Ulcerative colitis is long-lasting disease that inflames the lining of the large intestine (the colon) and rectum. Ulcerative colitis usually affects people from 15 to 30 years of age. People with ulcerative colitis have tiny ulcers and small abscesses in their colon and rectum that flare up periodically and cause bloody stools and diarrhea.
Ulcerative colitis is characterized by alternating periods of flare-ups and remission, when the symptoms of the disease disappear.
The periods of remission can last from weeks to years.
Inflammation usually begins in the rectum and then spreads to other segments of the colon. How much of the colon is affected varies from person to person. If it is limited to the rectum, the disease may be called ulcerative proctitis. Ulcerative colitis, unlike Crohn's disease, does not affect the esophagus, stomach, or small intestine.
When grouped together, ulcerative colitis and Crohn's disease are referred to as "inflammatory bowel disease" because they cause inflammation of the bowel.
What Are the Symptoms of Ulcerative Colitis?
Symptoms of ulcerative colitis may include:
• Blood or pus in diarrhea
• Abdominal pain
• Painful, urgent bowel movements
In addition, ulcerative colitis may be associated with weight loss, skin disorders, joint pain or soreness, eye problems, anemia (a deficiency in red blood cells), blood clots, and an increased risk for colon cancer.
What Causes Ulcerative Colitis?
The cause of ulcerative colitis remains unknown, but it is likely caused by an abnormal response of the immune system. Food or bacteria in the intestines, or even the lining of the bowel may cause the uncontrolled inflammation associated with ulcerative colitis.
Who Gets Ulcerative Colitis?
Ulcerative colitis can be inherited. Up to 20% of people with inflammatory bowel disease have a first-degree relative (mother, father, brother, sister) with the disease.
In addition, the disease is most common in the U.S. and northern Europe and people of Jewish descent.
How Is Ulcerative Colitis Diagnosed?
A variety of diagnostic procedures and lab tests are used to distinguish ulcerative colitis from other conditions. First, your doctor will review your medical history and perform a complete physical exam. One or more of the following tests may be ordered:
• Endoscopy, such as colonoscopy or proctosigmoidoscopy
• Blood tests
• Stool samples
How Is Ulcerative Colitis Treated?
Treatment for ulcerative colitis can include drug therapy, changes in diet, and/or surgery. Though treatments cannot cure ulcerative colitis, they can help most people lead normal lives.
It is important for you to seek treatment for ulcerative colitis as soon as you start having symptoms. If you have severe diarrhea and bleeding, hospitalization may be necessary to prevent or treat dehydration, reduce your symptoms, and ensure that you receive proper nutrition.
Medications for Ulcerative Colitis
Several medications, including sulfa drugs, corticosteroids, immunosuppressive agents and antibiotics, are used to reduce inflammation of the bowel tissue, allowing it to heal and relieve symptoms of ulcerative colitis.
• 5-aminosalicylic acid (5-ASA). Mesalamine and sulfasalazine are principal medications in the treatment of ulcerative colitis. Let your doctor know if you are allergic to sulfa before taking this drug. He or she can prescribe a sulfa-free 5-ASA.
• Corticosteroids. These anti-inflammatory drugs can be used when 5-ASA is ineffective. Corticosteroids are also used to treat people who have more severe disease. The use of corticosteroids is limited by side effects and the potential of long-term complications. In general, corticosteroids are used for short periods of time to cause remission. Remission is maintained with a 5-ASA medication.
• Immunosuppressants. If corticosteroids or 5-ASA are not effective, immunosupressants, such as 6-mercaptopurine (6-MP), azathioprine (Imuran), or cyclosporine-A may be prescribed.
Diet Changes for Ulcerative Colitis
While foods appear to play no role in causing ulcerative colitis, certain foods may cause more symptoms when the disease is active. Your doctor may suggest dietary recommendations depending on your symptoms. Vitamins or nutritional supplements may also be suggested by your doctor.
Surgery for Ulcerative Colitis
Surgery for ulcerative colitis, in which the diseased section or entire colon is removed, may be necessary when drugs are not effective or if you have significant progression of symptoms or severe complications of the disease.
If the entire colon is removed, the operation most often creates an opening, or stoma, in the abdominal wall, to which a bag is attached (called a permanent ileostomy or Brooke ileostomy). The tip of the lower small intestine is brought through the stoma. Wastes pass through this opening and collect in an external pouch, which is attached to the stoma and must be worn at all times.
The pelvic pouch, or ileal pouch anal anastomosis (IPAA), is a newer procedure that does not require a permanent stoma. In this sugery, the colon and rectum are removed, and the small intestine is used to form an internal pouch or reservoir that will serve as a new rectum. This pouch is connected to the anus. The reservoir is called a J-pouch. This procedure is frequently done in two operations and requires a temporary ileostomy in between.
The continent ileostomy (Kock pouch) is an option for people who would like their old-style ileostomy converted to an internal pouch and for people who don't qualify for the IPAA procedures. In this procedure, there is a stoma but no bag. The colon and rectum are removed, and an internal reservoir is created from the small intestine. An opening is made in the abdominal wall, and the reservoir is then joined to the skin with a nipple valve. To drain the pouch, you insert a catheter through the valve into the internal reservoir.
There are also other techniques that are available. All surgeries carry some degree of risk and complications. If you have been told you need surgery to treat ulcerative colitis, you may want to seek a second opinion to ensure the treatment prescribed is the most appropriate option. Make sure your diagnosis is confirmed by experts at an institution experienced in identifying and treating digestive disorders.
When Should I Call My Doctor About Ulcerative Colitis ?
If you have ulcerative colitis, call your doctor immediately if:
• You are having heavy, persistent diarrhea.
• You have rectal bleeding, with clots of blood in your stool.
• You have constant pain and a high fever.