Symptoms and Signs of Ulcerative Colitis
The cardinal symptom of ulcerative colitis is bloody diarrhea, often accompanied by rectal urgency, tenesmus, and colicky abdominal pain that may be relieved by defecation. 1 These symptoms reflect the characteristic continuous mucosal inflammation that begins in the rectum and extends proximally to variable extents of the colon.
Primary Gastrointestinal Symptoms
Most Common and Impactful Symptoms
- Rectal bleeding - Present in 51% of patients and ranked as the most important symptom by expert panels 1
- Rectal urgency - Reported by 72% of patients as having the largest impact on quality of life 1
- Stool frequency/diarrhea - Affects 51% of patients significantly 1
- Abdominal pain - Experienced by 56% of patients with substantial impact on quality of life 1
Characteristics of Bowel Urgency
Bowel urgency deserves special attention as it is:
- One of the most disruptive symptoms for patients
- A leading cause of treatment dissatisfaction
- Often underreported due to patient embarrassment
- Associated with reduced rectal compliance and hypersensitivity 2
Systemic Symptoms and Extraintestinal Manifestations
- Fatigue - Reported by 59% of patients as having major impact on quality of life 1
- Sleep disturbance - Common and significantly affects quality of life 1
- Extraintestinal manifestations - Present in approximately 27% of patients 3, including:
- Joint symptoms (most common and important)
- Eye symptoms (uveitis)
- Skin manifestations
- Primary sclerosing cholangitis
Disease Patterns and Progression
Ulcerative colitis follows a relapsing and remitting course, with:
- Approximately 50% of patients experiencing a relapse in any given year 1
- A minority developing frequently relapsing or chronic continuous disease 1
- 20-30% of patients with pancolitis eventually requiring colectomy 1
Diagnostic Findings
Endoscopic Features
- Continuous colonic inflammation starting from the rectum
- Erythema and loss of normal vascular pattern
- Granularity, erosions, friability, bleeding, and ulcerations
- Distinct demarcation between inflamed and non-inflamed bowel 4
Histological Features
- Decreased crypt density
- Crypt architectural distortion
- Irregular mucosal surface
- Heavy diffuse transmucosal inflammation
- Absence of genuine granulomas 4
Radiological Findings
- CT scan may show mural thickening (mean wall thickness of 8mm)
- Mesenteric vessel engorgement
- Fluid-filled colonic distention 1, 4
Severe Disease Warning Signs
Patients should be counseled to immediately report:
- Severe abdominal pain or distention
- High fever
- Profuse bleeding
- Signs of dehydration
- Significant weight loss
- Inability to maintain oral intake 1
Impact on Quality of Life
Ulcerative colitis significantly impacts quality of life through:
- Gastrointestinal symptoms causing physical discomfort
- Urgency and frequency limiting social activities
- Fatigue affecting work productivity
- Sleep disturbances
- Psychological impact (anxiety and depression) 1
Clinical Course and Prognosis
- After the first year, approximately 90% of patients are fully capable of work
- Modern medical management has reduced mortality to near-normal population levels
- However, severe attacks remain potentially life-threatening
- Patients have approximately 5 years shorter life expectancy compared to the general population 1, 3
Understanding these symptoms and signs is crucial for early diagnosis, appropriate treatment selection, and monitoring disease activity to improve outcomes and quality of life for patients with ulcerative colitis.