Clinical features

Ulcerative colitis may be fulminant, chronic, or relapsing. The patient may present dehydrated and/or toxic.

The symptoms of UC depend on the severity and extent of the condition. The cardinal symptoms include:

• bloody diarrhoea for more than six weeks or rectal bleeding
  • visible blood in stools is reported in more than 90% of cases of UC (1)
  • number of stools may vary from 1 or 2 to 20 or 30 per day
• urgency
• tenesmus
• nocturnal defecation
• crampy abdominal pain or ache in the left iliac fossa
• pre-defecation pain relieved by passing of stools (1)

Patients with proctitis usually have rectal bleeding, urgency, tenesmus and occasionally severe constipation (1).

If this condition occurs in infancy or childhood, then the presentation may be of failure to thrive or failure to progress normally into puberty.

The onset of the disease is usually insidious and patients may present to the doctor after several months. Usually the symptoms may present as intermittent episodes or as a severe attack (in about 15%) (1). In fulminating disease the presentation may be of abdominal distension, catastrophic diarrhoea, fever and collapse

Signs may be as follows:

• pallor, dehydration, mouth ulcers, abdominal tenderness

Associated conditions include:

• erythema nodosum
• pyoderma gangrenosum
• uveitis
• arthritis

Reference:

• (1) Stange EF et al. European evidence-based Consensus on the diagnosis and management of ulcerative colitis: Definitions and diagnosis. Journal of Crohn's and Colitis (2008) 2, 1–23