The Connection Between Ulcerative Colitis and Anemia
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If you have ulcerative colitis, feeling overly tired and fatigued may be more than just the aftermath of a long day. It could be a sign of iron deficiency.
Anemia, a condition characterized by a deficiency of red blood cells or of hemoglobin in the blood, is common for people living with ulcerative colitis for a number of reasons.
“People with ulcerative colitis will often experience bleeding, such as bloody stools, so they’re losing these red blood cells,” says Jessica Philpott, MD, PhD, a gastroenterologist at the Cleveland Clinic in Ohio. “Also because of the presence of inflammation in the body, they actually absorb iron poorly, so any iron they’re ingesting may not be absorbing the same way as if they were healthy.”
Additionally, foods rich in iron, including read meat, poultry, and leafy green vegetables, may be difficult for many ulcerative colitis patients to tolerate and may exacerbate a flare-up.
“These foods won’t make colon inflammation worse, but they can cause gas cramps and diarrhea,” says Sonia Friedman, MD, an associate professor of gastroenterology at Brigham and Women’s Hospital in Boston who specializes in IBD.
Dr. Philpott says that while not every person with ulcerative colitis will develop anemia, “a good number of my patients do become anemic.”
A study published in 2015 inBioMed Research Internationalestimates that about 21 percent of patients with inflammatory bowel disease develop the condition.
Symptoms of anemia include:
- Fatigue or weakness
- Shortness of breath
- Pica or the desire to eat ice
Diagnose and Treat Anemia With Ulcerative Colitis
Screening for anemia can be done with a simple blood test. While doctors should be routinely checking ulcerative colitis patients for anemia, some research suggests this doesn’t always happen.
A study published in the December 2019 issue ofInflammatory Bowel Diseases, the official journal of the Crohn's & Colitis Foundation of America (CCFA), found that over an eight year period, 70 percent of the 836 ulcerative colitis patients studied went on to develop anemia. Yet, about one-third of those patients with anemia did not undergo the recommended tests for iron deficiency. Furthermore, only 76 percent of those diagnosed with anemia received recommended iron replacement therapy.
"Our study emphasizes the need to educate gastroenterologists and general practitioners to diagnose and treat iron-deficiency anemia at an early stage," the researchers wrote.
Treatment varies depending on the severity of the deficiency. A person may need to take iron or vitamin B12 supplements or receive the nutrients intravenously. Some supplements may cause GI symptoms, such as abdominal cramps, so you may need to work with your doctors to try several different types until you find one that’s tolerable, Philpott says. In serious cases, a patient may need a blood transfusion.
Once iron deficiency is treated properly, energy levels can improve dramatically.
Treating the ulcerative colitis itself is also necessary. “If we don’t treat the disease, the patient is going to keep losing blood,” Philpott says. “It’s kind of like trying to refill a pail that has a hole in it.”
There’s not much ulcerative colitis patients can do to prevent anemia, Dr. Friedman says.
If you think you may be anemic, speak to your doctor right away about not only testing and treatment for anemia, but getting your ulcerative colitis under control. “You can’t just sit at home with bloody diarrhea,” Friedman says.
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