Understanding Ulcerative Colitis: Symptoms, Diagnosis, and Treatment

Ulcerative colitis is a chronic inflammatory bowel disease that primarily affects the mucosal layer of the colon, leading to recurrent symptoms. Most of its symptoms are related to the digestive system, but in severe cases, systemic effects may accompany. Early symptoms may be mild and easily overlooked, but as the condition progresses, patients may face significant issues such as abdominal pain, bloody diarrhea, and weight loss. Understanding the characteristics of these symptoms aids in early diagnosis and treatment, preventing the worsening of complications.

The severity of symptoms varies from person to person; some patients may experience intermittent flare-ups and periods of remission, while others may be persistently troubled. The variability of symptoms and their non-specific characteristics often necessitate a combination of endoscopy and tissue examination for accurate diagnosis. This article will detail the early signs of ulcerative colitis, common symptoms, disease progression, and when emergency medical intervention is needed.

Early Symptoms and Signs

In the early stages of ulcerative colitis, symptoms may be subtle and often mistaken for general indigestion or gastroenteritis. The most common initial signs include:

• Mild lower abdominal discomfort or bloating
• Increased frequency of bowel movements, but not yet multiple times a day
• Stools containing traces of blood or mucus
• Unexplained fatigue or decreased energy

These signs may appear intermittently, and patients may only occasionally feel discomfort, leading to delays in seeking medical attention. It is noteworthy that about 15-20% of patients may have only mild symptoms or even no obvious discomfort in the early stages, making early diagnosis of the disease more challenging.

Differentiating from Other Gastrointestinal Issues

Early symptoms can easily be confused with general gastroenteritis or food poisoning. The key difference is that the symptoms of ulcerative colitis are recurrent and may gradually worsen. For example, a patient with occasional bloody stools may develop into daily bloody diarrhea accompanied by fever or anemia over weeks to months. If symptoms persist for more than two weeks without improvement, one should be alert.

Common Symptoms

When the disease enters an active phase, patients typically exhibit the following core symptoms:

• Bloody diarrhea: Stools mixed with bright red blood and mucus, possibly accompanied by a sense of urgency to defecate
• Abdominal pain and bloating: Persistent dull pain in the left lower abdomen or lower abdomen, which may temporarily relieve after bowel movements
• Unexplained weight loss: Due to impaired intestinal absorption and loss of appetite
• Systemic symptoms: Fever (often low-grade), anemia, joint pain, or skin rashes

Extraintestinal Effects

Ulcerative colitis may trigger systemic symptoms, indicating that the inflammatory response has affected other organ systems. About 20-30% of patients may experience arthritis, conjunctivitis, or liver abnormalities. In severe cases, high fever, rapid weight loss, or even a state of weakness may occur. Although these symptoms are not direct intestinal issues, they are important indicators for assessing the severity of the disease.

Disease Progression and Symptom Changes

The symptoms of ulcerative colitis may exhibit cyclical changes of "active and remission phases." During the active phase, abdominal pain, bleeding, and inflammatory markers (such as C-reactive protein) will significantly increase; during the remission phase, symptoms may greatly alleviate or disappear. However, about 30-40% of patients may experience a gradual worsening of symptoms, leading to an increased risk of complications.

Symptom Changes Due to Complications

If not properly controlled, ulcerative colitis may lead to severe complications, at which point symptoms will present dramatic changes:

• Toxic megacolon: Severe abdominal distension, with the abdomen swollen like a drum, possibly accompanied by severe abdominal pain and a drop in blood pressure
• Ulcer perforation: Sudden severe abdominal pain, fever, and signs of peritonitis
• Nutritional absorption disorders: Leading to symptoms of vitamin deficiency (such as glossitis, pale skin)

These complications can be life-threatening and require immediate hospitalization. Patients who have not been controlled for a long time also face an increased risk of colorectal cancer as the disease progresses.

When to Seek Medical Attention

The following situations indicate that symptoms have reached a threshold requiring emergency medical intervention:

• More than 6 bloody bowel movements per day lasting over 48 hours
• Signs of dehydration such as dizziness and rapid heartbeat
• Persistent high fever exceeding 38.5°C
• Sudden worsening of abdominal pain or generalized abdominal pain

Even if symptoms seem mild, medical evaluation should be sought if the following conditions are met: weight loss exceeding 5% in the past six months, unexplained signs of anemia (such as pale nails, shortness of breath), or persistent abdominal bloating that prevents normal eating. Early diagnosis can prevent intestinal structural damage and worsening systemic inflammatory responses.

Warning Signs in Special Populations

Children or elderly patients may present symptoms differently due to metabolic and immune system differences. Children may be diagnosed for the first time due to developmental delays or growth retardation, while elderly individuals may seek medical attention due to complications such as bowel obstruction. Pregnant women experiencing new symptoms or exacerbation of existing symptoms should promptly inform their healthcare team, as treatment strategies during pregnancy need special adjustments.

 

Common Questions

Can ulcerative colitis symptoms be completely controlled through diet?

Dietary adjustments can alleviate some symptoms but cannot completely control the disease. A low-fiber, easily digestible diet is recommended, avoiding irritant foods, and adjusting based on individual responses. However, it should be combined with medication treatment, and regular communication with a physician is necessary to develop a personalized plan.

Do ulcerative colitis patients need surgical treatment? Under what circumstances would it be considered?

Most patients can be controlled with medication, but if severe complications (such as bleeding, perforation, precancerous lesions) occur or if medications fail, surgical removal of the colon may be necessary. This decision should be made by a gastroenterologist based on the severity of the condition.

What potential risks are associated with long-term steroid use for treating ulcerative colitis?

Long-term steroid use may lead to side effects such as osteoporosis, high blood sugar, and decreased immunity. Physicians typically use the lowest effective dose and combine it with other medications (such as immunomodulators or biologics) to reduce risks, and patients need regular monitoring of bone density and blood sugar.

What should ulcerative colitis patients pay attention to when exercising?

Moderate aerobic exercise (such as walking or swimming) can help improve intestinal health and relieve stress, but excessive vigorous exercise should be avoided to prevent triggering abdominal pain or fatigue. During flare-ups, rest is recommended, while exercise can gradually resume during remission, avoiding extreme weather conditions to reduce irritation.

How will treatment methods be adjusted for ulcerative colitis patients during pregnancy?

During pregnancy, careful adjustments to medications are necessary; some immunomodulators may affect the fetus, and physicians may prioritize safer medications (such as certain steroids or biologics). Patients should plan their pregnancy in advance with their physician and closely monitor changes in their condition to ensure the safety of both mother and baby.