Table of ContentsView AllTable of ContentsChronic AnemiaArthritisFatty Liver DiseaseOsteoporosisEpiscleritisPrimary Sclerosing CholangitisBowel PerforationColorectal Cancer
Table of ContentsView All
View All
Table of Contents
Chronic Anemia
Arthritis
Fatty Liver Disease
Osteoporosis
Episcleritis
Primary Sclerosing Cholangitis
Bowel Perforation
Colorectal Cancer
The risks of untreated ulcerative colitis (UC) are many, affecting not only the gastrointestinal tract but also the eyes, joints, liver, kidneys, heart, and bones.As arguably the more severe form ofinflammatory bowel disease (IBD), UC can lead to potentially severe complications if symptoms like bloody diarrhea and intestinal inflammation are allowed to go unchecked.
By getting UCtreatedand into a state oflong-term remission, you can live a healthier, more productive life and avoid complications ranging from chronic anemia to colorectal cancer.
2:33What Causes Ulcerative Colitis?
2:33
What Causes Ulcerative Colitis?
One of the hallmark signs ofulcerative colitisis blood in your stool, also known ashematochezia. Even during the early stages of the disease, this can lead toanemia, a condition in which there are not enough red blood cells to carry oxygen to cells.
With untreated UC, anemia can become especially problematic as the bleeding may not only bechronic(persistent) but tends to get progressively worse. This can lead to a form of anemia known asanemia of chronic disease.
With chronic anemia, the lack of oxygen puts excessive strain on the heart and respiratory tract as they work harder to compensate for the loss. This can lead to a cascade of long-term complications such as:
In pregnant people, untreated anemia can causepremature birthandlow birth weight.
Arthritisis the most common extraintestinal complication of IBD, affecting as many as 30% of people with UC orCrohn’s disease(the other form of IBD).
In people with untreated IBD, the forms of arthritis most commonly seen include:
Fatty liver disease (hepatic steatosis) is another common complication of untreated UC. This is when extra fat gets deposited in the liver, supplanting and damaging healthy liver cells and tissues. Research suggests that nearly two out of every three people with IBD meet the clinical criteria for fatty liver disease.
Osteoporosis and Bone Loss
People with untreated UC can develop vitamin deficiencies due tomalabsorptionof nutrients in the intestines. Chief among these isvitamin D deficiency.
Vitamin D is the nutrient that helps calcium get into your bones, making them stronger. When there is not enough vitamin D in the body, the loss of calcium absorption can decrease bone mass (referred to asosteopenia), leading toosteoporosis(porous bones) andosteomalacia(softer bone).
Older females with UC are at greatest risk due to the co-occurring decline ofestrogenduring and after menopause. Untreated UC combined with the loss of estrogen (which supports bone growth) can lead to severe symptoms of osteoporosis at an earlier age. These include abnormal spinal curvature and an increased risk ofpathologic fracturesof the hip or spine.
Episcleritis and Other Eye Diseases
Episcleritisis the inflammation of the episclera, the thin layer of tissue between thesclera(the white of the eye) andconjunctiva(the clear membrane covering the eye).
Episcleritis is common with untreated UC. The combination of systemic inflammation and increased blood pressure can cause tiny blood vessels in the episclera to become swollen, leading to eye redness, pain, watering, and light sensitivity, The severity of episcleritis tends to mirror the severity of UC.
Although episcleritis tends to be relatively mild in most people, those with untreated UC may experience a more severe form called nodular episcleritis in which tiny bumps form on the surface of the eye.
Left untreated, UC can lead to the progression of eye disease, resulting in chronicuveitis(inflammation of the middle layer of the eye) and an increased risk ofcataractsandglaucoma.
Studies suggest that nine out of 10 people with PSC have UC or Crohn’s disease. On the other hand, only one out of every 10 people with UC or Crohn’s disease have PSC.People with poorly controlled IBD appear to be at greatest risk.
In people with UC, inflammation in the right side of the colon (cecum) is associated with a greater risk of PSC.
In 10% to 20% of cases, PSC can lead to a rare form of cancer calledcholangiocarcinomaaffecting the bile ducts.
Bowel Perforation and Toxic Megacolon
Bowel perforationis a rare but potentially life-threatening complication of ulcerative colitis. It is more common in those with long-standing, severe UC whose intestinal walls have become swollen, wider, and thinner (referred to as fulminant colitis).
With bowel perforation, the contents of the intestine can spill into the abdomen and cause a serious infection known asperitonitis. Even with aggressive treatment, a bowel perforation with peritonitis poses a high risk of death, hovering around 30% to 50%.
Most cases of bowel perforation occur with a condition called toxic megacolon. This is the most severe form of fulminant colitis in which the colon spontaneously dilates (widens) and loses its ability to contract.
Toxic megacolon is a rare complication (most commonly seen in older adults with UC), but one that may require emergency surgery to avoid death.
Colorectal cancer is most common in people with long-standing UC, with the risk progressively increasing after eight to 10 years. Those who experiencepancolitis(meaning inflammation throughout the entire colon) are at greatest risk. Other risk factors include a family history of colorectal cancer or a co-occurring diagnosis of primary sclerosing cholangitis.
Research suggests that long-term remission can significantly reduce the risk of colorectal cancer in people with UC, highlighting the importance of early treatment.
Routinesurveillance for colorectal canceris recommended in people with long-standing UC. A colonoscopy is typically advised every 1 to 3 years to check for polyps or early signs of cancer.
© Verywell, 2018
Summary
Ulcerative colitis (UC) can lead to potentially serious complications if left untreated, affecting not only the digestive tract but also the eyes, bones, kidneys, liver, heart, and bile duct. These include complications like chronic anemia, arthritis, fatty liver disease, osteoporosis, episcleritis, primary sclerosing cholangitis, bowel perforation, and colorectal cancer.
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Isene R, Bernklev T, Høie O, et al.Extraintestinal manifestations in Crohn’s disease and ulcerative colitis: results from a prospective, population-based European inception cohort.Scand J Gastroenterol. 2015;50(3):300-5.Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF.Ulcerative colitis.Lancet. 2017;389(10080):1756-1770. doi:10.1016/S0140-6736(16)32126-2.National Institute of Diabetes and Digestive and Kidney Diseases.Anemia of inflammation or chronic disease.Crohn’s and Colitis Foundation.Fact sheet: arthritis and joint pain.Navarro P, Gutierrez-Ramirez L, Tejera-Munoz A, Arias A, Lucendo AJ.Systematic review and meta-analysis: prevalence of non-alcoholic fatty liver disease and liver fibrosis in patients with inflammatory bowel disease.Nutrients. 2023 Nov;15(21):4507. doi:10.3390/nu15214507Piodi LP, Poloni A, Ulivieri FM.Managing osteoporosis in ulcerative colitis: something new?World J Gastroenterol.2014 Oct 21;20(39):14087–14098. doi:10.3748/wjg.v20.i39.14087Salama A, Elsheikh A, Alweis R.Is this a worrisome red eye? Episcleritis in the primary care setting.J Community Hosp Intern Med Perspect. 2018;8(1):46-48. doi:10.1080/20009666.2017.1418110Pytrus W, Akutko K, Pytrus T, Turno-Krecicka A.A review of ophthalmic complications in inflammatory bowel diseases.J Clin Med. 2022 Dec;11(24):7457. doi:10.3390/jcm11247457Dyson JK, Beuers U, Jones DEJ, Lohse AW, Hudson M.Primary sclerosing cholangitis.Lancet.2018;391(10139):2547-2559. doi:10.1016/S0140-6736(18)30300-3Univerisity of Chicago Medicine.Primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD).Mertz A.Primary sclerosing cholangitis and inflammatory bowel disease comorbidity: an update of the evidence.Ann Gastroenterol.2019 Mar-Apr;32(2):124-133. doi:10.20524/aog.2019.0344Crohn’s and Colitis Foundation.Fact sheet: intestinal complications.Agency for Healthcare Research and Quality.A missed bowel perforation - the importance of diagnostic reasoning.Li W, Zhao T, Wu D, et al.Colorectal cancer in ulcerative colitis: mechanisms, surveillance and chemoprevention.Curr Oncol.2022 Sep;29(9):6091–6114. doi:10.3390/curroncol29090479
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Isene R, Bernklev T, Høie O, et al.Extraintestinal manifestations in Crohn’s disease and ulcerative colitis: results from a prospective, population-based European inception cohort.Scand J Gastroenterol. 2015;50(3):300-5.Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF.Ulcerative colitis.Lancet. 2017;389(10080):1756-1770. doi:10.1016/S0140-6736(16)32126-2.National Institute of Diabetes and Digestive and Kidney Diseases.Anemia of inflammation or chronic disease.Crohn’s and Colitis Foundation.Fact sheet: arthritis and joint pain.Navarro P, Gutierrez-Ramirez L, Tejera-Munoz A, Arias A, Lucendo AJ.Systematic review and meta-analysis: prevalence of non-alcoholic fatty liver disease and liver fibrosis in patients with inflammatory bowel disease.Nutrients. 2023 Nov;15(21):4507. doi:10.3390/nu15214507Piodi LP, Poloni A, Ulivieri FM.Managing osteoporosis in ulcerative colitis: something new?World J Gastroenterol.2014 Oct 21;20(39):14087–14098. doi:10.3748/wjg.v20.i39.14087Salama A, Elsheikh A, Alweis R.Is this a worrisome red eye? Episcleritis in the primary care setting.J Community Hosp Intern Med Perspect. 2018;8(1):46-48. doi:10.1080/20009666.2017.1418110Pytrus W, Akutko K, Pytrus T, Turno-Krecicka A.A review of ophthalmic complications in inflammatory bowel diseases.J Clin Med. 2022 Dec;11(24):7457. doi:10.3390/jcm11247457Dyson JK, Beuers U, Jones DEJ, Lohse AW, Hudson M.Primary sclerosing cholangitis.Lancet.2018;391(10139):2547-2559. doi:10.1016/S0140-6736(18)30300-3Univerisity of Chicago Medicine.Primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD).Mertz A.Primary sclerosing cholangitis and inflammatory bowel disease comorbidity: an update of the evidence.Ann Gastroenterol.2019 Mar-Apr;32(2):124-133. doi:10.20524/aog.2019.0344Crohn’s and Colitis Foundation.Fact sheet: intestinal complications.Agency for Healthcare Research and Quality.A missed bowel perforation - the importance of diagnostic reasoning.Li W, Zhao T, Wu D, et al.Colorectal cancer in ulcerative colitis: mechanisms, surveillance and chemoprevention.Curr Oncol.2022 Sep;29(9):6091–6114. doi:10.3390/curroncol29090479
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Isene R, Bernklev T, Høie O, et al.Extraintestinal manifestations in Crohn’s disease and ulcerative colitis: results from a prospective, population-based European inception cohort.Scand J Gastroenterol. 2015;50(3):300-5.Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF.Ulcerative colitis.Lancet. 2017;389(10080):1756-1770. doi:10.1016/S0140-6736(16)32126-2.National Institute of Diabetes and Digestive and Kidney Diseases.Anemia of inflammation or chronic disease.Crohn’s and Colitis Foundation.Fact sheet: arthritis and joint pain.Navarro P, Gutierrez-Ramirez L, Tejera-Munoz A, Arias A, Lucendo AJ.Systematic review and meta-analysis: prevalence of non-alcoholic fatty liver disease and liver fibrosis in patients with inflammatory bowel disease.Nutrients. 2023 Nov;15(21):4507. doi:10.3390/nu15214507Piodi LP, Poloni A, Ulivieri FM.Managing osteoporosis in ulcerative colitis: something new?World J Gastroenterol.2014 Oct 21;20(39):14087–14098. doi:10.3748/wjg.v20.i39.14087Salama A, Elsheikh A, Alweis R.Is this a worrisome red eye? Episcleritis in the primary care setting.J Community Hosp Intern Med Perspect. 2018;8(1):46-48. doi:10.1080/20009666.2017.1418110Pytrus W, Akutko K, Pytrus T, Turno-Krecicka A.A review of ophthalmic complications in inflammatory bowel diseases.J Clin Med. 2022 Dec;11(24):7457. doi:10.3390/jcm11247457Dyson JK, Beuers U, Jones DEJ, Lohse AW, Hudson M.Primary sclerosing cholangitis.Lancet.2018;391(10139):2547-2559. doi:10.1016/S0140-6736(18)30300-3Univerisity of Chicago Medicine.Primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD).Mertz A.Primary sclerosing cholangitis and inflammatory bowel disease comorbidity: an update of the evidence.Ann Gastroenterol.2019 Mar-Apr;32(2):124-133. doi:10.20524/aog.2019.0344Crohn’s and Colitis Foundation.Fact sheet: intestinal complications.Agency for Healthcare Research and Quality.A missed bowel perforation - the importance of diagnostic reasoning.Li W, Zhao T, Wu D, et al.Colorectal cancer in ulcerative colitis: mechanisms, surveillance and chemoprevention.Curr Oncol.2022 Sep;29(9):6091–6114. doi:10.3390/curroncol29090479
Isene R, Bernklev T, Høie O, et al.Extraintestinal manifestations in Crohn’s disease and ulcerative colitis: results from a prospective, population-based European inception cohort.Scand J Gastroenterol. 2015;50(3):300-5.
Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF.Ulcerative colitis.Lancet. 2017;389(10080):1756-1770. doi:10.1016/S0140-6736(16)32126-2.
National Institute of Diabetes and Digestive and Kidney Diseases.Anemia of inflammation or chronic disease.
Crohn’s and Colitis Foundation.Fact sheet: arthritis and joint pain.
Navarro P, Gutierrez-Ramirez L, Tejera-Munoz A, Arias A, Lucendo AJ.Systematic review and meta-analysis: prevalence of non-alcoholic fatty liver disease and liver fibrosis in patients with inflammatory bowel disease.Nutrients. 2023 Nov;15(21):4507. doi:10.3390/nu15214507
Piodi LP, Poloni A, Ulivieri FM.Managing osteoporosis in ulcerative colitis: something new?World J Gastroenterol.2014 Oct 21;20(39):14087–14098. doi:10.3748/wjg.v20.i39.14087
Salama A, Elsheikh A, Alweis R.Is this a worrisome red eye? Episcleritis in the primary care setting.J Community Hosp Intern Med Perspect. 2018;8(1):46-48. doi:10.1080/20009666.2017.1418110
Pytrus W, Akutko K, Pytrus T, Turno-Krecicka A.A review of ophthalmic complications in inflammatory bowel diseases.J Clin Med. 2022 Dec;11(24):7457. doi:10.3390/jcm11247457
Dyson JK, Beuers U, Jones DEJ, Lohse AW, Hudson M.Primary sclerosing cholangitis.Lancet.2018;391(10139):2547-2559. doi:10.1016/S0140-6736(18)30300-3
Univerisity of Chicago Medicine.Primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD).
Mertz A.Primary sclerosing cholangitis and inflammatory bowel disease comorbidity: an update of the evidence.Ann Gastroenterol.2019 Mar-Apr;32(2):124-133. doi:10.20524/aog.2019.0344
Crohn’s and Colitis Foundation.Fact sheet: intestinal complications.
Agency for Healthcare Research and Quality.A missed bowel perforation - the importance of diagnostic reasoning.
Li W, Zhao T, Wu D, et al.Colorectal cancer in ulcerative colitis: mechanisms, surveillance and chemoprevention.Curr Oncol.2022 Sep;29(9):6091–6114. doi:10.3390/curroncol29090479
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