Iron deficiency anemia is a condition in which a person doesn’t have enough iron in the body and, therefore can’t produce enough healthy red blood cells. It can be present in people who have inflammatory bowel disease (IBD), including UC and Crohn’s disease. In fact, a study published in the June 2020 issue of the journal Inflammatory Bowel Diseases found that more than half of people with conditions such as UC 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.” Additionally, foods rich in iron, including red meat, poultry, and leafy green vegetables, can be difficult to tolerate for many people with UC 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. Symptoms of anemia can include:
DizzinessFatigue or weaknessLight-headednessMalaiseShortness of breath (at rest or with exertion)Pica or the desire to eat ice
How to Diagnose and Treat Anemia When You Have Ulcerative Colitis
Screening for anemia can be done with a simple blood test. While doctors should be routinely checking UC patients for anemia, some research suggests this doesn’t always happen. The same study from Inflammatory Bowel Diseases found that while 56 percent of people with UC develop anemia, only a little over one-third of them have had iron replacement therapy recommended. Treatment varies depending on the severity of the deficiency. You may need to take iron supplements 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 types until you find one that’s tolerable, Dr. Philpott says. In serious cases, you may need a blood transfusion. Once iron deficiency is treated properly, energy levels can improve dramatically. Treating the UC 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.” Though there’s not much else you can do to prevent the condition if you have UC, if you think you may be anemic, speak to your doctor right away about not only testing and treatment but also getting your UC symptoms under control. Treating UC can help resolve the colon inflammation that causes bleeding and, thus, 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.”
