Major symptoms of ulcerative colitis are diarrhea, rectal bleeding, the passage of mucus, and abdominal pain. The onset of symptoms is usually slow and insidious and often symptoms have been present for weeks or even months before patients seek medical help. Patients often experience frequent bowel movements of small volume and fecal incontinence. Other symptoms include fever, pain and weight loss.
In general, the severity of symptoms correlates with the severity of the disease. More generalized symptoms such as fever, fatigue, and weight loss are more common if inflammation is extended to all or most of the colon. If the disease is confined to the rectum, the only symptoms may be persistent desire to empty the bowel or spasm of the rectum with or without bloody diarrhea. Some patients, especially elderly patients or those with inflammation confined to the rectum, may complain of constipation and hard stools.
Classification of disease severity
Severity of disease is categorized as mild, moderate, or severe according to clinical symptoms.
Mild: diarrhea and rectal bleeding are usually the only symptoms. Patients experience less than four stools daily, with or without blood.
Moderate: typical symptoms are five or six bloody bowel movements per day and bloody diarrhea is often associated with large amount of mucus and pus. Incontinence is often a problem especially when the rectum is severely inflamed. Abdominal pain may also be present in addition to low-grade fever and fatigue.
Severe: patients experience frequent episodes of bloody diarrhea (more than six bloody stools daily) and they may become anorectic and nauseated. In severe attacks, patients may vomit and experience symptoms of anemia such as breathlessness, ankle swelling, and fatigue. Weight loss, fever, fast heartbeat, dizziness, and severe cramping or abdominal pain can also occur with severe cases of the disease.
Other organ systems affected by ulcerative colitis
Skin: most rashes are related to drug therapy, which can cause an allergic skin reaction or photosensitivity reaction to sulfasalazine and 5-aminosalicylic acid (5-ASA). A condition called pyoderam gangrenosum, an inflammatory bacterial dermatitis with pus and ulceration, is a rare skin condition that occurs in patients with ulcerative colitis and it occurs principally on the trunk or the limbs.
Mouth: oral ulcers occur in about ten percent of patient s with active ulcerative colitis.
Eyes: inflammation of the eyes occurs in approximately five to eight percent of patients with active ulcerative colitis. Corticosteroid eye drops are useful for controlling symptoms of inflammation.
Joints: in approximately ten to fifteen percent of patient s with an acute attack of ulcerative colitis, larger joints (knees, hips, ankles, wrists, and elbow) become hot and swollen. This condition resolves as the disease goes into remission.
Liver disease: in severe attacks of ulcerative colitis, minor elevations in liver enzymes are common and the level returns to normal once remission is achieved. However, in about three percent of patients with ulcerative colitis, a major liver complication can occur in which chronic inflammation of the bile duct can lead to progressive liver disease. The cause of this liver disease is unknown and there is currently no satisfactory treatment for this condition.