Can Ulcerative Colitis Cause Mouth Sores?
Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD). UC is a chronic (lasting and persistent) condition that mainly affects the colon, part of the large intestine. If you have UC, you get ulcers in your colon, but you can also get sores in your mouth.
It’s not fully understood if ulcerative colitis causes mouth sores, according to Elisa Boden, MD, a spokesperson for the American Gastroenterological Association and an associate professor of medicine at Oregon Health & Science University. They could be a sign of ulcerative colitis affecting the entrance to the intestinal tract. They may also signal inflammation in a separate body system.
Doctors don’t know exactly what causes UC, but it’s connected to inflammation. Inflammation is how the immune system responds to irritants like germs or injuries. It can cause pain, redness, and swelling. The inflamed area may not work as well as usual or at all.
With UC, genes and things in your environment may trigger an immune system response, creating inflammation and sores. "Inflammation drives a significant amount of these [sores]," says Kian Keyashian, MD, a clinical associate professor of medicine, gastroenterology, and hepatology at Stanford University in Stanford, California.
Mouth sores are more likely to happen when your UC flares up. If you don’t get enough of certain nutrients, you can also get mouth sores. Some prescription ulcerative colitis medicines can cause them too.
Types of Ulcerative Colitis Mouth Sores
You might get various kinds of sores in your mouth if you have UC. "A number of different things [can] happen in the mouth of patients with inflammatory bowel disease," Boden says. For example, some people with UC have burning mouth syndrome, which is exactly what it sounds like. Other people with UC have dry mouth, bad breath, gum disease, or sores.
Among the different types of ulcerative colitis mouth sores:
Aphthous ulcers (canker sores)
This is the most common type of mouth sore with ulcerative colitis. They are small, shallow, round, or oval sores that may appear on the sides of your mouth, on your tongue, or inside your lips. "They're the same thing that can happen in the intestines of people with inflammatory bowel disease," Boden says. They can be very painful and last for about one to two weeks. Some can last for as long as six weeks. They affect people without UC, as well, but tend to be more severe and come back more often in those who have the condition.
About 4% of people with ulcerative colitis get canker sores. People with UC can get canker sores because of inflammation, such as during a flare. Whether or not you have UC, some canker sores can be caused by the herpes virus, according to Keyashian. This is the type of virus that can cause cold sores.
Pyostomatitis vegetans
Pyostomatitis vegetans (PSV) is a mouth rash that can happen if you have ulcerative colitis. PSV causes redness and many small yellow or white pus-filled sores. These sores can break open easily, causing swelling and thickening of your skin. The swelling can also create folds of skin. PSV usually affects the sides and roof of your mouth, but it may not be very painful.
Angular cheilitis
Angular cheilitis is a condition that affects the corners of your mouth. This area can come into contact with saliva and digestive enzymes, causing sores, redness, and painful cracks in the skin. In rare cases, angular cheilitis can cause scarring and discoloration or lead to a fungal infection.
Angular cheilitis can vary with different skin tones. It can look pale rather than red on darker skin.
Not getting enough vitamin B complex, vitamin B2, or vitamin B12 may also lead to angular cheilitis.
One study found that about 12.5% of children and 21.6% of adults with UC have angular cheilitis.
Glossitis
Glossitis is inflammation of the tongue. Your tongue can look smooth and glossy because of changes to its inner lining. You may feel pain or burning in your tongue or have dry mouth. Some people with glossitis have a hard time speaking, eating, or swallowing because of swelling.
Glossitis is more common with Crohn's disease than ulcerative colitis. It can happen with UC, but it’s unclear why. UC can cause low iron levels, which can affect your muscles, including your tongue. Other vitamin deficiencies that can lead to glossitis in people with UC are those of B vitamins, folic acid, or zinc.
Ulcerative Colitis Mouth Sores Treatment
There are some things you can do to manage symptoms of any type of ulcerative colitis mouth sore:
Stay hydrated. Drinking plenty of water may boost both your oral and general health.
Practice good oral hygiene. "Keeping up with dental appointments, doing good brushing and flossing, and cleaning of the tongue is probably helpful," says Keyashian. He also recommends trying toothpaste and mouthwash without sodium lauryl sulfate (SLS). Studies have shown that it can cause mouth sores.
Chew carefully. You should also be careful to avoid biting your cheeks or lips, which can cause sores.
Avoid eating spicy foods, which can irritate mouth sores. Also steer clear of acidic foods like citrus fruits.
Canker sore treatment
If you do have canker sores, you’ll want to relieve the pain – quickly. Here are some ways to treat different types of ulcerative colitis mouth sores:
For short-term relief, your doctor may prescribe steroid gels and numbing gels (lidocaine) to apply directly to the affected areas, according to Boden. If those treatments don’t help, then your doctor may prescribe prednisone or corticosteroid pills or liquids, Keyashian says.
For more serious canker sores or sores that aren’t going away, you may want to see a dermatologist, according to Keyashian. They can prescribe medicines called anti-infectives, such as dapsone, or anti-inflammatory medicines, such as colchicine. Your doctor may also prescribe medications that suppress your immune system, such as azathioprine and cyclosporine. But some medications used to treat ulcerative colitis can also cause mouth lesions. Talk to your doctor if you get mouth sores while you're in treatment so they can suggest a treatment for them or change your treatment plan.
Ulcerative colitis medications can also help get your disease under control and prevent flares that can trigger canker sores.
Pyostomatitis vegetans treatment
There are ways to treat the swollen, thickened areas of skin in your mouth that can happen with pyostomatitis vegetans. Treatments include topical steroids that you apply directly to the surface of the affected area. There are also oral corticosteroids you can take in pill or liquid form. These types of treatments help reduce inflammation, according to Keyashian.
Angular cheilitis treatment
Treatments for angular cheilitis can help keep the corners of your mouth free of saliva and relieve inflammation.
Your doctor may prescribe antifungal creams to apply to the affected areas. Antifungal lozenges, liquids, tablets, or gels can also treat oral thrush. This is a fungal infection that can happen in rare cases of angular cheilitis because of broken skin or vitamin deficiencies. Your doctor may recommend another topical along with the antifungal to bring down inflammation.
A bacterial infection can sometimes be behind angular cheilitis. Antibacterial ointments can help treat the infection so it won't spread to other areas of skin.
Applying petroleum jelly to your lips and the corners of your mouth can also help "to make sure that you're not losing moisture into the air," Boden says.
Glossitis treatment
Your doctor may prescribe a corticosteroid gel on your tongue to relieve inflammation from glossitis.
Mouthwashes that contain corticosteroids and lidocaine (sometimes called "magic mouthwash") can also relieve pain and swelling from glossitis.
Your doctor might also suggest taking vitamins, such as B12 supplements, if you have a deficiency.
Ulcerative Colitis Mouth Sores Prevention
UC flare prevention
When it comes to ulcerative colitis mouth sores, an ounce of prevention really is worth a pound of cure. "Preventing a flare of your disease is probably the best thing you can do to prevent the sores in the mouth," Boden says. As part of your treatment plan:
Take medications as directed. If you’re on medication for ulcerative colitis, make sure to take it regularly. "Missing doses is a common cause of flares of disease," Keyashian says.
Other habits that can help keep you healthy and prevent flares include exercising regularly and reducing stress, Boden says.
Steer clear of triggers. Tobacco, NSAIDs, and antibiotics can also bring on ulcerative colitis flares. Avoid smoking and other tobacco products, don’t use ibuprofen too often, and take antibiotics only when needed.
Maintain a balanced diet. There isn’t strong evidence for how diet can prevent ulcerative colitis flares, Keyashian says. The strongest evidence suggests that avoiding processed foods and consuming whole foods may help.
Vitamin deficiencies are very common for people with any form of IBD. They probably don't lead to UC flares, but you might not be able to eat well when you have a flare, Boden says. That can result in vitamin deficiencies that may lead to mouth sores. The most common deficiencies you may have with ulcerative colitis are:
- Iron
- B vitamins (B12, B6, B1)
- Vitamin D
- Vitamin K
- Folic acid
- Selenium
- Zinc
"Getting micronutrients checked is always a good idea anyways when you have ulcerative colitis or Crohn's disease. And sometimes, replacing those vitamins can be helpful for improving mouth sores," Boden says.
Some evidence shows that probiotics can relieve UC symptoms. Foods rich in omega-3 fatty acids, such as salmon and flaxseed oil/meal, may help lower inflammation in the body. Other healthy foods to add to your diet include starches that have been cooked and cooled or reheated, such as sweet potatoes and oatmeal. Eat lots of leafy green vegetables, either cooked or blended into smoothies. Try to avoid spicy and acidic foods, like sriracha and coffee.
Keep your mouth healthy. Oral hygiene may help you avoid ulcerative colitis mouth sores. Brushing your teeth with a soft brush, flossing, and using SLS-free toothpaste and mouthwash may also reduce your risk of mouth sores, according to Keyashian. See your dentist regularly too.
Stay hydrated. It's also a good idea to keep your body hydrated to maintain your overall health. Drink plenty of water every day. Avoid drinking too much alcohol, caffeinated beverages, and carbonated drinks, which can worsen flares.
Keeping your lips hydrated with petroleum jelly can also help prevent dryness and cracking that make the skin of this area prone to sores.
Work closely with your doctor. To avoid ulcerative colitis flares, it's also important to keep up with regular doctor appointments. A specialist, like a gastroenterologist, can order blood and stool tests that may help detect flares early. "Oftentimes we see stool inflammation markers go up, even when people aren’t symptomatic, and we can intervene early so that we can prevent a big flare," Boden says.
When to See a Doctor
Most mouth sores will go away within about five to seven days, according to Keyashian. If sores won't go away, even after treatment at home, tell your doctor. It’s also important to tell your doctor about sores that keep coming back, or that make it harder to eat or drink. If you have a fever or very large mouth sores, you should also see your doctor.
Keep an eye out for sores that change size and any on the tongue or back of the throat, according to Keyashian. Tell your doctor about these right away.
Sores can also be a sign that your ulcerative colitis isn’t under control, or your medicine isn’t working. "If it's impacting quality of life, it's always good to talk about it with your doctor, because there may be things they can do that help sores go away," Boden says.
Takeaways
- Many people with ulcerative colitis get mouth sores, especially during flares.
- Ulcerative colitis mouth sores are usually small canker sores (also called aphthous ulcers) on the sides of the cheeks or inner lip.
- UC mouth sores can also affect your tongue and the corners of your mouth.
- Preventing ulcerative colitis flares is the best way to prevent mouth sores, but if you have UC sores, treatments can relieve pain and swelling.
FAQs
What do autoimmune mouth sores look like?
Autoimmune mouth sores can look like canker sores. Behcet disease is an autoimmune disease that can cause painful mouth ulcers that look like canker sores. Another autoimmune disease that can cause mouth sores is lupus. Lupus mouth sores may look red with a white line around the outside edge.
What are the oral lesions linked to ulcerative colitis?
The oral lesions that can come with ulcerative colitis are called aphthous ulcers or canker sores. Other mouth problems linked to UC are pyostomatitis vegetans (pus-filled sores and folds of skin in the mouth), angular cheilitis (sores in the corners of your mouth), and glossitis (a swollen tongue).
How common are mouth ulcers with UC?
Mouth ulcers with UC are very common, according to Boden. Studies suggest that between 5% and 50% of people with IBD may get mouth sores.
