Ulcerative Colitis – Overview
Gastroenterology & GI Surgery Blog
An inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers (sores) in your digestive tract is known as ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis). The innermost lining of the large intestine (colon) and rectum is affected by the ulcerative colitis. Development of symptoms is usually over time, rather than suddenly.
Ulcerative colitis can be debilitating and life-threatening complications can also be caused sometimes. While its cure is unknown, treatment can greatly decrease signs and symptoms of the disease and long-term remission can also be brought.
Symptoms and symptoms of ulcerative colitis can vary, depending on the severity of inflammation and where it occurs which may include:
- Diarrhea, often with blood or pus
- Abdominal pain and cramping
- Rectal pain
- Rectal bleeding — passing small amount of blood with stool
- Urgency to defecate
- Inability to defecate despite urgency
- Weight loss
- In children, failure to grow
Mid to moderate symptoms are found in most people with ulcerative colitis. The course of ulcerative colitis may vary, long periods of remission in some people.
Ulcerative colitis is often classified by doctors according to its location. Types of ulcerative colitis may include:
- Ulcerative proctitis. The area closest to the anus (rectum) is where the inflammation is confined, and rectal bleeding may be the only sign of the disease. This form is the mildest form of ulcerative colitis.
- Proctosigmoiditis. The rectum and sigmoid colon (lower end of the colon) are involved in the inflammation. Bloody diarrhea, abdominal cramps and pain are included in signs and symptoms, and an inability to move the bowels in spite of the urge to do so (tenesmus).
- Left-sided colitis. From the rectum up through the sigmoid and descending colon the inflammation is extended. Bloody diarrhea, abdominal cramping and pain on the left side, and unintended weight loss are included in signs and symptoms.
- Pancolitis. The entire colon is often affected by pancolitis and causes bouts of bloody diarrhea that may be severe, abdominal cramps and pain, fatigue, and significant weight loss.
- Acute severe ulcerative colitis. The entire colon is affected by this rare form of colitis and causes severe pain, profuse diarrhea, bleeding, fever and inability to eat.
When to see a doctor
Doctor should be consulted if experiencing a persistent change in bowel habits or if having signs and symptoms such as:
- Abdominal pain
- Blood in your stool
- Ongoing diarrhea that doesn’t respond to over-the-counter medications
- Diarrhea that awakens you from sleep
- An unexplained fever lasting more than a day or two
Although ulcerative colitis usually isn’t fatal, it’s a critical disease that, in some cases life-threatening complications may be caused.
The precise cause of ulcerative colitis remains not known. Previously, diet and stress were doubted, but now doctors know that these factors may not cause ulcerative colitis but may aggravate.
An immune system malfunction is one likely cause. When an invading virus or bacterium is tried to fight off by the immune system, an abnormal immune response causes the immune system to attack the cells in the digestive tract also.
A role is played by heredity in which ulcerative colitis is more common in people who have family members with the disease. However, family history is not present in most people with ulcerative colitis.
The same number of women and men are affected by ulcerative colitis. Risk factors may include:
- Age. Before the age of 30, ulcerative colitis begins generally. But, it can occur at any age, and the disease may not be developed by some people until after age 60.
- Race or ethnicity. Although the risk of the disease is higher in whites, it can occur in any race. If candidate is Ashkenazi Jewish descent, the risk is even higher.
- Family history. The risk is higher if having a close relative, such as a parent, sibling or child, with the disease.
Complications which are likely to occur of ulcerative colitis include:
- Severe bleeding
- A hole in the colon (perforated colon)
- Severe dehydration
- Liver disease (rare)
- Bone loss (osteoporosis)
- Inflammation of skin, joints and eyes
- An increased risk of colon cancer
- A rapidly swelling colon (toxic megacolon)
- Increased risk of blood clots in veins and arteries
Ulcerative colitis is likely to be diagnosed by the doctor after ruling out other possible causes for signs and symptoms. A diagnosis of ulcerative colitis to be confirmed, one or more of the below tests and procedures may be required:
- Blood tests. Blood tests may be conducted by the doctor to check for anemia which is a condition in which there aren’t enough red blood cells to carry adequate oxygen to the tissues or signs of infection may also be checked.
- Stool sample. Ulcerative colitis is indicated when white blood cells in stool. Other disorders, such as infections caused by bacteria, viruses and parasites can be ruled out with the help of stool sample.
- Colonoscopy. The entire colon is reviewed by the doctor in this exam using a thin, flexible, lighted tube with an attached camera. During the procedure, take small samples of tissue (biopsy) can also be taken by the doctor for laboratory analysis. Sometimes for the diagnosis to be confirmed, a tissue sample is taken.
- Flexible sigmoidoscopy. A slender, flexible, lighted tube is used by the doctor to examine the rectum and sigmoid, the last portion of the colon. If the colon is severely inflamed, this test might be performed by the doctor instead of a full colonoscopy.
- X-ray. If having severe symptoms, a standard X-ray of the abdominal area to rule out serious complications might be used by the doctor, such as a perforated colon.
- CT scan. If a complication is suspected by the doctor from ulcerative colitis then a CT scan of the abdomen or pelvis may be performed. How much of the colon is inflamed can also be revealed by the CT scan.
- Computerized tomography (CT) enterography and magnetic resonance (MR) enterography. One of these noninvasive tests might be recommended by the doctor if they want to exclude any inflammation in the small intestine. When compared to traditional imaging tests, these tests are more sensitive for finding inflammation in the bowel. A radiation-free alternative is MR enterography.
Drug therapy or surgery is involved generally in ulcerative colitis treatment.
For treating ulcerative colitis, several categories of drugs may be effective. Depending on the severity of condition and location the type will be chosen. The drugs that work well for some people may not work for others, so to find a medication that helps may take time.
5-aminosalicylic acid (5-ASA)
The first step in the treatment of ulcerative colitis is often 5-aminosalicylic acid (5-ASA). Sulfasalazine (Azulfidine), mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal) and olsalazine (Dipentum) are examples of this type. Which one being taken, and whether it is taken by mouth or as an enema or suppository, the area of colon that’s affected is dependent on that.
Prednisone and budesonide (Uceris) are included in these drugs which are generally reserved for moderate to severe ulcerative colitis. Due to the side effects, consuming long term might not be advised
Inflammation is also reduced by these drugs, but they do so by suppressing the immune system response that starts the process of inflammation. Examples which may include:
- Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). Medications consumed that requires follow up closely with the doctor and have the blood checked regularly to look for side effects, including effects on the liver.
- Cyclosporine (Gengraf, Neoral, Sandimmune). People who haven’t responded well to other medications use this drug and is not for long-term use.
- Tofacitinib (Xeljanz). Ulcerative colitis, rheumatoid arthritis or psoriatic arthritis are used for which this drug has recently been approved for treatment of conditions.
To treat ulcerative colitis types of biologics used may include:
- Infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi). These drugs are also known as tumor necrosis factor (TNF) inhibitors and work by neutralizing a protein produced by the immune system.
- Vedolizumab (Entyvio). Is a gut-specific medication which works by blocking inflammatory cells from getting to the area of the inflammation.
Additional medications may be needed to manage specific symptoms of ulcerative colitis. Loperamide (Imodium A-D) may be effective for severe diarrhea. However, anti-diarrheal medications should be used with great caution and only after talking with the doctor.
Ulcerative colitis can be eliminated often through surgery in which usually by removing the entire colon and rectum (proctocolectomy).
In most cases, a procedure called ileal pouch anal anastomosis is involved which eliminates the need to wear a bag to collect stool. A pouch from the end of your small intestine is constructed by the surgeon. The pouch is then attached directly to the anus, allowing for the waste to be expelled relatively normally.
In some cases it is not possible to construct a pouch. Instead, a permanent opening in the abdomen (ileal stoma) is created by the surgeon through which stool is passed for collection in an attached bag.
More-frequent screening will be required for colon cancer because of the increased risk. The schedule which is suggested will depend on the location of the disease and how long you have had it.
If more than the rectum is involved in the disease, a surveillance colonoscopy will be required every one to two years. A surveillance colonoscopy is needed beginning as soon as eight years after diagnosis if the majority of the colon is involved, or 15 years if only the left side of the colon is involved.
Lifestyle and home remedies
Sometimes helpless may be felt when facing ulcerative colitis. But symptoms may be controlled with the help of changes in the diet and lifestyle and lengthen the time between flare-ups.
Firm evidence is not available that what is being eaten actually causes inflammatory bowel disease. But signs and symptoms may be aggravated by certain foods and beverages, especially during a flare-up.
A food diary might be helpful to keep track of what is being eaten, as well as how it is felt. If it is discovered that some foods are causing the symptoms to flare, eliminating them can be tried. Below are some suggestions that may help:
Limiting or avoiding foods
- Limit dairy products. Problems such as diarrhea, abdominal pain and gas are found in many people with inflammatory disease improve by limiting or eliminating dairy products. Being lactose intolerant that is, the body can’t digest the milk sugar (lactose) in dairy foods. An enzyme product such as Lactaid may help as well if used.
- Limit fiber, if it’s a problem food. If having inflammatory bowel disease, symptoms can become worse with high-fiber foods, such as fresh fruits and vegetables and whole grains. If raw fruits and vegetables are bothersome, steaming, baking or stewing them can be tried.
In general, more problems may occur with foods in the cabbage family, such as broccoli and cauliflower, and nuts, seeds, corn and popcorn.
- Avoid other problem foods. Signs and symptoms may become worse by having spicy foods, alcohol and caffeine.
Other dietary measures
- Eat small meals. Eating five or six small meals a day is better rather than two or three larger ones.
- Drink plenty of liquids. Plenty of fluids daily should be consumed. Water is best. Caffeine is contained in alcohol and beverages that stimulate the intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.
- Talk to a dietitian. A registered dietician should be consulted if beginning to lose weight or the diet has become very limited.
Although inflammatory bowel disease is not caused by stress, it can make the signs and symptoms worse and may trigger flare-ups.
To help in controlling stress, try:
- Exercise. Stress can be reduced with even mild exercise, depression is relieved and bowel function normalized. Doctor should be consulted about an exercise plan that’s right.
- Biofeedback. Muscle tension is reduced and heart rate is slowed with the help of a feedback machine is done with the help of this stress-reduction technique. The aim is to help in entering a relaxed state so that coping with stress is done more easily.
- Regular relaxation and breathing exercises. Performing relaxation and breathing exercises is an effective way to cope with stress. Yoga classes and meditation or practice at home using books, CDs or DVDs can be done.
Some form of complementary and alternative (CAM) therapy is used by many people with digestive disorders.
Some commonly used therapies include:
- Herbal and nutritional supplements. FDA has not regulated the majority of alternative therapies. Therapies are safe and effective can be claimed by the manufacturers but they don’t need to prove it. In addition, side effects may be possible even in natural herbs and supplements and dangerous interactions caused. Doctor should be consulted if deciding to try any herbal supplement.
- Probiotics. Researchers suspect that the disease can be combat with the help of adding more of the beneficial bacteria (probiotics) that are normally found in the digestive tract. Although research is limited, adding probiotics along with other medications may be helpful has some evidence, but this has not been proved.
- Fish oil. An anti-inflammatory is acted by fish oil, adding fish oil to aminosalicylates may be helpful has some evidence, but this has not been proved.
- Aloe vera. An anti-inflammatory effect may be present in aloe vera gel for people with ulcerative colitis, but it can also cause diarrhea.
- Acupuncture. Regarding it benefit there is only one clinical trial which has been conducted. The insertion of fine needles into the skin is involved in the procedure, which may stimulate the release of the body’s natural painkillers.
- Turmeric. A compound found in the spice turmeric known as curcumin has been combined with standard ulcerative colitis therapies in clinical trials. There is some evidence of benefit, but more research is required.
Preparing for appointment
Family doctor or general practitioner may be visited first when symptoms of ulcerative colitis occurs. A specialist who treats digestive diseases (gastroenterologist) may be referred by the doctor.
Because appointments can be brief, and a lot of information to discuss is often there, it’s a good idea to be well-prepared. Below are some information to help in getting ready, and what to expect from the doctor.
- Be aware of any pre-appointment restrictions should be made aware of at the time of making the appointment, be sure to ask if there’s anything needed to be done in advance, such as restricting diet.
- Any symptoms being experienced should be written down, including any that may seem unrelated to the reason for which the appointment is scheduled.
- Key personal information should be written down, including any major stresses or recent life changes.
- A list of all medications should be made, vitamins or supplements that are being taken. Doctor should be informed if taking any herbal preparations, as well.
- A family member or friend should be asked to come along as sometimes it can be difficult to remember all the information provided during an appointment. To help in remembering questions to ask and what the doctor said, someone who accompanies you may remember something that was missed.
- Questions to ask the doctor should be written down.
Your time is limited with the doctor, so preparing a list of questions ahead of time can help to make the most of the time. Questions from most important to least important should be listed in case time runs out.
A number of questions is likely to asked by the doctor. Being ready to answer them may reserve time in order to go over points on which the time is wanted to be spent. The doctor may ask:
- Beginning of experiencing symptoms?
- Symptoms been continuous or occasional?
- Severity of the symptoms?
- Having abdominal pain?
- Having diarrhea? How often?
- Lost any weight unintentionally recently?
- Anything improving the symptoms?
- Anything worsening the symptoms?
- Liver problems, hepatitis or jaundice being experienced?
- History of any problems with joints, eyes, skin rashes or sores, or sores in mouth?
- Awaken from sleep during the night due to diarrhea?
- Travel history recently? If so, where?
- Anyone else in the home sick with diarrhea?
- Consumed antibiotics recently?
- Nonsteroidal anti-inflammatory drugs being taken regularly, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve)?