5 Ulcerative Colitis Complications You Should Know

UC has non-intestinal complications, too. Experts tell us how you can lower your risk.

by Vanessa Caceres Health Writer

There’s no question about it, it takes a lot to manage ulcerative colitis (UC). The chronic, progressive inflammation of the lining of the large intestine causes a lot of digestive issues, including diarrhea, GI pain, and having to rush to the bathroom a lot. However, the problems caused by a dysfunctional immune system when you have UC don’t affect only your large intestine. They also spill over and affect other organs, causing a variety of health complications. Still, with regular screenings and healthy living, you can minimize the chance of developing these UC complications. Keep reading to learn more about each one.


Anemia refers to having a low level of iron. It occurs in one in three people living with UC, according to the Crohn’s & Colitis Foundation, and it’s due to bleeding and poor absorption of iron that’s secondary to your active inflammation, says Tauseef Ali, M.D., chief of the Gastroenterology Section at SSM Health St. Anthony Hospital and a clinical assistant professor at the University of Oklahoma in Oklahoma City. In other words, when your UC is flaring it’s near impossible for your body to hold on to the iron it gets from your diet or supplements. Anemia can make you feel tired, and severe anemia can put extra stress on your heart, leading to complications such as a faster heart rate.

What you can do about it: Doing your best to control inflammation caused by UC and regularly replenishing your iron stores are two ways to address anemia, Dr. Ali says. Beef, beans, and cooked greens are good iron sources. Talk to your doctor before choosing an iron supplement as too much iron is toxic for the liver. Regular lab work (three to four times a year) can help you and your doctor monitor your iron levels.


The joint pain associated with arthritis occurs in about 30% of people with IBD, according to the Crohn’s & Colitis Foundation. Although arthritis is typically related to older adults, it also can occur in younger people who have UC. The three most common types of arthritis in those who have IBD are peripheral arthritis (which affects the large joints of the arms and legs, including the elbows, wrists, knees, and ankles), axial arthritis (which affects the back), and ankylosing spondylitis.

What you can do about it: Arthritis symptoms usually get better when your intestinal symptoms improve because you lower inflammation in your body that contributes to joint pain, the Crohn’s & Colitis Foundation reports. A heating pad or a warm bath can help loosen your joints, and an ice pack can reduce joint swelling. Gentle stretches geared toward the area where you have pain also help. Check with your doctor before using common pain relievers like ibuprofen and aspirin as they may increase inflammation when you have IBD.

Blood Clots

If you have UC, you’re three times more likely than someone without UC to develop a blood clot in your legs or lungs. During a flare up, your risk can be six times higher, says Adeeti Chiplunker, M.D., an assistant professor of medicine with the Division of Gastroenterology, Hepatology, and Nutrition at The Ohio State University Wexner Medical Center in Columbus, OH. That’s because there are proteins you may lose through the colon that would normally help regulate clotting.

What you can do about it: The best way to lower your risk for blood clots? Treat the inflammation from your UC, but also take breaks when you are sitting or if you’re flying for more than four hours. Get up every hour to walk around. This can help decrease the chance you’ll develop a blood clot. If you’re hospitalized for UC, you will probably receive a blood thinner medication to help prevent blood clots.

Skin Complications

From painful red bumps on your legs called erythema nodosum to skin ulcers called pyoderma gangrenosum, about 20% of those with IBD experience some sort of skin complication, the Crohn’s & Colitis Foundation reports. Here’s why: The same inflammation associated with UC can simultaneously trigger skin flares. In addition, sometimes the medications you use when you have ulcerative colitis increase your risk of skin complications.

A note about skin cancer: When you have UC, your risk for non-melanoma skin cancer is about 1.5 times higher than in those who don’t have UC. It’s another effect of inflammation, Dr. Chiplunker says. And skin cancer risk is two to three times higher than those without UC if you’re using immunosuppressive therapy such as azathioprine or 6-mercaptopurine.

What you can do about it: Cold compresses are soothing for some of the rashes and bumps like erythema nodosum. Ask your healthcare provider if there are any over-the-counter or prescription creams for your skin problems. Regular visits with a dermatologist to monitor, identify and treat problems are super important, especially if you are on immunosuppressive therapy.

Colon Cancer

Your risk for colon cancer is higher if you have long-standing UC with active inflammation, Dr. Ali says. If you’ve had UC for 10 years, your risk is 1.6%; about 30 years after diagnosis, your risk increases to 18%. The long-term inflammation in the colon leads to a regular turnover of cells in the lining of the intestines, and that increases the chance of cell irregularities like cancer, according to the Crohn’s & Colitis Foundation.

What you can do about it: Controlling inflammation from UC and regular colonoscopies can help detect colon cancer earlier on or prevent it altogether, he says.

5 More Ways to Lower Your Risk for Complications

One thing to keep in mind: “Living well with UC is possible,” Dr. Chiplunker says. “Just because you have UC does not mean that UC has you. There are many people who have UC who live healthy, productive lives.” Here are some things that they do to minimize complication risk:

  1. Do your best to eat healthy. This means adhering to your doctor’s recommendations for an overall healthy diet. Focus more on fruits and vegetables and less on sweets and fast foods to help decrease the risk for a flare up, says Jesse P. Houghton, M.D., senior medical director of gastroenterology at Southern Ohio Medical Center Gastroenterology Associates in Portsmouth, OH. One caution: If you are having an active flare, your doctor may want you to follow a low-residue diet, which means avoiding harder-to-digest raw vegetables and fruits with skins, like apples and pears.

  2. Take your meds as advised but talk about any side effects. Taking your medication is important to keeping UC under control. You should not stop any medications without guidance from your health-care team. However, if a medication is not working, let your physician know so you can discuss any alternatives to treat inflammation, Dr. Chiplunker says. One slippery slope when you have UC is to assume that any medication side effects or new symptoms will just go away with time, Dr. Houghton says. That’s why a regular dialogue with your physician is key.

  3. Stop smoking. You know lighting up is bad for you but when it comes to UC, it can also raise your risk for cancer, lower your ability to heal wounds, and reduce the effectiveness of your meds, Dr. Chiplunker says. Quitting is hard but there are many free and low-cost resources to help you, according to Smokefree.gov.

  4. Schedule regular health checks. When you have UC, regular health screenings can help you and your health team detect any problems earlier on. These screenings may include:

    • A bone density scan if you have any history of prednisone use. If you already have low bone density, the scan should be repeated every couple of years to make sure your bone density isn’t getting lower, Dr. Chiplunker advises.

    • A regular skin check by a dermatologist (especially if you are on biologic therapy).

    • A colonoscopy—every one to three years—especially if you have had UC for more than eight to 10 years. This helps to check for colon cancer.

    • Regular visits to a gastroenterologist who can assess your UC and help keep your condition under control, Dr. Houghton says.

    • Lab work done three to four times a year to help monitor for anemia and liver and kidney function.

Vanessa Caceres
Meet Our Writer
Vanessa Caceres

Vanessa Caceres is a freelance health, travel, and food writer. She enjoys helping consumers better understand their health and helping health providers better understand their patients. She also has a background teaching English as a second language to adults and has a master's degree in this area from Georgetown University. Her background in education helps her with many of the stories she writes.