Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting the large intestine, including the colon and rectum. It causes inflammation and ulceration of the intestinal lining, leading to various symptoms. Rectal bleeding is a common experience for individuals with UC. This article explores why bleeding occurs, when to seek medical attention, and outlines medical treatments and long-term strategies to manage and prevent bleeding episodes.
Why Bleeding Occurs in Ulcerative Colitis
Bleeding in ulcerative colitis stems from the chronic inflammatory process targeting the innermost lining of the large intestine. Persistent inflammation causes the intestinal tissue to become fragile and damaged, leading to open sores or ulcers. These ulcers are prone to bleeding because blood vessels within the inflamed tissue are exposed and easily ruptured. The continuous irritation and compromise of the mucosal barrier contribute to this susceptibility to bleeding.
The extent and appearance of bleeding vary with the severity and location of inflammation. Small streaks of bright red blood on toilet paper or mixed with stool indicate bleeding closer to the rectum. More extensive cases may show darker, more significant blood or blood clots, reflecting bleeding higher in the colon.
When to Seek Medical Attention for Bleeding
Knowing when to seek medical attention for bleeding in ulcerative colitis is important. Mild bleeding, like occasional small streaks of bright red blood on toilet paper, can usually be discussed with a gastroenterologist during regular office hours. These instances often indicate mild inflammation and do not typically require emergency care. However, always inform a healthcare provider about any new or changing bleeding patterns.
Seek immediate medical attention for large amounts of blood in the stool, blood clots, or persistent bleeding. Other concerning symptoms include dizziness, weakness, fainting spells, or a rapid heart rate, which signal significant blood loss. Severe abdominal pain or signs of substantial anemia, such as unusual paleness and extreme fatigue, also warrant immediate medical evaluation. If any severe symptoms occur, call emergency services or go to the nearest emergency room without delay.
Medical Approaches to Stop Bleeding
Medical interventions for stopping bleeding in ulcerative colitis primarily focus on reducing inflammation and promoting intestinal lining healing. Anti-inflammatory medications are often the first line of treatment. Aminosalicylates, such as mesalamine, reduce colon inflammation, helping to heal damaged tissue and stop bleeding.
For more severe inflammation, corticosteroids like prednisone quickly suppress the immune response and reduce swelling, rapidly alleviating bleeding. If inflammation remains active, immunosuppressants like azathioprine or methotrexate may be introduced to modulate the immune system and promote sustained healing. Biologic therapies, such as infliximab or adalimumab, target specific inflammatory pathways, effectively controlling severe UC and stopping bleeding by inducing remission.
For chronic blood loss leading to low iron levels, iron supplements manage anemia. If a specific, localized bleeding source is identified, endoscopic interventions might be considered, though this is less common than medication-based approaches. For severe, acute blood loss or profound anemia, blood transfusions may be necessary to restore blood volume and red blood cell count. Surgical removal of the colon, known as colectomy, is a last-resort option for severe, uncontrolled bleeding unresponsive to other medical treatments.
Strategies for Long-Term Bleeding Prevention
Preventing future bleeding episodes in ulcerative colitis centers on maintaining long-term disease remission by managing underlying inflammation. Consistently taking prescribed medications, even when symptoms are absent, prevents flares that can lead to bleeding. Adherence to treatment keeps the intestinal lining healthy and less prone to ulceration and bleeding.
Regular follow-up appointments with a gastroenterologist are important for monitoring disease activity and adjusting treatment. Adhering to recommended screening schedules, such as colonoscopies, allows healthcare providers to assess the colon and detect inflammation or complications early. These assessments help ensure the disease remains under control, reducing bleeding likelihood.
While diet does not cause UC, certain foods can trigger symptoms or worsen inflammation during flares, potentially exacerbating bleeding. Identifying and avoiding personal trigger foods, often with the guidance of a dietitian specializing in inflammatory bowel disease, can support overall gut health. During active flares, a bland diet may minimize irritation.
Lifestyle factors also play a role. Stress management techniques can help, as stress may exacerbate UC symptoms. Avoiding non-steroidal anti-inflammatory drugs (NSAIDs) is important, as they can irritate the gut lining and worsen bleeding. Quitting smoking is advised, as smoking worsens UC and increases flare risk.