

UC and Your Digestive System

UC symptoms usually come on slowly over time instead of suddenly. They can vary, depending on where the inflammation is affecting your large intestine. You might have:

  • Diarrhea, often with blood or pus
  • An urgent feeling that you need to poop 
  • Trouble going, even when you feel like you need to
  • Cramps and pain in your belly
  • Pain or bleeding in your rectum
  • Nausea or loss of appetite
  • A gurgling or splashing sound in your belly

It’s also common to lose weight or feel tired.

Most people with UC have mild to moderate symptoms, but the disease can be severe for about 10% of those who have it. People usually have periods when their symptoms get worse, called a flare, and other times when they seem to fade, called remission.

The symptoms and the damage that UC causes to your digestive system make you more likely to have other problems, such as:

  • Anemia. If the inflammation in your colon and rectum leads to bleeding, you may lose enough blood to cause low numbers of red blood cells in your body, a condition called anemia. It can make you weak, cold, pale, and short of breath. Your doctor can give you iron supplements or suggest diet changes to help with symptoms. Rarely, bleeding is severe enough that a person needs surgery to remove their colon or rectum.
  • Megacolon. This rare complication happens when inflammation affects the deepest tissue of your colon and makes it swell. Once it’s swollen, it stops working, and this can be life-threatening. You need to have surgery to fix it.
  • Colon cancer. If UC affects your entire colon, you’ve had it for 8 years or more, your inflammation is constant, or you’re a man, you’re more likely to get colon cancer. Your risk is also higher if you have a liver condition called primary sclerosing cholangitis, another UC complication. Your doctor may want to screen you for colon cancer earlier than normal if you’re in these risk categories.

UC and Your Joints

Joint pain is one of the most common non-GI symptoms of UC. As many as 30% of people with UC or Crohn’s disease will have arthritis, or pain and swelling of the joints. It can happen at any age.

Joint problems usually begin after you’ve had UC symptoms for a while. But for some people, they happen months or even years before any digestive issues.

Pain, stiffness, and swelling can affect your body in different ways.

In general, your doctor may tell you to ease the symptoms of joint pain and swelling with:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin. Note: these drugs can sometimes irritate your intestinal lining, so they may not be the best option for everyone with UC.
  • Prescription medicines, like corticosteroids, methotrexate, or biologics 
  • Rest
  • Moist heat
  • Exercises with a physical therapist

UC and Your Bones

Some people with UC get weak, brittle bones. Some will have low bone density, a condition called osteopenia. Others will have osteoporosis, when bones become weak enough that they break easily. These issues tend to happen more often to women who are older, but people with IBD can have them at any age.

It’s natural for people to lose bone mass as they get older. Your body constantly breaks down old bone tissue and builds new. After age 35 or so, the breaking down of old bone happens faster than your body can make new tissue. 

When you have UC, a few things can speed up normal bone loss:

  • UC medications. Corticosteroid drugs that fight inflammation, like prednisone and cortisone, can harm bone growth and strength over time. 
  • Inflammation. The same hormones that increase in your body with UC inflammation will affect your bones. They can get in the way of normal bone replacement. 

To help offset bone issues, your doctor may suggest you:

  • Change your medications. They may recommend you stop taking corticosteroids and switch to options like infliximab or methotrexate. 
  • Take medicines that can build your bone mass.
  • Avoid alcohol.
  • Stop smoking.
  • Exercise regularly.
  • Get more calcium and vitamin D, whether in your diet or with a supplement.

UC and Your Eyes

Around 10% of people with IBD deal with eye issues. The inflammation that comes along with UC can make your eyes red, swollen, and painful. Your doctor needs to know if you have any of these eye symptoms. They could be a sign of eye disorders linked to UC, such as:

  • Uveitis. This disorder is inflammation of the middle layer of your eye, or the uvea. It causes pain, blurred vision, sensitivity to light, and redness. There are special eyedrops that can help treat it. If you don’t take care of it, uveitis can turn into glaucoma, a disease that boosts the pressure in your eye and can cause vision loss.
  • Episcleritis. Tiny blood vessels in the outer covering of the white part of your eye get inflamed. It makes your eyes look red and feel tender and painful. To treat it, your doctor can give you steroid drops or drops that narrow your blood vessels. Typically, it goes away on its own when your UC symptoms die down.
  • Dry eye. If your UC is causing low vitamin A levels in your body, you may not be able to make or keep tears in your eyes the way you should. This can lead to infection, itching, and burning. You may need vitamin A drops to treat it. Artificial tears can help soothe the itching and burning.

Rarely, other parts of your eye can get inflamed when you have UC, such as your retina or your optic nerve. If you are on corticosteroid treatment for a long time, it can sometimes lead to glaucoma or cataracts in your eyes.

You should make a point to see an ophthalmologist regularly, so they can monitor you for any UC-related eye problems.

UC and Your Liver

UC inflammation can lead to irritation and damage in the liver. Some of this damage is reversible, but about 5% of people with UC will have serious liver disease. You might not have any outward symptoms, but some people have:

  • Fatigue
  • Low energy
  • A feeling of fullness or pain on the upper right side of the torso
  • Itching
  • Yellow skin and eyes (jaundice)
  • Bruises that happen easily
  • Fluid buildup in the body

Specifically, you could be dealing with:

  • Fatty liver disease. When you have this condition, your body deposits extra fat into your liver. It crowds out normal cells in the organ. Fatty liver disease doesn’t usually cause symptoms. You can typically reverse the damage with weight loss or cholesterol medications.
  • Hepatitis is inflammation of the liver. UC itself, or sometimes the medications that treat it, like methotrexate, may cause it. Treatments that ease your UC inflammation should also treat hepatitis. Your doctor will monitor your blood to check for signs of hepatitis.
  • Primary sclerosing cholangitis (PSC) is inflammation in your bile duct, the tube that connects your liver to your small intestine. Bile flows from your liver to your small intestine to help break down fatty acids. About 3% of people with UC get PSC. It can scar your bile duct, and eventually your liver. If bile can’t get out of your liver the way it needs to, it builds up. This causes itching and jaundice. PSC doesn’t have a treatment, but a stent in your bile duct may help bile flow better.

UC and Your Kidneys

Inflammation from UC can damage the kidneys. But problems with the organs can also happen because of trouble absorbing nutrients through your large intestine, or because of some of the medications you take to treat the disease. Generally, signs of kidney problems include:

  • The need to pee a lot
  • Blood in your urine
  • Dark or cloudy urine
  • Nausea or vomiting
  • Fever
  • Rash
  • High blood pressure
  • Drowsiness, confusion
  • Swelling or weight gain from holding on to extra fluid in your body

It’s rare for UC to cause serious kidney problems, but you might have:

  • Interstitial nephritis. This condition makes the small tubes inside your kidneys swell. That makes it harder for your kidneys to filter waste from your blood. Doctors aren't sure whether UC itself or a specific medicine for it causes the condition. Once you get your UC under control, interstitial nephritis should also go away.
  • Glomerulonephritis. This is a rare complication for people with UC. A cluster of blood vessels in the kidney called the glomerulus forms a lesion in your kidney and keeps it from filtering blood the way it should. If it’s severe, you may need dialysis or a kidney transplant.

UC and Your Skin

Around 20% of people with UC have skin problems of some kind. The inflammation that damages the colon and rectum can also trigger rashes, bumps, sores, and more. 

There are a few conditions that are often linked to UC flares or the medicines that treat UC.

UC and Your Blood Vessels

If you have UC, your risk of getting blood clots goes up. In fact, you’re three times more likely to get one than people without UC. Doctors aren’t exactly sure why that’s the case, but it may have something to do with your genes and substances in your blood that help it clot. 

Your chances of having blood clots are highest during a flare of your UC, when you’re in the hospital, and when you're not getting enough nutrients in your diet. Smoking, obesity, birth control pills, surgery, and pregnancy can also raise your risk of getting one.

If a blood clot forms in your leg, you have a condition called deep vein thrombosis (DVT). Symptoms include:

  • Pain in your leg that starts in your calf and feels like a cramp
  • Swelling in your leg
  • Redness or strange coloring on your leg
  • A warm area on your leg

A blood clot in the lungs is called a pulmonary embolism (PE). Symptoms include:

  • Shortness of breath that comes on suddenly
  • Chest pain when you cough or take a deep breath
  • Feeling dizzy or lightheaded
  • Rapid heartbeat
  • Coughing up blood

Your doctor may put you on blood thinners or medicines called thrombolytics that break apart clots. They’ll likely also recommend you get up and move as soon as you can after any surgery or rest period. You may also wear compression stockings to help keep blood from pooling and ease swelling in your legs.

UC and Mental Health

Life with any medical condition can be challenging. Because UC symptoms can be unpredictable, they can add an extra level of emotional strain. It’s normal to feel angry, sad, anxious, or stressed about your condition. But for some people, those feelings deepen into mental health conditions, like depression or anxiety.

Beyond the daily challenges of your condition, experts think there may actually be a link between the depression and the inflammation behind UC. But scientists aren’t sure exactly how they are connected. 

You may go through tough times, especially when your symptoms get worse. But if the feelings last for 2 weeks or more, you should talk to your doctor or a mental health professional. 

Stress and other emotions don’t cause UC, but they can make symptoms worse. So it’s important to find ways to handle your feelings when the going gets rough. Make sure you have some go-to stress relief tactics, like breathing exercises, meditation, light exercise like going for a walk, or spending time with friends or family. 

There are also many ways to manage depression, anxiety, or other mental health problems and improve your day-to-day life. These include:

  • Therapy. Both talk therapy and other forms such as cognitive behavioral therapy can help you change negative thought patterns. 
  • Medication. Many types of antidepressants can ease the symptoms of depression. Your doctor can prescribe these medications or refer you to a psychiatrist.
  • Lifestyle changes. Getting outside more, eating healthy foods, and exercising regularly are all mood boosters. Once you’ve found other forms of treatment that can help you through the worst of your depression, these practices can help you maintain a stable mental health pattern.

Managing Your UC

UC is a lifelong condition. Although medications can’t cure it, they can help keep flares under control. As you treat your UC overall, symptoms in other parts of your body will also improve.

Typical treatment for UC includes drug therapy and, in some cases, surgery.

Medications

Drugs that treat UC fall into several categories. Your doctor may try several different types of medications before finding the one that works best for you. Categories include:

Aminosalicylates (balsalazide, mesalamine, olsalazine, sulfasalazine). These drugs are a common choice for treating UC because they control inflammation. Doctors typically prescribe them for people with mild to moderate symptoms. You take them by mouth, as an enema or suppository, or both, depending on which parts of your colon are affected.

Corticosteroids (budesonide, hydrocortisone, methylprednisolone, prednisone). Also called steroids, these drugs both dial back the activity of your immune system and help lower inflammation in your body. Doctors usually wait to see if aminosalicylates work first before they prescribe steroids. But your doctor may start with steroids as your treatment if your symptoms are severe. You shouldn’t use steroids long-term, though.

Immunomodulators (azathioprine, cyclosporine, mercaptopurine, tofacitinib). These drugs reduce inflammation by dampening the immune system response that turns on inflammation. They can take 3 weeks to a month to start working. Doctors usually prescribe them when aminosalicylates haven’t worked.

Biologics. Adalimumab, golimumab, and infliximab are biologic medications called anti-TNF therapies. Biologics dial back your immune system response by targeting specific proteins, called tumor necrosis factor (TNF), that turn on inflammation. You get these drugs through a shot or IV. Your doctor will typically use them only if no other medication is working.

Other medications. You might need something else to ease UC symptoms, like pain or diarrhea, such as:

  • Acetaminophen for pain
  • Antibiotics for infections
  • Meds to ease diarrhea, such as loperamide

Surgery

People with mild or moderate UC won’t need surgery to treat their condition. But if your symptoms are severe and medications aren’t helping, your doctor may recommend an operation to remove all or parts of your colon and rectum.

The two main types of surgery include:

Proctocolectomy with ileostomy. This is the most common operation for UC. A surgeon removes your entire colon and rectum. Then they make a small hole in the wall of your belly and attach the bottom part of your small intestine to that opening. After the surgery, you won’t poop the way you did before. Your waste will come out of the new opening and drain into a bag, called an ostomy pouch.

Ileoanal anastomosis. In this surgery, a surgeon removes your whole colon and the tissue lining the inside of your rectum. You keep the outer muscles of your rectum. Your surgeon creates a “new” rectum from your small intestine and attaches it to your anus. This new pouch holds your stool. This allows you to poop much like you did before surgery. But bowel movements may happen more often and be more watery than before.

Surgery to remove your colon and rectum cures UC.

Diet and Nutrition

Though you can’t make your UC go away with a special diet, you can stretch out the time between flares and have better control of your symptoms by focusing on how and what you eat each day. Filling up on certain foods and avoiding others can help heal your colon and replace vital nutrients you may be losing from symptoms of UC.

Tips for Eating Well With UC