10 Warning Signs of Primary Biliary Cholangitis

Everyone feels tired sometimes, but PBC-related fatigue is different. It’s not the kind of exhaustion that a good night’s sleep can fix. Instead, it can feel like:

• You’re constantly drained, even after resting.
• You struggle to concentrate or stay alert throughout the day.
• Even small tasks—like cooking or walking—feel overwhelming.

Doctors still don’t fully understand why PBC causes extreme fatigue, but it’s one of the most common and earliest symptoms.

Itching is one of the biggest warning signs of PBC. But this isn’t just dry skin—it’s a deep, persistent itch that won’t go away.

PBC-related pruritus is believed to be caused by bile acid buildup in the skin due to bile duct damage. It may:

• It often gets worse at night, making it hard to sleep.
• It can be triggered by heat, stress, or pregnancy.
• Some people itch all over, while others feel it in just one area.

This itching happens because bile acids build up in the skin when bile can’t flow properly. If you’ve been dealing with intense itching without a clear cause, it’s worth bringing up with your doctor.

If your eyes feel gritty and irritated or your mouth is constantly dry, PBC could be the reason. These symptoms are common because PBC is linked to another autoimmune condition—Sjögren’s syndrome—which affects moisture-producing glands.

Signs to look for:

• Frequent eye infections or difficulty wearing contact lenses.
• Trouble swallowing dry foods without a drink.
• Waking up feeling like your mouth is parched.

Pain in the upper right abdomen (where your liver is located) is another early symptom of PBC.

• It might feel like a dull ache or pressure under your ribcage.
• The pain may come and go or feel constant.
• Some people also develop joint, muscle, or bone pain as the disease progresses.

Ever stand up too fast and feel like you might faint? People with PBC often experience low blood pressure episodes. This happens because the disease can affect the way your body regulates blood flow.

Symptoms include:

• Feeling dizzy or lightheaded when standing up.
• Brief blurry vision or nausea.
• In extreme cases, fainting.

Jaundice is a major sign of liver dysfunction. It happens when bilirubin builds up in the blood, causing:

• Yellowish skin and eyes.
• Dark urine and pale stools.
• Sometimes, intense itching alongside the discoloration.

Some people with PBC also develop hyperpigmentation, where patches of skin darken without sun exposure.

If your feet, ankles, or legs are suddenly swelling, it could be due to fluid retention caused by liver dysfunction. This condition, called edema, happens when the liver can’t properly regulate fluids in the body.

• Swelling may feel tight or uncomfortable.
• It can worsen after sitting or standing for long periods.
• Skin may hold an imprint if pressed with a finger.

As PBC progresses, some people develop ascites, which is fluid buildup in the abdomen. This can cause:

• A swollen, distended belly.
• A feeling of fullness or tightness.
• Difficulty breathing due to pressure.

Ascites often signals advanced liver disease and requires medical attention.

PBC disrupts cholesterol processing, sometimes leading to fatty deposits under the skin. These are known as xanthomas and can appear as:

• Soft, yellowish plaques around the eyes.
• Lumps on the hands, feet, elbows, or knees.

If you notice these unusual skin changes, it’s a sign to check your cholesterol and liver health.

If your stools seem greasy or difficult to flush, your body might not be absorbing fat properly. This condition, called steatorrhea, happens when the liver doesn’t produce enough bile.

Signs include:

• Oily, pale-colored stools.
• A strong, unpleasant odor.
• Difficulty flushing stools down the toilet.

Steatorrhea can lead to nutrient deficiencies, so it’s important to address.

Many symptoms of primary biliary cholangitis overlap with other conditions, making it difficult to diagnose without medical testing. If you’ve been dealing with persistent symptoms like fatigue, itching, jaundice, or unexplained swelling, it’s important to consult a healthcare provider.

A doctor can:

• Perform liver function tests to assess bile duct health.
• Order antimitochondrial antibody tests, which are highly effective in detecting PBC.
• Recommend treatment options to manage symptoms and slow disease progression.

PBC is a progressive autoimmune disease, but early diagnosis and treatment can significantly improve quality of life.

If your symptoms persist, don’t ignore them. A healthcare provider can evaluate your liver health and suggest lifestyle changes, medications, or further testing to help you manage PBC effectively.