What is Ulcerative Colitis?
If you or someone you love have recently been diagnosed with ulcerative colitis, it’s important to begin learning as much as you can about what ulcerative colitis is. By developing a better understanding of ulcerative colitis, you will be more prepared to manage its symptoms and live a full life.
Ulcerative colitis is a chronic disease of the large intestine, also known as the colon, in which the lining of the colon becomes inflamed and develops tiny open sores, or ulcers, that produce pus and mucous. The combination of inflammation and ulceration can cause abdominal discomfort and frequent emptying of the colon.
Ulcerative colitis is the result of an abnormal response by your body’s immune system. Normally, the cells and proteins that make up the immune system protect you from infection. In people with IBD, however, the immune system mistakes food, bacteria, and other materials in the intestine for foreign or invading substances. When this happens, the body sends white blood cells into the lining of the intestines, where they produce chronic inflammation and ulcerations.
It’s important to understand the difference between ulcerative colitis and Crohn’s disease. Crohn’s disease can affect any part of the gastrointestinal (GI) tract, but ulcerative colitis affects only the colon. Additionally, while Crohn’s disease can affect all layers of the bowel wall, ulcerative colitis only affects the lining of the colon.
While both ulcerative colitis and Crohn’s disease are types of inflammatory bowel diseases (IBD), they should not be confused with irritable bowel Syndrome (IBS), a disorder that affects the muscle contractions of the colon. IBS is not characterized by intestinal inflammation.
What are the Signs and Symptoms?
About half of all patients with ulcerative colitis experience mild symptoms. Be sure to consult your doctor if you experience any of the following symptoms:
- bowel movements become looser and more urgent
- persistent diarrhea accompanied by abdominal pain and blood in the stool
- stool is generally bloody
- crampy abdominal pain
People suffering from ulcerative colitis often experience loss of appetite and may lose weight as a result. A feeling of low energy and fatigue is also common. Among younger children, ulcerative colitis may delay growth and development.
The symptoms of ulcerative colitis do tend to come and go, with fairly long periods in between flare-ups in which patients may experience no distress at all. These periods of remission can span months or even years, although symptoms do eventually return. The unpredictable course of ulcerative colitis may make it difficult for physicians to evaluate whether a particular course of treatment has been effective or not.
What are the Causes of Ulcerative Colitis? Who is Affected?
Although considerable progress has been made in IBD research, investigators do not yet know what causes this disease. Studies indicate that the inflammation in IBD involves a complex interaction of factors: the genes the person has inherited, the immune system, and something in the environment. Foreign substances (antigens) in the environment may be the direct cause of the inflammation, or they may stimulate the body’s defenses to produce an inflammation that continues without control. Researchers believe that once the IBD patient’s immune system is “turned on,” it does not know how to properly “turn off” at the right time. As a result, inflammation damages the intestine and causes the symptoms of IBD. That is why the main goal of medical therapy is to help patients regulate their immune system better.
Research sponsored by the Crohn’s & Colitis Foundation has led many scientists to believe that ulcerative colitis may be the result of an interaction of a virus or bacterial infection of the colon and your body’s natural immune system response. Normally, your immune system will cause temporary inflammation to combat an illness or infection, and then the inflammation will be reduced as you regain health. In people with ulcerative colitis, however, this inflammation can persist long after your immune system should have finished its job.
Ulcerative colitis may affect as many as 907,000 Americans. Men and women are equally likely to be affected, and most people are diagnosed in their mid-30s. The disease can occur at any age and older men are more likely to be diagnosed than older women.
While ulcerative colitis tends to run in families, researchers have been unable to establish a clear pattern of inheritance. Studies show that up to 20 percent of people with ulcerative colitis will also have a close relative with the disease. The disease is more common among white people of European origin and among people of Jewish heritage.
Colitis Diagnosis & Testing
Your doctor will make a diagnosis based on your medical history, a physical examination, and a series of tests. The first goal of these tests is to differentiate ulcerative colitis from infectious causes of diarrhea. Following this, the patient generally undergoes an evaluation of the colon, using one of two tests — a sigmoidoscopy or total colonoscopy.
In addition to making the initial diagnosis, the tests your doctor performs will also help determine which type of ulcerative colitis you have. Each type has its own specific symptoms and associated complications
Early Tests and Exams
Your doctor will conduct a physical exam of your body and interview you to learn more about your general health, diet, family history, and environment.
Early steps in the diagnostic process can include laboratory tests of blood and fecal matter. Stool specimens are analyzed to eliminate the possibility of bacterial, viral, or parasitic causes of diarrhea. Blood tests can check for signs of infection as well as for anemia, which may indicate bleeding in the colon or rectum.
Endoscopy and Biopsy
Your doctor may recommend endoscopy, which is the use of medical instruments to visually examine the interior of your colon with a lighted tube that is inserted through the anus. Your doctor may recommend two types of endoscopic examinations: a sigmoidoscopy and a total colonoscopy.
- Sigmoidoscopy involves the insertion of a flexible instrument into the rectum and lower colon that allows the doctor to visualize the extent and degree of inflammation in these areas.
- Total colonoscopy is a similar exam, but it visualizes the entire colon.
During these procedures, your doctor may wish to obtain a sample of affected tissue, called a biopsy. Biopsied tissues are then analyzed in pathology to determine the presence of disease.
While endoscopy and biopsy may sound invasive, modern medical technology and techniques have made these procedures virtually painless and easily accomplished during an outpatient visit.
Your doctor may recommend a colonoscopy to look for any polyps or pre-cancerous changes in the setting of colitis. Chromoendoscopy is a technique of spraying a blue liquid dye during the colonoscopy in order to increase the ability of the endoscopist specialist to detect slight changes in the lining of your intestine. The technique may identify early or flat polyps which can be biopsied or removed. It is common to have blue bowel movements for a short time following this procedure.
Colitis Treatment Options
The primary goal in treating ulcerative colitis is to help patients regulate their immune system better. While there is no known cure for ulcerative colitis and flare ups may recur, a combination of treatment options can help you stay in control of your disease and lead a full and rewarding life.
Treatment for ulcerative colitis and other IBD varieties is multifaceted and includes the use of medication, alterations in diet and nutrition, and sometimes surgical procedures to repair or remove affected portions of your GI tract.
Medication for ulcerative colitis can suppress the inflammation of the colon and allow for tissues to heal. Symptoms including diarrhea, bleeding, and abdominal pain can also be reduced and controlled with effective medication.
In addition to controlling and suppressing symptoms (inducing remission), medication can also be used to decrease the frequency of symptom flare ups (maintaining remission). With proper treatment over time, periods of remission can be extended and periods of symptom flare ups can be reduced. Several types of medication are being used to treat ulcerative colitis today.
In some circumstances, a health care provider may recommend adding an additional therapy that will work in combination with the initial therapy to increase its effectiveness. For example, combination therapy could include the addition of a biologic to an immunomodulator. As with all therapy, there are risks and benefits of combination therapy. Combining therapies can increase the effectiveness of IBD treatment, but there may also be an increased risk of additional side effects and toxicity. Your health care provider will identify the treatment option that is most effective for your individual health care needs.
Diet & Nutrition
While ulcerative colitis is not caused by the foods you eat, you may find that once you have the disease, particular foods can aggravate the symptoms. It’s important to maintain a healthy and soothing diet that helps reduce your symptoms, replace lost nutrients, and promote healing.
For people diagnosed with ulcerative colitis, it is essential to maintain good nutrition because the disease often reduces your appetite while increases your body’s energy needs. Additionally, common symptoms like diarrhea can reduce your body’s ability to absorb protein, fat, carbohydrates, as well as water, vitamins, and minerals.
Many people with ulcerative colitis find that soft, bland foods cause less discomfort than spicy or high-fiber foods. While your diet can remain flexible and should include a variety of foods from all food groups, your doctor will likely recommend restricting your intake of dairy foods if you are found to be lactose-intolerant.
In one-quarter to one-third of patients with ulcerative colitis, medical therapy is not completely successful or complications arise. Under these circumstances, surgery may be considered. This operation involves the removal of the colon (colectomy).
Depending on a number of factors, including the extent of the disease and the patient’s age and overall health, one of two surgical approaches may be recommended. The first involves the removal of the entire colon and rectum, with the creation of an ileostomy or external stoma (an opening on the abdomen through which wastes are emptied into a pouch, which is attached to the skin with adhesive).
Today, many people are able to take advantage of new surgical techniques, which have been developed to offer another option. This procedure also calls for removal of the colon, but it avoids an ileostomy. By creating an internal pouch from the small bowel and attaching it to the anal sphincter muscle, the surgeon can preserve bowel integrity and eliminate the need for the patient to wear an external ostomy appliance.
Colitis Medication Options
Medication is a common form of treatment for ulcerative colitis and IBD. Depending on your overall health, the severity of your disease, and other factors, your doctor may recommend different medications to treat your ulcerative colitis symptoms.
Five major classes of medication are used today to treat ulcerative colitis are described below.
These include medications that contain 5-aminosalicylate acid (5-ASA). Examples are sulfasalazine, mesalamine, olsalazine, and balsalazide. These drugs are not specially approved by the Food and Drug Administration (FDA) for use in ulcerative colitis.. However, they can work at the level of the lining of the GI tract to decrease inflammation. They are thought to be effective in treating mild-to-moderate episodes of ulcerative colitis and useful as a maintenance treatment in preventing relapses of the disease. They work best in the colon and are not particularly effective if the disease is limited to the small intestine.
Prednisone, methylprednisolone and budesonide are steroids that are available orally and rectally. Prednisone and methylprednisolone nonspecifically suppress the immune system and are used to treat moderate to severely active ulcerative colitis. (By “nonspecifically,” we mean that these drugs do not target specific parts of the immune system that play a role in inflammation, but rather, that they suppress the entire immune response.) These drugs have significant short- and long-term side effects and should not be used as a maintenance medication. Budesonide is a steroid that is used to treat localized inflammation. It has the benefit of minimal systemic exposure with far fewer risks and side effects. Because corticosteroids cause the adrenal glands to slow or stop the natural production of the human steroid cortisol, they cannot be stopped abruptly. If you cannot come off steroids without suffering a relapse of your symptoms, your doctor may need to add some other medications to help manage your disease.
This class of medications modulates or suppresses the body’s immune system response so it cannot cause ongoing inflammation. Immunomodulators generally are used in people for whom aminosalicylates and corticosteroids haven’t been effective or have been only partially effective. They may be useful in reducing or eliminating the need for corticosteroids. They also may be effective in maintaining remission in people who haven’t responded to other medications given for this purpose. Immunomodulators may take several months to begin working.
Antibiotics may be used when infections—such as abscesses—occur. They can also be helpful with fistulas around the anal canal and vagina. Antibiotics used to treat bacterial infection in the GI tract include metronidazole, ampicillin, ciprofloxacin, others.
These therapies represent the latest treatment class used for people suffering from moderate-to-severe ulcerative colitis. These treatments are called biologics because, unlike chemical medications, they are made out of material found in life, usually proteins. Many biologic treatments are proteins called antibodies, which normally are part of the body’s immune defense. The antibodies used for biologic therapy have been developed to bind and interfere with the inflammatory process in the disease.
Colitis Questions to Ask
Being diagnosed with ulcerative colitis may fill you with questions and concerns. Ulcerative colitis can affect many aspects of your life and these effects can change overtime.
The best way to prepare for your life with ulcerative colitis is to learn all that you can about your disease and begin a dialogue with your doctor.
The better informed you are, the more equipped you’ll be to work with your doctor and other healthcare providers to manage your disease and lead the life you want to live.
In discussing your new diagnoses with your doctor, be sure to ask questions like these:
Understanding Your Condition
- What is ulcerative colitis?
- What causes colitis?
- What type of colitis do I have?
- What are the signs and symptoms of colitis?
- What can I do to monitor my condition?
- How will I know if I’m having a flare up?
- How will I know if my colitis is in remission?
Effects on Lifestyle
- How will colitis affect my ability to work, travel, and exercise?
- Should I modify my diet? If so, how?
- How will ulcerative colitis affect pregnancy?
- How will other people react to my illness?
- What are my treatment options?
- What are the risks and benefits of different treatment options?
- If I am prescribed medication, what kind of side effects should I expect?
- Will I require surgery? If so, what does that entail?
- What other treatments are available?
Managing Your Disease
- Can I prevent flare-ups of colitis?
- When should I see a doctor?
- What can I do at home to treat symptoms?
You and your doctor are partners in your health. By establishing a productive relationship with your doctor, you will gain a better understanding of your condition and how to best manage it.
Types of Ulcerative Colitis
If you are diagnosed with ulcerative colitis, the symptoms and complications of your disease will vary depending on the extent of the disease. It’s important to understand which type of ulcerative colitis you have and how it will affect you.
In addition to ulcerative colitis, there are several other types of ulcerative colitis. The following is a description of the different types of ulcerative colitis and descriptions of common symptoms and complications for each:
For approximately 30% of all patients with ulcerative colitis, the illness begins as ulcerative proctitis. In this form of the disease, bowel inflammation is limited to the rectum. Because of its limited extent (usually less than the six inches of the rectum), ulcerative proctitis tends to be a milder form of ulcerative colitis. It is associated with fewer complications and offers a better outlook than more widespread disease.
Colitis affecting the rectum and the sigmoid colon, the lower segment of colon located right above the rectum. Symptoms include bloody diarrhea, cramps, and a constant feeling of the need to pass stool, known as tenesmus. Moderate pain on the lower left side of the abdomen may occur in active disease.
Continuous inflammation that begins at the rectum and extends as far as a bend in the colon near the spleen called the splenic flexure. Symptoms include loss of appetite, weight loss, diarrhea, severe pain on the left side of the abdomen, and bleeding.
Pan-ulcerative (total) Colitis
Affects the entire colon. Symptoms include diarrhea, severe abdominal pain, cramps, and extensive weight loss. Potentially serious complications include massive bleeding and acute dilation of the colon (toxic megacolon), which may lead to an opening in the bowel wall. Serious complications may require surgery.
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