Digestive and Gastrointestinal Conditions

Ulcerative Colitis Symptoms and Diagnosis

Symptoms of Ulcerative Colitis

The most common symptoms of ulcerative colitis are:

  • Cramping pain in the belly 
  • Ongoing diarrhea, sometimes bloody

This happens because the inflamed intestine cannot absorb water and nutrients like it should. Inflammation also makes the intestine empty itself often.

The symptoms range from mild pain, loose stools or gassy belly to severe, where a child doubles over with pain, loses weight, passes stools more than eight times a day and passes blood. They can vary over time. It's normal for a child to go without symptoms for months or even years and then have symptoms reappear.

Other health problems

Ulcerative colitis can lead to other health problems. The main complications doctors watch for include:

  • Dehydration, or loss of fluids, due to diarrhea
  • Sores (ulcers) in the intestine, which can cause bleeding. When ulcers go all the way through the intestinal wall, it is called perforation.
  • Anemia, or low level of red blood cells, due to internal bleeding from ulcers. Anemia can cause extreme tiredness.
  • Severe swelling of the belly
  • Weight loss
  • Slowed growth or delayed puberty. This can be caused by the inflammation or by medicines like steroids that interfere with the function of hormones. Or the body might not get enough nutrients. Children with ulcerative colitis might have less appetite and eat less.
  • Toxic megacolon, in which the large intestine (colon) gets severely inflamed. Then the colon wall weakens and balloons out. This can rupture, or perforate, the colon.
  • Increased risk of colon cancer in people who have the disease for more than 10 years.

Some people with ulcerative colitis get health problems that affect other parts of their bodies. These problems include:

  • Inflamed joints (arthritis)
  • Skin problems ( erythema nodosum , pyoderma gangrenosum or psoriasis )
  • Inflamed eyes (uveitis)
  • Inflamed mouth
  • Kidney stones
  • Gallstones  
  • Problems with the liver or bile ducts
  • Anxiety Disorders  
  • Depression  
  • Rarely, blood clots

Ulcerative Colitis Diagnosis

Diagnosis always starts with a detailed health history. To diagnose ulcerative colitis, the team in the Inflammatory Bowel Disease (IBD) Center  will ask for a detailed history of your child's illness. Your child's doctors and other team members will examine your child.

Your child might also have tests, including lab work, body imaging (radiology) and endoscopy.

Lab tests

  • Blood tests. Blood tests check for anemia, which can be a sign of heavy internal bleeding in the gut, and high levels of white blood cells and platelets, which can be signs of inflammation. Blood protein levels can tell the team if your child isn't eating enough protein, isn't absorbing enough protein or is losing too much protein because of inflammation. Other tests look for substances in the blood that are signs of inflammation (C-reactive protein test, sedimentation rate).
  • Tests on a stool sample. The team uses these tests to look for blood or signs of infection. Certain stool tests can tell the team if your child has active inflammation.

Body imaging

Pictures that show the inside of your child's belly or pelvic area can help the team learn more about your child's condition. At Seattle Children's, we try to use methods that use low or no radiation, such as ultrasound and MRI (magnetic resonance imaging) .

Some children might need an upper GI (PDF) (gastrointestinal) series of X-rays with a small bowel follow-through or a CT (computed tomography) scan .

Endoscopy

One of the best ways to tell what's happening in your child's intestine is for the doctor to look at it. Doctors do this by inserting a thin, flexible, lighted tube (endoscope) through your child's mouth or anus.

The tube has a camera that's connected to a computer and a TV monitor. Using this camera, doctors can look for swelling, redness, ulcers and bleeding. They can even take a tiny sample (biopsy) of the intestine for testing. This can help your child's team diagnose IBD, figure out the type of IBD and tell how much of the intestine is affected.

Your child might have one or more of these types of endoscopy (pronounced end-OSS-cope-ee):

  • Upper endoscopy. The doctor puts the endoscope through your child's mouth to look at their stomach and the first part of their small intestine.
  • Sigmoidoscopy (pronounced sig-moid-OSS-cope-ee). The doctor puts the endoscope through your child's anus to look at only their lower colon.
  • Colonoscopy (pronounced coal-un-OSS-cope-ee). The doctor puts the endoscope through your child's anus to look at their whole colon.

Before these procedures, we give your child medicine that makes them fall asleep (anesthesia). They will not feel any pain and will not move. 

Sometimes, doctors ask children to swallow a pill-like device that carries a tiny camera (capsule endoscopy). (The doctor might also place the capsule in your child's digestive tract using an endoscope.) This device takes pictures of the intestine. It passes out of your child's body in stool. Doctors view the pictures on a computer. This lets them see parts of the intestine they cannot see using a regular endoscope.