Ulcerative Colitis is a chronic inflammatory bowel disease (IBD) that affects millions of people worldwide. Characterised by the inflammation and ulceration of the colon’s inner lining, this condition often brings along a host of uncomfortable and debilitating symptoms, including blood in the stools.
While this symptom is common among individuals with Ulcerative Colitis, how much blood is too much? Determining when it becomes a cause for concern can be challenging.
This article sheds light on the issue of blood in stools among Ulcerative Colitis patients. It explores why this symptom occurs, how to assess its severity, and most importantly, when it warrants medical attention.
When To Be Concerned About Blood In Stool
Ulcerative Colitis primarily affects the large intestine or colon. This chronic condition happens when there is an inflammation and a formation of ulcers (open sores) on the inner lining of the colon. Unlike Crohn’s disease, Ulcerative Colitis is confined to the colon and rectum.
Ulcerative Colitis can manifest with a range of symptoms, including
- Diarrhoea, often with blood or mucus
- Abdominal pain and cramping
- Urgent need to have a bowel movement
- Fatigue
- Unexplained weight loss
- Reduced appetite
- Rectal bleeding
While rectal bleeding is a common occurrence among UC patients, it should not be overlooked. Patients must be attentive to and monitor the presence of blood in their stool, as excessive bleeding can pose significant health risks. Certain warning signs and red flags should prompt immediate concern and action.
Frequent Bowel Movement And Blood In Stool: A mild flare-up may result in several daily bowel movements with intermittent blood in the stool. In more severe flare-ups, individuals may experience six or more bowel movements per day, with blood consistently present.
The copious amount of blood in your stool is definitely a concern. If you notice a significant increase in the amount of blood in your stool or if you experience continuous or heavy bleeding, it is essential to contact your healthcare provider immediately.
Signs Of Excessive Bleeding: You should also be aware of signs that suggest excessive bleeding, such as lightheadedness, dizziness, or weakness. Profuse or uncontrolled bleeding, especially if accompanied by symptoms like fainting, should be taken seriously and require immediate medical attention.
Severe abdominal pain: Intense abdominal pain, particularly if it is persistent or accompanied by bloating and distension, requires prompt evaluation.
Paleness: If you notice a marked paleness of your skin or experience symptoms of anaemia, such as persistent weakness and fatigue, it may indicate significant blood loss.
High fever: A high fever, especially if associated with chills, may suggest an infection or a complication of Ulcerative Colitis that requires immediate attention.
Change in mental status: Confusion, disorientation, or altered mental status should be taken seriously and investigated promptly.
Change in Symptoms: Pay attention to changes in your overall health and other UC symptoms. If you experience a decline in well-being, unexplained weight loss, or other new symptoms alongside rectal bleeding, it may warrant further evaluation.
Why Does Ulcerative Colitis Cause Blood In Stools?
Among the symptoms commonly associated with Ulcerative Colitis, rectal bleeding or blood in stools stands out as a significant and sometimes troublesome sign. This occurrence is intimately linked to the intricate pathophysiology of the disease.
The inflammation and ulceration in the colon can directly impact the delicate blood vessels residing within the colon’s tissues. When inflammation takes hold, it can weaken these blood vessels, which is why they are more susceptible to rupture.
As a result, even minor trauma or irritation to the colon’s lining can prompt these small blood vessels to break, leading to the leakage of blood into the intestinal contents. Consequently, the blood mixes with the stool as it traverses the colon, causing rectal bleeding.
Types Of Bleeding Associated With Ulcerative Colitis
Blood in stools can manifest in various ways for individuals with Ulcerative Colitis. They are classified into three different types of bleeding, including:
Gross Hematochezia
Gross Hematochezia refers to the noticeable and visible presence of bright red blood in the stool. The blood is usually vivid red in colour and is easily seen in the stool or on toilet paper after a bowel movement.
It is often alarming and can be a cause for immediate concern because it is easily visible, indicating active and significant bleeding from the lower gastrointestinal tract.
The duration of gross hematochezia can vary. It may be intermittent, occurring during flare-ups, or it may be persistent in cases of severe bleeding.
Occult Bleeding
Occult bleeding is less apparent, as it involves the presence of blood in stools that may not be visually noticeable. The blood is typically not bright red but may be darker in colour or even black (melena). The bleeding can be intermittent and subtle.
Occult bleeding is often detected through specialised tests like faecal occult blood tests (FOBT) or faecal immunochemical tests (FIT), which can detect small amounts of blood not visible to the naked eye.
Mucosal Bleeding
In some cases, the bleeding may be limited to the colon’s mucosal layer. This type of bleeding may result in mucus-coated stools with streaks of blood. The blood may mix with mucus, making it appear less obvious than gross hematochezia.
Mucosal bleeding can be chronic and may persist over time, necessitating ongoing management and treatment to control inflammation.
Monitoring Blood In The Stool For UC Patients
There isn’t a universally defined “normal” level of rectal bleeding in UC patients because it can vary widely. It’s important to keep track of your symptoms and let your healthcare provider know. They can help you figure out the best treatment based on your situation.
Individuals can use a simple scale to describe the amount of blood, ranging from minimal spotting to significant bleeding. This self-assessment can aid in monitoring changes in bleeding over time. While it may not replace a medical evaluation, it can provide valuable information.
- Keep a Symptom Journal: Maintain a daily or weekly journal where you record your symptoms, including details about rectal bleeding. Note the frequency, consistency, and colour of blood in your stools. Be as specific as possible to help your healthcare provider understand your symptoms accurately.
- Use the Bristol Stool Chart: This chart categorises stool types from 1 to 7, with 1 being very hard stools and seven being entirely liquid. Note where your stools fall on this scale and whether they are accompanied by blood. This can provide valuable information about changes in your bowel habits.
- Measure Blood Loss: If you notice blood in your stools, you can try to estimate the amount. For example, you might describe it as “a few drops,” “streaks,” or “a noticeable amount.” This can help you gauge the severity of bleeding over time.
- Monitor Other Symptoms: Alongside rectal bleeding, keep track of other UC symptoms such as abdominal pain, diarrhoea, fatigue, or changes in appetite. Understanding how these symptoms correlate with rectal bleeding can provide a more comprehensive picture of your condition.
- Consult Your Healthcare Provider: Share your symptom journal with your doctor during regular check-ups or when you notice significant changes in your condition. Your healthcare provider can use this information to adjust your treatment plan and ensure your UC is well-managed.
Managing UC-Associated Rectal Bleeding
Rectal bleeding is common among individuals with UC, but it’s not necessarily a severe symptom for everyone. There is no cure yet for this condition.
Fortunately, there are ways to manage its symptoms and reduce or stop rectal bleeding. This is necessary because left untreated, it increases the risk of developing colorectal cancer.
To address excessive rectal bleeding in UC, doctors recommend a combination of medications and therapies tailored to the individual’s condition and the severity of their symptoms.
Aminosalicylates: These anti-inflammatory drugs, such as mesalamine, help manage UC. They work by reducing inflammation in the colon’s lining, potentially alleviating rectal bleeding. Aminosalicylates can be administered orally or as rectal formulations, such as suppositories or enemas, for more targeted treatment.
Corticosteroids: In cases of more severe UC or during flare-ups, corticosteroids like prednisone may be prescribed. These medications are potent anti-inflammatories and are used to suppress inflammation quickly.
Immunosuppressants: Medications like azathioprine or 6-mercaptopurine modulate the immune response. They can be effective in managing UC by reducing inflammation and preventing immune-related damage to the colon. These drugs are often used when aminosalicylates are ineffective or for maintaining remission.
Biologics: Biologic agents, such as infliximab or adalimumab, are advanced treatments that target specific proteins involved in the inflammatory process. Biologics are typically prescribed to patients with moderate to severe UC cases who do not respond to other treatments. They can be highly effective in managing UC symptoms and promoting remission.
Therapy: In addition to medications, certain therapies can directly address rectal bleeding in UC. For example, mesalamine enemas or suppositories deliver the medication directly to the rectum and lower colon, providing targeted relief from inflammation and bleeding in this area. These therapies are particularly useful in cases where rectal involvement is prominent.
Surgery: In severe cases of UC or when medications prove ineffective in controlling symptoms and preventing complications, surgery may be necessary. Doctors may recommend the removal of the colon (colectomy), with or without the creation of an ileal pouch-anal anastomosis (IPAA). Surgery can provide a long-term solution for managing UC but involves significant lifestyle adjustments and potential changes in bowel function.
Colonoscopy: Colonoscopy is a diagnostic procedure that can be performed to evaluate various gastrointestinal conditions, including rectal bleeding. It allows healthcare providers to visualise the colon and rectum directly to look for abnormalities, such as inflamed tissue, ulcers, polyps, or tumours that may be responsible for the bleeding.
One of the essential purposes of colonoscopy in cases of rectal bleeding is to screen for colorectal cancer. Colorectal cancer can cause rectal bleeding, and early detection through colonoscopy is crucial for successful treatment and improved outcomes.
Conclusion About UC-Associated Rectal Bleeding
While rectal bleeding is a common symptom of UC, the level of concern depends on factors such as frequency, severity, and associated symptoms. Monitoring changes and discussing them with your healthcare provider is essential to determine their significance.
It’s essential to remember that UC is a chronic condition often requiring ongoing treatment and monitoring. With the right approach, including medications, dietary modifications, and lifestyle adjustments, individuals with UC can achieve symptom relief, maintain remission, and enjoy an improved quality of life.
It’s important for people with UC to consult with reputable healthcare professionals like Dr. QM Leong. Regular consultations with experts can greatly improve the management of Ulcerative Colitis, enhance quality of life, and lower the risk of complications.
Book a consultation today!
Frequently Asked Questions About UC-Associated Rectal Bleeding
Can Diet Changes Help Manage Rectal Bleeding In Ulcerative Colitis?
Yes, dietary modifications can be beneficial for some individuals. Avoiding trigger foods and consuming a balanced diet may help reduce symptoms, including rectal bleeding.
Are There Natural Remedies For Addressing Bleeding In Ulcerative Colitis?
While some people find relief from natural remedies like aloe vera or curcumin supplements, it’s essential to consult with a healthcare provider before trying any alternative therapies.
Can Stress Exacerbate Rectal Bleeding In UC?
Stress can potentially worsen UC symptoms, including rectal bleeding, in some individuals. Stress management techniques and lifestyle adjustments may help mitigate its impact.
How Often Should Patients Undergo Colonoscopy For Surveillance?
The frequency of colonoscopy surveillance for UC patients varies based on disease severity and duration. Gastroenterologists typically recommend regular colonoscopies to monitor for complications and assess disease activity.
