What is ulcerative colitis?| Symptoms| Diagnosis| Treatment| Surgery| What Can You Do?| Finding a Specialist
What is ulcerative colitis?
Eugene Yen, MD with patient
Ulcerative colitis is found in the colon (large intestine). This disease does not skip sections of the intestine as Crohn’s can; rather the inflammation begins at the rectum and extends up the colon in a continuous manner. Another difference between Crohn’s and ulcerative colitis is that colitis affects the lining of the colon as opposed to Crohn’s disease which can impact the entire thickness of the bowel.
Like Crohn’s, the cause of ulcerative colitis is unknown. The disease impacts each person differently and can remain dormant for years or flare-up more frequently. Ulcerative colitis is a chronic condition that cannot be cured but can be managed. It is very important to control the disease under the care of an IBD specialist, as those who have been diagnosed with colitis for a longer period of time are at a higher risk of getting colon cancer. Your physician can help you lower your risk of developing cancer.
A variety of terms may be used to describe ulcerative colitis depending upon where the disease is located in the colon:
- Ulcerative proctitis – involves only the rectum
- Proctosigmoiditis – involves the rectum and sigmoid colon
- Distal colitis – involves only the left side of the colon
- Pancolitis – involves the entire colon
Ulcerative colitis can occur at any age but is typically diagnosed in patients in their mid-thirties. It appears more in Caucasians than those of other races. Jews, mostly Eastern European, tend to have a higher rate of the disease. Similar to Crohn’s disease, colitis tends to have a genetic connection and runs in families although there is no way to predict if a relative will develop the disease.
One of the major symptoms of ulcerative colitis is diarrhea. Loose stools occur when the lining of the intestine becomes inflamed and ulcerated and loses its ability to absorb water from the waste material that passes through the colon. That damage also can produce mucus and blood in the stool which can lead to anemia. Other symptoms include:
- urgency to have a bowel movement
- crampy abdominal pain – may be stronger on the left side
- loss of appetite
- weight loss
- children may fail to develop or grow properly
Rarely, ulcerative colitis and the medications used to treat the disease can affect other areas of the body:
- eyes – redness and itching
- mouth – sores
- joints – swelling and pain
- skin – bumps and other lesions
- bones – osteoporosis
- kidney – stones
- liver – hepatitis and cirrhosis (a rare development)
These symptoms may be the first signs of ulcerative colitis and may appear before the bowel symptoms or right before a flare-up of the disease.
To diagnose ulcerative colitis, doctors ask about the symptoms, do a physical exam, and do a number of tests. Testing can help the doctor rule out other problems that can cause similar symptoms, such as Crohn’s disease, irritable bowel syndrome, or diverticulitis.
Tests that may be done include:
- A colonoscopy. In this test, a doctor uses a thin, lighted tool to look at the inside of your entire colon. At the same time, the doctor may take a sample (biopsy) of the lining of the colon to substantiate a diagnosis of ulcerative colitis.
- And x-ray study may be done to identify and evaluate inflammation.
- Blood tests, which are done to look for infection or inflammation.
- Stool sample testing to look for blood, infection, and white blood cells.
Each patient has a different reaction and treatment plan with ulcerative colitis. Some may receive over-the-counter medications while others may require more intense medical therapies.
Doctors often prescribe medicines to reduce inflammation, such as:
- Steroid medicines. These can help reduce or stop symptoms. They are only used for short periods because they can cause side effects, such as bone thinning (osteoporosis).
- Aminosalicylates. After your symptoms are under control, these medicines may help prevent flare-ups.
- Immunomodulators: Medicines that control the immune system You may need these if your disease is severe and aminosalicylates don't keep it from flaring up.
- Biologic Therapies These have recently been proscribed for patients with UC and are changing the way gastroenterologists treat IBD. These are the newest class of drugs for people suffering inflammatory bowel disease. They are made from antibodies that bind with certain molecules to block a particular action. Biologic drugs target specific pathways to help reduce inflammation and the chance of surgery.
At some point, patients with ulcerative colitis may require surgery for severe disease or precancerous changes. It may be a desirable option when medical therapies are no longer working. Surgeons remove the entire colon (colectomy) which is the only cure for ulcerative colitis.
There are two common surgical approaches which may be recommended:
- Creation of an ileostomy and removal of the entire colon (colectomy). During an ileostomy surgeons bring the small bowel to the skin so that waste products may be emptied into a pouch attached to the abdomen.
- Ileoanal pouch anal anastomosis (IPAA): during this procedure a pouch is created from the small bowel and is attached to the anal sphincter muscle which allows patients to have normal bowel movements without the use of an external ostomy bag.
What can you do?
Keeping a food diary may be helpful in identifying foods that irritate your system. Eliminating those foods and eating bland, soft foods during flare-ups may help control your symptoms. Smaller, more frequent meals may help as well.
Bouts of diarrhea can lead to a nutritional imbalance in your body. Therefore, people with ulcerative colitis should be sure to eat a healthy, well-balanced diet with foods from all food groups and include a daily multivitamin.
Develop some strategies for daily living with ulcerative colitis. When going out, find out where the restrooms are and carry extra underclothing or toilet paper. If you are planning a trip, be sure to speak to your doctor about having enough medication, its generic name in case you run out or lose it, and the names of doctors in the area you will be visiting.
Learning to live with ulcerative colitis will allow you to pursue the activities you’ve always enjoyed and lead a full life.
Finding a specialist
To make an appointment with an NorthShore University HealthSystem IBD specialist, please call 847.657.1900.