When we think of ulcerative colitis (UC), we naturally think of the colon.
But did you know that this chronic inflammatory bowel disease impacts way more than just your intestines? Affecting approximately one in 400 Americans, UC is primarily known for gut-related symptoms like abdominal pain, diarrhea, and rectal bleeding.
Here’s the kicker, though. As many as 40 percent of patients actually experience extraintestinal manifestations (EIMs) that occur outside the digestive tract. These symptoms can be very deceiving and confusing, especially when they affect unexpected body parts like the wrist, eye, liver, and bones.
So let’s get into it. Here’s everything you need to know to address uncommon UC symptoms and seize back control of your condition, and your life at large…
Understanding Extraintestinal Manifestations (EIMs)
EIMs are UC symptoms that affect other parts of the body, but that doesn’t mean they have a different cause. EIMs are actually driven by the same systemic inflammation that targets the colon. And their timing is all over the place. They can appear before, during, or after gut symptoms, varying in severity depending on the flare-up.
That said, in rare cases, they can continue independently of your other UC symptoms. Because of this, many UC patients – especially historically underdiagnosed Black patients – may face delays in diagnosing these EIMs. They are often underreported or misattributed to other conditions.
Fortunately, by recognizing the various manifestations, we can better tailor treatments and preventative measures that work.
1. Wrist, Knee, and Ankle Arthritis
What’s known as peripheral arthritis, this condition impacts joints like your wrists, knees, and ankles. It’s the most common EIM in sufferers, affecting up to 20 percent of all UC patients. The problem with this arthritis is that it can move from parts of the body to others, and is not always symmetrical. In other words, its severity and body distribution are not equal.
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Because of this, doctors usually employ various diagnostic tools. Blood tests, physical exams, imaging like X-rays, and inflammation biomarkers can all be linked to this EIM. That said, peripheral arthritis is usually linked to noticeable flares in UC.
To manage this condition, gentle exercises like stretching or swimming are perfect. Low-impact activities can go a long way, as can local wellness groups focused on yoga and free-flowing movements. Combined with anti-inflammatory foods, like turmeric or fatty fish, these exercises can really confer some benefits.
If the pain persists, definitely consult a rheumatologist.
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2. Mouth Ulcers
These are called aphthous ulcers, or canker sores, and affect 10 percent of UC patients. You’ll notice them pretty quickly, as they appear as painful sores on the gums, tongue, or inner cheeks. For the most part, these painful ulcers are linked to systemic inflammation and nutrient deficiencies, which are common in UC due to poor absorption. A lack of iron or vitamin B12 is usually the main reason.
To get properly diagnosed, you’ll typically require oral exams and, in severe cases, biopsies to rule out other causes like the herpes simplex virus.
Sick of all that mouth pain? To address this on your own, rinse regularly with salt water or baking soda. This will soothe the ulcers and is a good remedy rooted in Black American home care traditions.
Also, mind what you don’t put in your mouth. Stay away from acidic foods, such as tomatoes, during flares. And don’t neglect dentist appointments. Get regular check-ups, many of which you can find inexpensively through community clinics.
3. Eye Inflammation
If you’re struggling with vision issues or discomfort, it could be due to your UC.
Eye conditions like uveitis (inflammation of the middle eye layer) or episcleritis (outer eye inflammation) affect two to five percent of UC patients. So the good news is, it’s rare. The bad news is, symptoms include redness, pain, or blurred vision. Fortunately, a comprehensive exam by an ophthalmologist can assess the inflammation.
Your doctor may prescribe steroid eye drops and better UC control to reduce your symptoms. You can likewise focus on protecting your eyes with sunglasses and staying up on your hydration. Electrolyte drinks like coconut water are a big one.
Just don’t put it off if symptoms persist. Visit an eye doctor as well as your rheumatologist, because you don’t want to play around with potential vision loss. Unfortunately, the rates are higher among Black patients, so know your risks and take initiative.
4. Liver Disease
You’ve probably never heard of primary sclerosing cholangitis (PSC), but now’s the time to know. A liver condition involving bile duct inflammation, PSC affects two to seven percent of UC patients. It also affects people with Crohn’s disease, but is more common in UC, leading to fatigue, jaundice, and itching.
The best way to get this properly diagnosed is to get a blood test for liver enzymes. Imaging like MRCP (magnetic resonance cholangiopancreatography) is also a top way to detect any issues.
If you’re looking to improve your diagnosis at home, start with diet. Cut out crummy processed foods, and eat more greens like collards. Make sure you’re regularly monitoring your liver function at doctor visits as well.
Antioxidant-rich foods like berries or okra are staples in Black cuisine and also great for liver health.
Eat up!
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5. Osteoporosis
Osteoporosis, or reduced bone density, impacts up to 15 percent of UC patients.
The main reasons for this are issues like chronic inflammation, steroid use, and nutrient malabsorption. When your body struggles to absorb calcium and vitamin D, osteoporosis risks can go up dramatically.
In fact, research indicates that Black patients with UC have higher fracture risks due to lower baseline bone density. Using DEXA scans, specialists can measure your bone density, while using blood tests for vitamin D levels.
How do you combat the risk of osteoporosis or address the condition when you’re diagnosed? To start, you can begin with weight-bearing exercises. Very light weights are actually beneficial, as is walking at a brisk pace, if you can manage.
As for food, calcium-rich foods like sardines are especially vital. Kale and fortified milk are also important, and when combined with light to moderate exercise and natural sunlight, you’re really hitting all the points. Getting more sunlight is especially vital for Black individuals, as they struggle with lower levels of melanin synthesis due to their darker skin.
And this is important to note. Not only do Black UC patients face environmental challenges, but they also endure structural and societal barriers. Challenges to healthcare, improper diagnoses, and a lack of culturally competent doctors all make addressing uncommon UC symptoms that much more difficult.
Fortunately, by knowing the signs and practicing the prevention & treatment strategies outlined here, you’ll be well on your way to taking control. Ulcerative colitis is certainly difficult, and there will always be ups and downs, but with the right approach, you can ride those lows and highs with minor trouble.
