The clinical picture of the ulcerative colitis largely depends on the extent of the process. The most common symptoms include:
- Diarrhea mixed with mucus and blood – occurs as a result of inflammation and ulceration of the interior lining of the colon. Depending on severity of the process it can occur:
- In mild cases - less than four times per day, with or without blood
- In moderate cases – more than four stools per day
- In severe cases – more than six bloody stools per day
- Fulminant disease – more than ten bloody stools per day
- Fever – usually there is no fever in mild cases; however, in moderate and more serious cases a high fever (38-39 °C (100-102 °F) and higher) can be observed, which correlates with signs of toxicity. Fever caused by ulcerative colitis is a very worrying sign because it indicates that the condition of the patient is getting worse.
- Weight loss – happens as a result of constant diarrhea which decreases the absorption rate of nutrients from the food. In mild cases people usually don’t experience weight loss. In moderate cases the person may gradually lose weight without eating a calorie-dense diet. In severe cases, the person usually loses a lot of weight; hypo- and avitaminosis may also develop due to malabsorption.
- Anemia – in mild cases a person usually doesn’t develop anemia. In more severe cases, however, the bleeding from the gastrointestinal tract is severe enough that an anemia may develop. Treatment against ulcerative colitis usually resolves this problem. However, in some cases the person may also need to take iron supplements.
- Pain – can range from mild discomfort to severe pain in the abdominal area. The pain is the result of constant inflammation and muscle spasms. In severe cases (especially when ulcerative colitis is complicated by toxic megacolon) the abdominal wall becomes tender to the touch, while the pain becomes very severe.
Quite often patients with ulcerative colitis also suffer from a number of symptoms and conditions that affect different parts of the body. It is believed that this happens due to the fact that ulcerative colitis has autoimmune origin. The frequency of those manifestations can be anywhere from 6 to 47 %. They include:
- Episcleritis – is an inflammatory disease of a thin layer of tissue that is located between the connective tissue layer of the sclera (white of the eye) and the conjunctiva. It is mainly characterized by redness and mild eye pain. The treatment is focused on decreasing the discomfort of the patient by using lubricating eye drops.
- Iritis (otherwise known as uveitis)– is the inflammatory process which affects the choroid, ciliary body, and iris. The patient with uveitis usually experiences blurred vision, redness of the eye, sensitivity to light, eye pain, irregular pupils, headaches, and dark sport floating in the field of vision.
- Aphthous ulcers in the mouth – are non-contagious mouth ulcers, which can appear in otherwise healthy individuals. They repeatedly appear and heal completely a few days afterwards. Symptoms range from very mild to debilitating as they can interfere with eating and drinking.
- Seronegative arthritis – during this condition the patient is tested negative for anti-nuclear antibodies and rheumatoid factor (hence the name – seronegative), while the levels HLA-B27 are increased. This type of arthritis can present itself in the form of oligoarthritis (affecting only one or two big joints) or polyarthritis (affecting numerous small joints).
- Ankylosing spondylitis – is an inflammatory disease which usually affects the joints of the spine eventually leading to the fusion of these joints. Complete fusion can result in a total rigidity of the spine, which is known as a “bamboo spine.” Unfortunately, there is no cure for this condition, even though some treatment may decrease the pain and some of the symptoms.
- Sacroiliitis – is an inflammatory process in the sacroiliac joint. This joint is located between the sacrum (lower spine) and the iliac bone. This process causes the person to feel pain the lower back and legs, which gets worse if the person is sitting down for too long or when rolling over in bed. The person may also experience stiffness after sitting still for a long period of time.
- Cutaneous (affecting the skin):
- Erythema nodosum – is an inflammatory process which affects the fat cells beneath the skin of the lower extremities, which causes tender red nodules to appear. It usually resolves spontaneously after three to six weeks.
- Pyodermagangrenosum – usually affects only the legs and causes deep necrosis of the skin, resulting in chronic wounds. This condition is accompanied by high fever and overall weakness due to toxins released into the bloodstream. These wounds tend to heal very slowly and leave a substantial amount of scar tissue as a result.
- Deep venous thrombosis – is a condition during which blood clots appear in deep veins of the legs. This may result in engorged superficial veins, redness, swelling and pain. It can also lead to embolization of the pulmonary artery (a life-threatening complication) if the blood clot detaches itself.
- Autoimmune hemolytic anemia – during this condition the person’s immune system attacks the red blood cells causing their lysis. While the usual lifetime of a red blood cell is 100-120 days, during this condition the lifetime can be shortened to only a few days (in severe cases).
- Nail clubbing (also known as watch-glass nails or drumstick fingers) – is a condition commonly associated with insufficient function of the lungs and heart; however, in 60 % of the cases the underlying cause is unknown.
- Primary sclerosing cholangitis – is a disease which causes inflammation and as a result obstruction of the bile ducts within and outside the liver. This process prevents the normal flow of the bile from the liver which eventually leads to cirrhosis, liver cancer, and liver failure. It is an autoimmune disease and in 80 % of the cases the person is also affected by ulcerative colitis. The only effective treatment is liver transplantation.