But where’s the blood coming from? It’s those open sores. It isn’t uncommon for people with ulcerative colitis to feel the strong urge to go to the bathroom and discover it’s just blood they’re passing (which can be very jarring). Over time, the blood loss can even lead to anemia and fatigue, according to the Crohn’s and Colitis Foundation. That’s why it’s really important to see a gastroenterologist if any of these symptoms sound familiar. Other symptoms to take note of include abdominal pain and cramping, the inability to go poop despite feeling like you need to, and sometimes even pus in the diarrhea.
What can I expect from an ulcerative colitis diagnosis?
So, you’ve made it from frantically Googling in the middle of the night to the doctor’s office—good job! Now what? From there, you’ll need to have several different kinds of tests to get a reliable diagnosis, according to the Crohn’s and Colitis Foundation. They’ll range in invasiveness from a friendly-but-frank discussion of your symptoms to a full-on colonoscopy. The process could involve several visits, and may require a trip to your primary care doctor, who will then refer you to a specialist (called a gastroenterologist). Here’s what to expect your gastroenterologist to do:
First they will examine your abdomen with a stethoscope to listen to all the gurgles bubbling up from that breakfast sandwich you ate, and then feel around your stomach for lumps or soreness.
Next, they’ll ask about your family history, because ulcerative colitis can run in families, according to a 2018 study published in the Annals of Gastroenterology.2 It’s also more common among white people and people with an Ashkenazi Jewish ancestry.
The next step is to draw blood and analyze a sample of your poop to check for anemia and rule out infections like E. coli and C. difficile. Some parasites also cause bloody diarrhea, so lab technicians will be looking for those culprits in your stool sample too, per the Crohn’s and Colitis Foundation.
Fourth, and this is where things get a little, well, intimate, is an endoscopy. This test is done to see whether ulcers and inflammation are present in the digestive tract. In an endoscopy, the doctor uses a narrow, bendy tube with a lighted camera on the tip to explore your colon. For ulcerative colitis purposes, there are two main kinds of endoscopy: sigmoidoscopy, which concentrates on the lower part of your colon, and colonoscopy, which looks at the whole large intestine. Colonoscopies are the more intense of the two, because they cover more ground (or colon in this case).
Some people opt for a sedation-free colonoscopy because they can drive themselves home afterward. For people with anxiety or those who are worried about pain, sedatives may be the way to go. If you’re a trauma survivor and you want reassurance, it’s okay to ask for sedatives and a detailed description of the process in advance (more on that below).
Finally, your doctor may snip a tiny bit of colon tissue to check for signs of cancer, assess the degree of inflammation, and rule out any infections. Because ulcerative colitis can raise your risk of colon cancer, a biopsy is important. But don’t worry—the biopsy won’t be painful, though you might notice a bit of extra bleeding afterward.
How do I prepare for a sigmoidoscopy or colonoscopy?
Truly the worst part of these tests is the prep you have to do before. Both require that you follow a special diet before the procedure—think clear liquids—and take a laxative, to effectively “clean out” your colon for the scope. You may also be asked to fast for a period of time and use an enema to flush out anything that remains in your colon (which, honestly, may not even feel like it’s possible). Your doctor may also need to adjust your medication schedule, if you take any, according to the Mayo Clinic.
What happens during these ulcerative colitis tests?
If you’ve ever found yourself with nothing but a thin hospital gown separating you from a room full of medical professionals ready to look in your colon, you probably know it can feel a little weird. But let’s not scare those who haven’t been there yet. It’s really not that bad. In the case of a colonoscopy, you’ll likely be sedated, and won’t be aware of anything anyway.