Ulcerative colitis (UC) is a chronic inflammatory bowel disease that primarily affects the large intestine, including the colon and rectum. This condition involves long-term inflammation of the colon’s inner lining, leading to the development of small sores or ulcers. A common symptom of UC is rectal bleeding, which occurs due to this inflammation and the resulting ulceration of the colon lining.
Understanding Bleeding in Ulcerative Colitis
Bleeding in ulcerative colitis occurs because persistent inflammation and ulceration of the colon lining make blood vessels fragile and susceptible to damage. As the immune system attacks healthy tissue, ulcers form, which can then bleed.
The appearance of bleeding in UC can vary. It often presents as bright red blood, which may be seen as streaks on stool or toilet paper. The blood can also be mixed in with the stool itself, or individuals may pass blood clots.
Recognizing Concerning Levels of Bleeding
While some rectal bleeding is a common symptom of ulcerative colitis, certain signs indicate a more significant level of blood loss. A noticeable increase in the volume of blood is a concern. This could manifest as bright red blood filling the toilet bowl or a consistent, heavy flow of blood during bowel movements.
Frequent passage of bloody stools, such as more than six bowel movements per day with consistent blood, or even more than 10 bloody bowel movements daily in severe cases, suggests a flare-up requiring attention. The presence of blood clots in the stool is also a sign that warrants immediate medical evaluation. Persistent bleeding over several days, even if the volume is not initially alarming, can lead to complications.
Beyond the visible blood, consider accompanying symptoms that can signal significant blood loss or its consequences. Fatigue, dizziness, and paleness are common indicators of anemia, which can develop from chronic blood loss. Shortness of breath, reduced exercise capacity, and a fast heartbeat can also point to low iron levels or anemia resulting from ongoing bleeding.
When to Seek Immediate Medical Attention
Certain scenarios involving bleeding in ulcerative colitis require immediate medical attention to prevent severe complications. A sudden onset of severe abdominal pain, particularly if it is persistent and accompanied by bloating, is a serious warning sign. This could indicate a severe flare or a complication such as a bowel perforation, where a hole develops in the colon wall.
A high fever, especially when accompanied by chills, should also prompt immediate medical evaluation, as it may suggest an infection or a severe complication like fulminant colitis. Signs of shock, such as a rapid heart rate (over 90 beats per minute), low blood pressure, confusion, or cold and clammy skin, combined with bleeding, indicate a medical emergency. Fainting or severe dizziness also signals significant blood loss and the need for urgent care. Additionally, an inability to pass stool or gas along with bleeding can suggest a serious intestinal obstruction. Vomiting blood is also an emergency situation.
Managing Bleeding in Ulcerative Colitis
Managing bleeding in ulcerative colitis primarily involves controlling the underlying inflammation in the colon. The goal of treatment is to reduce inflammation and induce remission, a period of few or no symptoms. Medications are the first line of treatment and aim to suppress the immune system’s overactivity that causes inflammation.
Common types of medications used include aminosalicylates (5-ASAs), which help reduce inflammation and allow damaged tissue to heal. Corticosteroids like prednisone may be used for short-term treatment of severe flare-ups to quickly reduce inflammation. Immunosuppressants, such as azathioprine, work to decrease overall immune system activity. Biologic medications target specific proteins in the immune system that promote inflammation and are often used for moderate to severe UC. Effective and consistent treatment of the underlying disease activity is the most reliable way to reduce or eliminate bleeding episodes.