The Connection Between Ulcerative Colitis and Anemia

If you have ulcerative colitis (UC), feeling overly tired and fatigued could be more than just the aftermath of a long day. It could also be a sign of anemia.

Iron-deficiency anemia is a condition in which a person doesn’t have enough iron in the body and can’t produce enough healthy red blood cells as a result. It can be present in people who have inflammatory bowel disease (IBD), including UC and Crohn’s disease. In fact, a study published in June 2020 in Inflammatory Bowel Diseases found that more than half of people with IBD are anemic.

“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 Cleveland Clinic. “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. They may also not make adequate blood cells due to inflammation.”

Additionally, foods rich in iron, including red meat, poultry, and leafy green vegetables, can be difficult for many people with UC 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, chief of gastroenterology at Tufts Medical Center in Boston.

Symptoms of anemia can include:

• Dizziness
• Fatigue or weakness
• Light-headedness
• Malaise
• Shortness of breath (at rest or with exertion)
• Pica or the desire to eat ice

How to Get Anemia Diagnosed and Treated When You Have UC

Screening for anemia can be done with a simple blood test. While doctors should be checking UC patients for anemia routinely, some research suggests this doesn’t always happen.

The same study from Inflammatory Bowel Diseases found that although 56 percent of people with UC develop anemia, only a little over one-third have had iron replacement therapy recommended.

In the past, “There was a belief that the anemia might resolve itself once the IBD was treated,” says Dr. Philpott. Doctors now treat anemia right away, rather than waiting for the anemia to subside.

Treatment varies, depending on the severity of the deficiency. Some people may need to take an iron supplement, although these can cause gastrointestinal symptoms, such as abdominal cramps. You may need to work with your doctors to try several types until you find one that works for you, Philpott says. If your IBD is active and you can’t tolerate oral iron, you may require iron infusions. In very serious cases, you may need a blood transfusion.

Once the iron deficiency is addressed, your energy levels can improve dramatically. Although there’s not much you can do to prevent the condition when you have UC, if you think you may be anemic, speak to your doctor right away about testing and treatment.

Getting your UC symptoms under control is also still necessary, even though you’re treating the anemia. “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 leak in it.”

Treating UC can help resolve the colon inflammation that’s causing the bleeding, which could help take care of the anemia, according to Dr. Friedman.

“You and your doctor should agree upon appropriate medications to fight inflammation and resolve the anemia. And, if you’re flaring, contact your doctor for help,” she says. “Don’t stay home with severe symptoms.”