Ulcerative colitis is a relatively common long-term condition that causes inflammation in the colon. It is a form of inflammatory bowel disease (IBD) that is similar to Crohn’s disease.
Knowing more about your Ulcerative Colitis can help you to feel better informed and able to take a more active part in decisions about your treatment.
The colon removes nutrients from undigested food and eliminates waste products through the rectum and anus as feces.
In severe cases, ulcers form on the lining of the colon. These ulcers may bleed, which produces pus and mucus.
Various medication options are available, and doctors can tailor treatment to meet individual needs.
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.
Ulcerative colitis can be debilitating and can sometimes lead to life-threatening complications. While it has no known cure, treatment can greatly reduce signs and symptoms of the disease and bring about long-term remission.
What Is Ulcerative Colitis?
Ulcerative colitis is a chronic disorder that affects the digestive system. This condition is characterized by abnormal inflammation of the inner surface of the rectum and colon, which make up most of the length of the large intestine. The inflammation usually causes open sores (ulcers) to develop in the large intestine. Ulcerative colitis usually appears between ages 15 and 30, although it can develop at any age. The inflammation tends to flare up multiple times throughout life, which causes recurring signs and symptoms.
The most common symptoms of ulcerative colitis are abdominal pain and cramping and frequent diarrhea, often with blood, pus, or mucus in the stool. Other signs and symptoms include nausea, loss of appetite, fatigue, and fevers. Chronic bleeding from the inflamed and ulcerated intestinal tissue can cause a shortage of red blood cells (anemia) in some affected individuals. People with this disorder have difficulty absorbing enough fluids and nutrients from their diet and often experience weight loss. Affected children usually grow more slowly than normal. Less commonly, ulcerative colitis causes problems with the skin, joints, eyes, kidneys, or liver, which are most likely due to abnormal inflammation.
Toxic megacolon is a rare complication of ulcerative colitis that can be life-threatening. Toxic megacolon involves widening of the colon and an overwhelming bacterial infection (sepsis). Ulcerative colitis also increases the risk of developing colon cancer, especially in people whose entire colon is inflamed and in people who have had ulcerative colitis for 8 or more years.
Ulcerative colitis is one common form of inflammatory bowel disease (IBD). Another type of IBD, Crohn disease, also causes chronic inflammation of the intestines. Unlike ulcerative colitis, which affects only the inner surface of the large intestine, Crohn disease can cause inflammation in any part of the digestive system, and the inflammation extends deeper into the intestinal tissue.
Types of Ulcerative Colitis
The type of ulcerative colitis you have depends on where it is in your body:
- Ulcerative proctitis is usually the mildest form. It’s only in the rectum, the part of your colon closest to your anus. Rectal bleeding may be the only sign of the disease.
- Proctosigmoiditis happens in your rectum and the lower end of your colon (you may hear the doctor call it the sigmoid colon). You’ll have bloody diarrhea, belly cramps, and pain. You’ll have the urge to poop, but you won’t be able to. (Your doctor may call this tenesmus.)
- Left-sided colitis causes cramps on that side of your belly. You’ll also have bloody diarrhea, and you might lose weight without trying. You’ll have inflammation from your rectum up through the left side of your colon.
- Pancolitis often affects your entire colon. It can cause severe bouts of bloody diarrhea, belly cramps, pain, fatigue, and major weight loss.
- Acute severe ulcerative colitis is rare. It affects your entire colon and causes severe pain, heavy diarrhea, bleeding, and fever.
Ulcerative Colitis Symptoms
The seriousness of UC symptoms varies among affected people. The symptoms can also change over time.
People diagnosed with UC may experience periods of mild symptoms or no symptoms at all. This is called remission. However, symptoms can return and be severe. This is called a flare-up.
Common symptoms of UC include:
- abdominal pain
- increased abdominal sounds
- bloody stools
- rectal pain
- weight loss
UC may cause additional conditions, such as:
- joint pain
- joint swelling
- nausea and decreased appetite
- skin problems
- mouth sores
- eye inflammation
The exact causes of ulcerative colitis are unclear. However, they may involve the following:
ResearchTrusted Source suggests that people with ulcerative colitis are more likely to have certain genetic features. The specific genetic feature that a person has may affect the age at which the disease appears.
The following environmental factors might affect the onset of ulcerative colitis:
- air pollution
- cigarette smoke
The body might respond to a viral or bacterial infection in a way that causes the inflammation associated with ulcerative colitis.
Once the infection resolves, the immune system continues to respond, which leads to ongoing inflammation.
Another theory suggests that ulcerative colitis may be an autoimmune condition. A fault in the immune system may cause it to fight nonexistent infections, leading to inflammation in the colon.
Ulcerative Colitis Diagnosis and Testing
The path to receiving a chronic disease diagnosis can be overwhelming and even frightening at times. The best thing you can do during this time is be educated and prepared. We can help you understand the process of diagnosing ulcerative colitis and learn about common procedures your healthcare team may recommend.
An ulcerative colitis diagnosis is based on several factors, including your medical history, a physical exam, and a series of medical tests. The tests your doctor recommends will help your healthcare team determine if you have ulcerative colitis and which type of ulcerative colitis
Endoscopy and Biopsy
Your doctor may recommend additional testing to look for signs of disease inside your colon and rectum. These tests are typically done in an outpatient setting and your health care providers will be careful to minimize any discomfort.
An endoscopy allows doctors to examine the inside of your colon and rectum with a lighted tube inserted through your anus. There are two types of endoscopies used during ulcerative colitis testing:
- A sigmoidoscopy allows your doctor to examine the extent of the inflammation in your lower colon and rectum.
- A total colonoscopy is a similar to the sigmoidoscopy, but this procedure allows your doctor to examine your entire colon.
Colonoscopies require bowel preparation. Talk to your healthcare team about ways to prepare, and tips for making this preparation easier.
Your doctor may want use this technique during a colonoscopy to look for polyps or precancerous changes.
- During a chromoendoscopy, a blue liquid dye is sprayed into the colon to highlight and detect slight changes in the lining of your intestine.
- Polyps can then be removed and/or biopsied.
- It is common to have blue bowel movements following this procedure.
Your doctor may want to get a biopsy of your colon while performing an endoscopy. During the biopsy, a small piece of tissue is removed from the inside of the intestine for further testing and analysis.
- Your biopsied tissue will be analyzed in a pathology laboratory and screened for disease. Biopsies are also used for colorectal cancer screening.
- There may be small amounts of blood in your stool after a biopsy.
- While a biopsy sounds scary, medical advances have made this procedure virtually painless.
Ulcerative Colitis Treatment
UC treatment has two main goals. The first is to make you feel better and give your colon a chance to heal. The second is to prevent more flare-ups. You may need a combination of diet changes, medication, or surgery to reach those goals.
Diet. Some foods can make your symptoms worse. You might find that soft, bland food doesn’t bother you as much as spicy or high-fiber dishes. If you can’t digest the sugar in milk called lactose (meaning you’re lactose intolerant), your doctor may tell you to stop eating dairy products. A balanced diet with plenty of fiber, lean protein, fruits, and veggies should provide enough vitamins and nutrients.
Medicine. Your doctor may prescribe a few different kinds of drugs, including:
- Antibiotics. These fight infections and let your large intestine heal.
- Aminosalicylates. These drugs have something called 5-aminosalicylic acid (5-ASA) that fights inflammation and helps control symptoms. You might get pills to swallow or an enema or suppository to put in your bottom.
- Corticosteroids. If aminosalicylates don’t work or your symptoms are severe, your doctor might give you these anti-inflammatory drugs for a short time.
- Immunomodulators. These help stop your immune system’s attack on your colon. They can take a while to take effect. You might not notice any changes for up to 3 months.
- Biologics. These are made from proteins in living cells instead of chemicals. They’re for people with severe ulcerative colitis.
- Loperamide. This can slow or stop diarrhea. Talk to your doctor before taking it.
Surgery. If other treatments don’t work or your UC is severe, you might need surgery to remove your colon (colectomy) or colon and rectum (proctocolectomy). If you have a proctocolectomy, your doctor might make a small pouch out of your small intestine and attach it to your anus. This is called ileal pouch-anal anastomosis (IPAA). It lets your body expel waste normally, so you don’t need to wear a bag to collect stool.
Diet does not cause the development of ulcerative colitis nor can any special diet cure the disease. However, the foods you or your child eat may play a role in managing symptoms and lengthening the time between flareups.
Some foods may make symptoms worse and should be avoided, especially during flareups. Foods that trigger symptoms are different from person to person. To narrow down what foods affect you, keep track of what you eat each day and how you feel afterward (a food journal).
Problem foods often include:
- Greasy foods.
- High sugar foods and drinks.
- Carbonated beverages.
- High-fiber foods.
In addition to the problem foods listed above, infants, children and teenagers can also experience issues with:
- Dairy products.
Keep a careful eye on your child’s diet and nutrition. Their appetite may decrease during a flareup and they might not eat enough to stay healthy, and grow. Also, the inflammation caused by ulcerative colitis may keep their digestive tract from absorbing enough nutrients. This can also affect your child’s health. For these reasons, you may have to increase the amount of calories your child consumes.
It’s best to work with your provider and nutritionist to come up with a personalized diet plan if you or your child has ulcerative colitis.