Ulcerative Colitis - Complications

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What are the Complications of Ulcerative Colitis?

Blood transfusions, pancolitis, and toxic megacolon

Patients with ulcerative colitis limited to the rectum (proctitis) or colitis limited to the end of the left colon (proctosigmoiditis) usually do quite well. Brief periodic treatments using oral medications or enemas may be sufficient. Serious complications are rare in these patients. In those with more extensive disease, blood loss from the inflamed intestines can lead to anemia and may require treatment with iron supplements or even blood transfusions. Rarely, the colon can acutely dilate to a large size when the inflammation becomes very severe. This condition is called toxic megacolon. Patients with toxic megacolon are extremely ill with fever, abdominal pain and distention, dehydration, and malnutrition. Unless the patient improves rapidly with medication, surgery usually is necessary to prevent colonic rupture.

In a published Scandinavian study of over 500 patients with ulcerative colitis followed for up to 10 years after diagnosis, it was found that their mortality rate did not differ from the general population. Also, the cumulative need for colectomy after 10 years was 9.8%, nearly 50% of the patients were relapse free in the last five years of the study, and only 20% of the patients with proctitis or left-sided disease progressed to pancolitis.


Colon cancer is a recognized complication of chronic ulcerative colitis. The risk for cancer begins to rise after eight to ten years of colitis. Patients with only ulcerative proctitis probably do not have increased risk of colon cancer compared to the general population. Among patients with active pancolitis (involving the entire colon) for 10 years or longer, the risk of colon cancer is increased compared to the general population. In patients with colitis limited to the left side of the colon, the risk of colon cancer is increased but not as high as in patients with chronic pancolitis.

Patients at higher risk of cancer are patients with positive family histories of colon cancer, long durations of colitis, extensive colon involvement, and primary sclerosing cholangitis (PSC), another complication of ulcerative colitis.

Since these cancers have a more favorable outcome when diagnosed and treated at an earlier stage, yearly colon examinations may be recommended after eight years of known extensive disease. During these examinations, samples of tissue (biopsies) can be taken to search for precancerous changes in the lining cells of the colon. When precancerous changes are found, removal of the colon may be necessary to prevent colon cancer.

Other complications of ulcerative colitis

Complications of ulcerative colitis can involve other parts of the body.

  • Ten percent of the patients can develop inflammation of the joints (arthritis).
  • Some patients have low back pain due to arthritis of the sacroiliac joints.
  • Ankylosing spondylitis (AS) is a type of arthritis that affects the vertebral joints of affected individuals. There seems to be an increased incidence of ankylosing spondylitis among patients with inflammatory bowel disease.
  • Rarely, patients may develop painful, red, skin nodules (erythema nodosum). Others can have painful, red eyes (uveitis, episcleritis). Because these particular complications can risk permanent vision impairment, eye pain or redness are symptoms that require a physician's evaluation.
  • Diseases of the liver and bile ducts also may be associated with ulcerative colitis. For example, in patients with a rare condition called sclerosing cholangitis, repeated infections and inflammation in the bile ducts can lead to recurrent fever, yellowing of skin (jaundice), cirrhosis, and the need for a transplantation of the liver.
  • Finally, patients with ulcerative colitis also might have an increased tendency to form blood clots, especially in the setting of active disease.
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See what others are saying

Comment from: zelda, 65-74 Female (Patient) Published: May 28

I've had ulcerative colitis for 20 years. It got out of control when I quit smoking. I lost 30 pounds and ended up in diapers for eight months. I wanted to have surgery, but insurance wouldn't let me. I went on steroids (a nightmare), Imuran, Rowasa and Remicade. Thankfully, Remicade was my miracle! I was able to get off steroids and did Remicade for about two years. I'm still on Imuran and occasionally use Rowasa. Stress and food triggers my UC. I didn't have side effects from Remicade like I had from steroids.

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Comment from: josefa, 35-44 Female (Patient) Published: March 04

I was diagnosed with UC (ulcerative colitis) in 1998 after 2 years of tests and antibiotics. I had bloody diarrhea and fatigue. I was put on Salazopyrine up to 2001. My doctor took me off it when I developed auto immune hepatitis in 2001. I have been on Imuran and prednisolone since then. I can't afford to miss a dose as the jaundice flares up even if I am in remission for UC.

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