Extraintestinal complications — those that exist outside the intestines — can even overshadow symptoms in your bowels, making UC tricky to diagnose. They are also highly prevalent, occurring in nearly half of UC patients and appearing more often in women, according to a review published in May 2019 in Current Gastroenterology Reports. While it remains unclear why UC complications can arise beyond the intestines, the review noted that genetic predisposition, irregular immune response, and changes to the gut microbiome are some common contributing factors. “It’s easy to forget that ulcerative colitis is not just a disease of the intestines but a systemic or body-wide disorder of the immune system,” says Jessica Philpott, MD, PhD, a gastroenterologist at Cleveland Clinic in Ohio. Below are five conditions commonly linked to ulcerative colitis, along with some treatment options. “While we can’t say there’s a direct cause, the joint pain usually flares up when the bowel disease flares up as well,” says Laura Raffals, MD, a gastroenterologist at the Mayo Clinic in Rochester, Minnesota. Range-of-motion exercises can help prevent joints from flaring, and anti-inflammatory drugs can alleviate joint pain.
2. Skin Disorders
About 5 percent of people with IBD experience some type of skin disorder. Canker sores in the mouth, skin tags, tender red bumps on the shins, ankles, and arms, and lesions that evolve into deep, chronic ulcers are among those commonly associated with IBD. Unlike joint pain, pyoderma gangrenosum — the skin lesions associated with UC — follow their own course and are difficult to treat. A case study published August 2020 in QJM: An International Journal of Medicine found that a course of biologics effectively treated both UC and skin lesions. “Biologics have shown to be highly effective treatments for a range of inflammatory diseases, and they’re much safer than steroids,” says Dr. Raffals. For other skin disorders associated with IBD, treatment may include antibiotics, ointments, warm baths, and surgery.
3. Eye Disorders
Roughly 5 percent of IBD patients experience extraintestinal complications in their eyes. The most common types — episcleritis and scleritis — follow along with a UC flare. Uveitis, a type of inflammation in the pigmented part of the eye, is a complication of UC that follows its own course. Left untreated, it can progress into glaucoma and vision loss. Eye drops with corticosteroids are generally prescribed to treat these complications, and effective management of UC will help reduce the frequency and severity of inflammation in the eyes.
4. Bone Loss
Osteoporosis (bone loss) and osteopenia (low bone density) are common UC complications that can occur for a variety of reasons, including:
Inflammation in the body that disrupts bone metabolismA side effect of certain medications used in treatment (particularly steroids)Vitamin D deficiency
Bone loss is more common in people with Crohn’s disease. Lifestyle measures, including regular weight-bearing exercise and supplements of calcium and vitamin D, may help prevent and treat this condition, as can prescription medication that boosts bone strength and density. Work with your doctor to customize your UC treatment plan to protect your bones; for example, lower doses of steroids might make sense for you.
5. Liver Disease
Nearly 3 percent of people with UC experience inflammation that causes scarring in the bile ducts (a condition called primary sclerosing cholangitis). “That’s the only liver disease that’s associated with UC,” says Raffals. “Others, like fatty liver disease, may be attributed to steroid use, but there’s nothing about UC that causes them.” There are no specific treatments for primary sclerosing cholangitis or fatty liver disease, though weight loss usually helps treat fatty liver disease.
Ways to Reduce Complications
Early intervention and frequent surveillance of ailments is key to reducing complications and improving outcomes. It’s important to maintain proper nutrition and avoid emotional stress, though neither stress nor sensitivity to certain foods causes the disease. Avoiding steroids can also be helpful if you and your doctor have an alternative way of treating UC flares. While the cure for UC has yet to be found, when the disease is treated properly, some complications may disappear altogether. Work with your doctor and other members of your healthcare team to get optimal control of the disease as soon as possible. Additional reporting by Jordan M. Davidson.
