Ulcerative Colitis Colonoscopy Risks

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Ulcerative colitis is a disease that causes inflammation of the colon. No one knows exactly what triggers the events that lead up to the abdominal pain, bloody diarrhea and other symptoms that ulcerative colitis sufferers experience. It’s a disease that requires treatment to reduce the inflammation along with close monitoring since people with this disease are at higher risk for colon cancer.

Because of the higher risk of colon cancer in people with ulcerative colitis, people diagnosed with this disease get regular colonoscopies to look for signs of colon cancer or polyps. But some ulcerative colitis sufferers fear this procedure because of the risk of complications. What are ulcerative colitis colonoscopy risks, and is it a safe procedure for people with inflammatory bowel disease?

Ulcerative Colitis Colonoscopy Risks: Is It Safe?

The most serious risk of a colonoscopy procedure is perforation of the colon. A colon perforation occurs when the instrument punctures the wall of the colon. If the hole in the colon is large enough, immediate surgery will be needed to repair the tear and prevent life-threatening complications.

The risk of perforation varies depending upon the skill of the doctor and the characteristics of the patient. Undergoing a colonoscopy with active inflammatory bowel disease such as ulcerative colitis could theoretically increase the risk of colon perforation, because air is injected into the colon during the procedure - and an inflamed colon can’t as easily accommodate the higher pressure. In addition, people with ulcerative colitis often have inflammation and scar formation, which makes it more difficult to navigate thorugh the colon without causing nicks and tears.

Although inflammatory bowel disease is sometimes regarded as a condition that increases the risk of colon perforation, a study published by the American Society for Gastrointestinal Endoscopy didn’t find an increased risk of colon perforation with colonoscopy in people with ulcerative colitis. Despite this, there are case reports of ulcerative colitis patients experiencing colon perforations - and perforation is one of the ulcerative colitis colonoscopy risks that doctors dread most.

Other Risks of Colonoscopy for People with Ulcerative Colitis

Another complication of colonoscopy procedures is bleeding. Bleeding occurs in about one out of a thousand cases of colonoscopy. You might expect the risk of bleeding to be higher in people with ulcerative colitis since an actively inflamed colon is more likely to bleed. According to studies, the risk of serious bleeding occurring after a colonoscopy even in a person with ulcerative colitis is still small.

In one study published in the American Journal of Gastroenterology, colonoscopy was performed on 34 patients during a severe attack of ulcerative colitis without complications such as bleeding or perforation. This should be reassuring to patients who have ulcerative colitis and need a colonoscopy.

Infection can rarely be a complication of colonoscopy. This usually occurs if the instrument isn’t properly sterilized. Since this is so rare, it’s not clear whether people with ulcerative colitis are more likely to experience this complication.

Ulcerative Colitis Colonoscopy Risks: The Bottom Line?

Colonoscopy is still a safe procedure for people with ulcerative colitis - and it’s important for people who have this condition to get regular colonoscopy screenings to look for polyps and cancers. One way to reduce the complication rate is to only allow a doctor who’s done this procedure many times to perform a colonoscopy. Using an inexperienced doctor will increase the risk of complications from this procedure more than having ulcerative colitis will.


Diseases of the Colon & Rectum. Volume 32, Number 7, 624-626.

Am J Gastroenterol. 1991 Feb;86(2):187-90.