Ulcerative Colitis

What is Ulcerative Colitis?

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Ulcerative colitis is an inflammatory bowel disease (IBD) that causes long-lasting inflammation and sores, called ulcers, in the lining of the large intestine, which includes the colon and rectum. Ulcerative Colitis is diagnosed and treated by the GI Division of Premier Medical Group. UC is one of two forms of chronic inflammatory disease (the other being Crohn’s Disease). The disease usually affects just the lower part of the colon, but it can affect the entire colon. UC can affect people of any age, but more commonly it is diagnosed before the age of 30. It seems to peak around the ages of 15-30 and then again from 50-70. Generally, the large intestine absorbs water from stool and changes it from a liquid to a solid, but with UC, the inflammation causes loss of the lining of the colon, leading to bleeding, production of pus, diarrhea, and abdominal discomfort. It is a chronic condition, so symptoms generally develop over time. Ulcerative Colitis can be incapacitating and can even lead to life-threatening complications.

Courtesy of National Digestive Diseases Information Clearinghouse

What causes ulcerative colitis?

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The cause of ulcerative colitis is unknown. Some researchers believe it might be caused by a person’s immune system overreacting to normal bacteria in the digestive tract; others maintain that different kinds of bacteria and viruses may cause ulcerative colitis. One thing is for certain: you are more likely to get UC if there is a family history. UC affects both men and women equally. It is more common in people of Jewish ancestry. Stress and certain foods can trigger symptoms, but are not the cause of UC.

Some risk factors for ulcerative colitis may include:

  • Age. Although ulcerative colitis can occur at any age, it typically begins before the age of 30, and some people may not develop the disease until their 50s or 60s.
  • Race or ethnicity. Ulcerative colitis is more prevalent in Caucasians, but it can occur in any race, and if you are of Ashkenazi Jewish descent, your risk is even higher.
  • Family history. If there is a family history of UC, such as a close relative, you are at a greater risk to develop the disease.

What are the symptoms of ulcerative colitis?

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Ulcerative colitis is a disease that causes inflammation; therefore the disease is most often characterized by abdominal pain and cramping, diarrhea, and bloody stools. Most people diagnosed with UC have mild to moderate symptoms, but an additional 10 percent suffer from severe symptoms such as frequent fevers, bloody diarrhea, nausea, and severe abdominal cramps. Many patients experience urgency and frequency in having to use the bathroom. In severe cases, ulcerative colitis patients may eliminate their bowels upwards of 20 times a day. In rare instances, ulcerative colitis can be debilitating.

Other symptoms known to be associated with UC are:

  • Weight loss
  • Fatigue
  • Nausea and vomiting
  • Loss of appetite
  • Rectal bleeding
  • Skin lesions
  • Anemia
  • Fever
  • Loss of body fluids and nutrients
  • Children’s growth may slow
  • Rectal pain
  • Abdominal sounds (a gurgling or splashing sound heard over the intestine)
  • Blood and pus in the stools
  • Diarrhea (ranging from only a few episodes to very often)
  • Joint pain
  • Kidney stones
  • Liver disease
  • Osteoporosis
  • Eye irritation
  • Gastrointestinal bleeding
  • Mouth sores (ulcers)

How is ulcerative colitis diagnosed?

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Ulcerative colitis is sometimes difficult to diagnose because its symptoms are similar to those of other intestinal disorders such as Crohn’s disease. UC differs from Crohn’s disease in that Crohn’s causes deeper inflammation within the intestinal wall and can occur in other parts of the digestive system, including the small intestine, mouth, esophagus, and stomach. UC normally affects only the colon and rectum and causes an apparent change in daily bowel habits, such as frequent stools with blood or mucus.

The first step you doctor will take is to complete a complete physical exam and take medical history. The most common diagnostic tests for UC include:

  • Stool analysis (including a test for blood in the stool). The lab will be able to analyze the stool sample for blood, signs of bacterial infection, parasites, or white blood cells. You will be provided with a pan or container to catch the stool and store the stool.
  • Blood and urine tests will allow the doctor to rule out anemia, inflammation, or malnutrition. Two other tests which may be recommended are an erythrocyte sedimentation rate (ESR, or sed rate) or a C-reactive protein (CRP) blood test.
  • Flexible sigmoidoscopy. A small lighted scope which looks inside the rectum and lower colon. A biopsy may be taken during the exam.
  • Colonoscopy. A colonoscopy scope views the rectum and entire colon. A biopsy may be taken during the exam.
  • Abdominal X-ray. It provides a picture of the inside of the abdomen.
  • Barium enema. Barium is inserted into the rectum through a tube, which allows the radiologist to view the colon and provide a report to your doctor.
  • Computed tomography (CT) scan or MRI. These provide detailed pictures of the inside of the body.

How is ulcerative colitis treated?

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The treatment for UC will depend on the severity of the disease. It generally includes medicines and changes in diet. Some people have chronic symptoms that last a long time and may require more medicines or surgery. If your blood work shows other problems such as anemia or infection, this would require a different form of treatment using other medications. Because UC can affect the growth of children, this would require taking nutritional supplements to restore normal growth and sexual development, besides treatment for UC.

Since we cannot cure UC (except by removing the colon) the goal of treatment is to put the disease into remission using medications, which is often accomplished.

For those people who do not have symptoms, or are in remission, it is possible that you do not need any treatment. However, your doctor may recommend that you take medicines to keep the disease in remission (maintenance therapy).

The most common medications for UC are corticosteroids and anti-inflammatory agents, such as sulfasalazine, in conjunction with symptomatic treatment with antidiarrheal agents and rehydration.

Surgery is only a consideration if all medical treatment fails or the person suffers a perforation in the colon, severe bleeding, or if the UC is unresponsive to medical treatment.

If required, the surgical options include:

  • Colectomy: removal of colon to eliminate disease
  • Ileostomy: A surgical procedure to link the end of the small intestine to an opening in the abdomen (stoma) or to an internal pouch. Alternatively, an artificial pouch can be created inside the body, which can be regularly emptied when required. This is a relatively common surgery.

With chronic ulcerative colitis there is a higher risk of carcinoma; colonic carcinoma may easily be missed in the setting of ulcerative colitis. For this reason, it is important for long-term UC patients to have regular endoscopic screenings.

If you have mild symptoms, you may respond to:

  • Diet changes
  • Antidiarrheal medicines
  • Steroid medicines
  • Enemas or suppositories that contain medicine
  • Aminosalicylates. These medicines relieve inflammation in the intestines. They are also taken to keep the disease in remission.

If you have moderate to severe symptoms, you respond to:

  • Higher doses of steroid medicines
  • Aminosalicylates to keep the condition in remission
  • Immunomodulator medicines. These strong medicines suppress the immune system to prevent inflammation.
  • Biologicals are now used to control UC

Helpful tips for ulcerative colitis

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It is helpful to keep a food diary of everything you eat. Write down everything, even if you eat just a tiny bit, like nuts or lemon: be detailed. Dietary changes may help reduce UC symptoms, but the diet will depend on the person’s symptoms, medications, and reactions to food.

Other helpful suggestions include:

  • Avoid carbonated beverages
  • Eat smaller, more frequent, meals
  • Eat bland foods
  • Avoid high-fiber foods such as corn and nuts
  • Add vitamins and nutritional supplements to your diet
  • Eliminate gluten (wheat, barley, rye) to see if this is a trigger
  • Avoid eggs, dairy, chocolate, caffeine, and soy and then re-introducing them
  • Prepare yourself when you go out socially; know where the bathrooms are before you sit down
  • Carry wet wipes or toilet paper
  • Carry extra undergarments
  • Do not skip meals
  • Eat a variety of foods from all food groups
  • Make sure that you have daily intake of an adequate level of calories, proteins, and nutrients
  • Always carry your medication with you
  • When flying, request an aisle seat

Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research.

For More Information

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Crohn’s & Colitis Foundation of America

386 Park Avenue South, 17th Floor
New York, NY 10016
Phone: 1–800–932–2423
Email: info@ccfa.org
Internet: www.ccfa.org

Reach Out for Youth with Ileitis and Colitis, Inc.

P.O. Box 857
Bellmore, NY 11710
Phone: 631–293–3102
Email: reachoutforyouth@reachoutforyouth.org
Internet: www.reachoutforyouth.org

United Ostomy Associations of America, Inc.

P.O. Box 512
Northfield, MN 55057–0512
Phone: 1–800–826–0826
Email: info@ostomy.org
Internet: www.ostomy.org