Ulcerative colitis: symptoms

The main symptoms of nonspecific ulcerative colitis are the following.

Diarrhea with blood, mucus and pus. With a pronounced clinical picture of the disease, a frequent loose stool with an admixture of blood, mucus, and pus is characteristic. Stool up to 20 times a day, and with a heavy current up to 30-40, mostly at night and in the morning. In many patients, the amount of blood in the feces is very significant, sometimes defecation occurs almost pure blood. The amount of blood lost by patients during the day can range from 100 to 300 ml. Fecal masses contain a large amount of pus and can have a fetid odor.

The onset of the disease may be different depending on the time of appearance of blood in the feces; the following options are possible:

• in the beginning there is a diarrhea, and in some days slime and a blood;
• the disease immediately begins with rectal bleeding, while the chair can be formed or mushy;
• At the same time, diarrhea and rectal bleeding begin, while the rest of the symptoms of the disease (abdominal pain, intoxication) are expressed in patients.

Diarrhea and hemorrhage are considered to be the main clinical manifestations of nonspecific ulcerative colitis. Diarrhea is caused by extensive inflammatory damage to the mucous membrane of the colon and a sharp decrease in its ability to reabsorb water and sodium. Bleeding is a consequence of ulceration of the mucous membrane of the colon and the development of loose connective tissue with a richly developed vasculature.

Stomach ache. A constant symptom of ulcerative colitis. The pains are cramped and localized mainly in the projection of the colon, most often in the sigmoid, transverse colon, rectum, rarely in the cecum, in the peri-ocular region. Usually, pain intensifies before defecation and calms down or weakens after a stool. Perhaps increased pain after eating.

It should be noted that extremely severe pain and symptoms of peritonitis for nonspecific ulcerative colitis are uncharacteristic, since the inflammatory process in this disease is limited to the mucosa and the submucosa. With a complicated course of ulcerative colitis, the inflammatory process spreads to the deep layers of the intestinal wall.

Tenderness of the abdomen with palpation. A characteristic sign of nonspecific ulcerative colitis. When palpation is determined clearly pronounced soreness in the sigmoid, transverse colon and cecum. The more pronounced the inflammatory process in the large intestine, the greater the pain when palpating its parts. Symptoms of irritation of the peritoneum, muscular tension in uncomplicated course of the disease, as a rule, is not observed, however, in severe course, the appearance of resistance of the muscles of the anterior abdominal wall is possible.

Intoxication syndrome. It is characteristic for severe course of ulcerative colitis and acute lightning-fast forms of the disease. The intoxication syndrome is manifested by severe weakness, adynamics, fever (often to high figures), weight loss, decreased or even complete lack of appetite, nausea, depression, marked emotional lability, crying, irritability.

Syndrome of systemic manifestations. Systemic manifestations of nonspecific ulcerative colitis are characteristic for severe course of the disease and in some cases occur in a form of moderate severity. Typical systemic manifestations include:

• polyarthritis - usually the ankle, knee, interphalangeal joints are affected, the intensity of pain and the degree of limitation of joint movements are generally small. With the onset of remission, joint changes completely disappear, deformities and violations of the function of the joints do not develop. In some patients, transient spondylitis and sacroiliitis develop. Sacroiliitis occurs more often and it is more severe with more extensive and severe lesions of the large intestine. Symptoms of sacroiliitis may precede over many years the clinical manifestations of ulcerative colitis;
• erythema nodosum - develops in 2-3% of patients, manifested by multiple nodes, more often on the extensor surface of the shin. The skin above the nodes has a purple-violet color, then becomes greenish, yellowish and then acquires a normal color;
• skin lesion - may develop gangrenous pyoderma (in severe septic disease); skin ulceration; focal dermatitis; post-ulcer and urticaria rashes. Especially hard is gangrenous pyoderma;
• lesions of the eyes - noted in 1.5-3.5% of patients, characterized by the development of iritium, iridocyclitis, uveitis, episcleritis, keratitis and even panophthalmitis;
• lesions of the liver and extrahepatic bile ducts are of great importance for assessing the course of the disease, treatment and prognosis tactics. With nonspecific ulcerative colitis, the following forms of liver damage are observed: fatty degeneration, portal fibrosis, chronic active hepatitis, cirrhosis of the liver. According to the research, the liver lesions practically do not change under the influence of conservative therapy of ulcerative colitis, and in severe forms progress and lead to the development of liver cirrhosis. After colectomy, changes in the liver regress. A characteristic lesion of extrahepatic biliary tract is sclerosing cholangitis;
• damage to the oral mucosa is characterized by the development of aphthous stomatitis, glossitis, and gingivitis, which occur with very severe pain; ulcerative stomatitis is possible;
• nephrotic syndrome - a rare complication of nonspecific ulcerative colitis;
• autoimmune thyroiditis;
• autoimmune hemolytic anemia.

The development of the syndrome of systemic manifestations is due to autoimmune disorders and reflects the activity and severity of the pathological process with ulcerative colitis.

Dystrophic syndrome. The development of the dystrophic syndrome is characteristic of the chronic form, as well as the acute course of ulcerative colitis. Dystrophic syndrome is manifested by significant weight loss, pallor and dry skin, hypovitaminosis, hair loss, nail changes.

Clinical forms of flow

Most gastroenterologists distinguish between the following forms of ulcerative colitis: acute (including fulminant) and chronic (recurrent, continuous).

Acute current

The acute form of the disease is characterized by the rapid development of the clinical picture, the severity of general and local manifestations, the early development of complications, the involvement of the whole colon in the pathological process. The acute course of ulcerative colitis is characterized by severe diarrhea, significant intestinal bleeding. With severe diarrhea, discharge from the rectum contains almost no stool, blood, mucus, pus, tissue detritus are released from the rectum every 15-20 minutes. Developing severe exhaustion (weight loss can reach 40-50%). The patients are adynamic, pale, sharply expressed symptoms of intoxication (dry skin and mucous membrane of the oral cavity, tachycardia, fever, lack of appetite, nausea). When palpation of the abdomen marked severity of the divisions of the large intestine. The acute course of the disease is characterized by complications (toxic dilatation of the large intestine, perforation, peritonitis).

The fulminant form (fulminant) is the most severe variant of the course of ulcerative colitis and usually requires surgical treatment. It is characterized by a sudden onset, a rapid development of the clinical picture (sometimes within a few days or 1-2 weeks). In a lightning-fast form, severe diarrhea, significant intestinal bleeding, high body temperature, severe intoxication, and often life-threatening complications develop. With a lightning-fast form of ulcerative colitis, there is a total lesion of the large intestine and a rapid development of systemic manifestations of the disease.

Chronic forms

Chronic continuous form is diagnosed if, 6 months after the initial manifestations, no remission of the process occurs. With this form of exacerbation follow one another often, remissions are very unstable, short-term, systemic manifestations of the disease are quickly formed, complications often develop.

Chronic recurrent form is most common and is characterized by remissions lasting 3-6 months or more, with alternating exacerbations of varying severity.

Degrees of gravity

With nonspecific ulcerative colitis, the severity of the disease is due to the degree of involvement in the pathological process of the large intestine. The most common proctosigmoiditis (70% of patients), isolated rectal damage is recorded in 5% of patients, total colitis - in 16% of patients. 

Classification of nonspecific ulcerative colitis

The course of nonspecific ulcerative colitis	Degree of severity	Prevalence of defeat
Acute (fulminant) Chronic continuous Chronic recurrent	Heavy Medium-heavy Lightweight	Total colitis with retrograde ileitis or without it Left-sided colitis Distal colitis (proctosigmoiditis, proctitis)

[1], [2], [3], [4], [5], [6], [7], [8]