Symptoms and Diagnosis of Ulcerative Colitis

For many people, it starts with loose stools and a few drops of blood - often the first signs that a flare-up of ulcerative colitis is beginning. Although the exact cause is unknown, ulcerative colitis tends to run in people whose genetics predispose them to develop the disease. Their immune systems seem to behave abnormally, causing inflammation and sores (or "ulcers") in the lining of the rectum and colon (or large intestine). Those ulcers damage the lining of the colon, causing bleeding (which may ultimately lead to anemia), and making the colon less able to absorb water, which can lead to frequent, chronic diarrhea. Other symptoms of ulcerative colitis may include:

  • Pain and abdominal cramping, particularly on the left side
  • Fatigue
  • Weight loss
  • Loss of appetite
  • Nausea
  • Fever
  • Extra-intestinal symptoms including: red, itchy eyes; mouth sores; swollen, painful joints; brittle bones (osteoporosis); and kidney stones
  • Liver problems (rarely)
  • Growth problems (in children who have ulcerative colitis)

The Right Diagnosis

Because these can be symptoms of many illnesses, ulcerative colitis can sometimes be difficult to diagnose. After you report your symptoms, your doctor may start an evaluation by ordering some routine blood tests to check for anemia, infection and possibly certain antibodies in the blood that can be present in people with ulcerative colitis. While these can be helpful, they are not sensitive enough or specific enough to make a definitive diagnosis.

"Colonoscopy is the gold standard for diagnosing ulcerative colitis and it should include biopsies of the lining of the colon to rule out other possible causes, such as infections," says Deborah Proctor, M.D., professor of medicine and medical director of the Inflammatory Bowel Disease Program at Yale University. In a colonoscopy, while you are sedated, an endoscope -- a thin, flexible tube that contains a lighted camera -- is inserted painlessly into the rectum and up through the colon to give a view of the entire colon and the lower part of the small intestine. The image is magnified and appears on a monitor so your doctor can examine the lining of your colon to look for lesions that can be biopsied. A sigmoidoscopy involves a similar procedure, but allows your doctor to view only the lower third of the colon, so most doctors prefer a colonoscopy. In some cases, use of other scanning devices such as X-rays, MRIs and CAT scans may also be used to get a clearer picture of the extent of ulcerative colitis.

Reviewed by: Vikram Tarugu, M.D.

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