Ulcerative Colitis (UC) is an inflammatory bowel disease (IBD) that causes long-lasting inflammation in the part of the digestive tract affecting that affects the innermost lining, also known as the mucosa of the large intestine (colon) and rectum. As a result, the mucosa erodes and forms ulcers, which bleed and produce pus. The resulting ulcers and inflammation then cause frequent, urgent, and often loose bowel movements. According to the National Digestive Diseases Information Clearinghouse, UC can occur in people of any age. However, it usually develops between the ages of 15 and 30 and between the ages of 60 to 80. The disease affects men and women equally. People with a family member or first-degree relative with an IBD are at higher risk for developing UC, as are Caucasians and Ashkenazi Jews (of Eastern European descent). The Crohn’s and Colitis Foundation of America says that 700,000 people have the illness.
What Is Ulcerative Colitis
What Causes Ulcerative Colitis
According to the Crohn’s and Colitis Foundation of America (CCFA) the cause of UC is not known. Medical experts are focusing on these factors:
- Immune system. Some scientists think a virus or bacterium may trigger ulcerative colitis. When the immune system tries to fight it off the digestive tract becomes inflamed. It’s also possible that inflammation may stem from an autoimmune reaction in which your body mounts an immune response even though no virus or bacterium is present.
- Heredity. If a parent or sibling has the disease you’re more likely to get it. That’s why scientists suspect genetic makeup may play a contributing role. However, most people who have UC don’t have a family history of the disease.
According to the National Digestive Diseases Information Clearinghouse (NDDIC), UC is not caused by emotional distress, but the stress of living with UC may worsen symptoms. In addition, while sensitivity to certain foods or food products does not cause UC, it may trigger symptoms in some people.
Risk Factors For Ulcerative Colitis
According to the Mayo Clinic UC risk factors include:
- Age. Ulcerative colitis usually begins before the age of 30. But, it can be triggered at any age.
- Race or ethnicity. The risk of developing UC is 5 times higher among those of Ashkenazi Jewish descent compared to the general population
- Family history. According to the National Institutes of Health, both genetic and other factors such as a carbohydrate-heavy diet, anti- inflammatory medications such as ibuprofen and antibiotics play a part in developing UC. But the exact inheritance pattern still isn’t known. However, you are at higher risk if you have a close relative, such as a parent, sibling or child, with the disease.
Diagnosing Ulcerative Colitis
Ulcerative colitis (UC) can be difficult to diagnose because it has symptoms similar to those of other intestinal disorders and to Crohn’s disease. The NDDIC says Crohn’s disease differs from UC in that Crohn’s disease causes inflammation deeper within the intestinal wall and can occur in other parts of the digestive system, including the small intestine, mouth, esophagus, and stomach.
Your doctor will make a diagnosis of ulcerative colitis based on the following:
- Physical examination. Your doctor will conduct a physical exam of your body and interview you to learn more about your general health, diet, family history, and environment.
- Blood tests. Blood test can reveal a high white blood cell (WBC) count, a sign of infection, as well as anemia, which may indicate bleeding in the colon or rectum. They can also rule out other causes of your gastrointestinal symptoms.
- Stool specimen. Stool specimens are analyzed to eliminate the possibility of bacterial, viral, or parasitic causes of diarrhea. Several stool samples may need to be taken, as certain gastrointestinal illnesses may not show up in just a single stool sample.
- Endoscopy. Done with a medical instrument, the doctor can visually examine the interior of your colon with a lighted tube that is inserted through the anus. Your doctor may recommend two types of endoscopic examinations: a sigmoidoscopy and a total colonoscopy.
- Sigmoidoscopy involves the insertion of a flexible instrument into the rectum and lower colon that allows the doctor to visualize the extent and degree of inflammation in these areas.
- Total colonoscopy is a similar exam, but it visualizes examines the entire colon.
During these procedures, your doctor may wish to obtain a sample of affected tissue, called a biopsy. Biopsied tissues are then sent to a laboratory to determine the presence of disease.
- Computerized tomography (CT) scan. According to the NDDIC, the CT scan uses both x-rays and computer technology to create three-dimensional (3D) images. A CT scan may include the injection of a dye called contrast medium in order for the images to be read more clearly. With a CT scan, a patient lies on a table that slides into a tunnel-like device where the images are captured. An x-ray technician performs the procedure and the images are interpreted by a radiologist—a doctor who specializes in medical imaging. Anesthesia is not needed. CT scans can identify abscesses or blockages in the colon that can be signs of UC, as well as rule out other causes for symptoms.
- Barium enema x-ray. A barium enema x-ray involves the injection of contrast medium, called barium, into the colon to make the colon, rectum, and lower part of the small intestine more visible in x-ray images. Intestinal narrowing or scar tissue from continued intestinal inflammation—both signs of UC—are made visible with barium enema x-rays. The procedure is performed in a hospital or outpatient center by an x-ray technician, and the images are interpreted by a radiologist; anesthesia is not needed.
Symptoms of Ulcerative Colitis
Most people diagnosed with UC have mild to moderate symptoms. About 10% have severe symptoms such as frequent fevers, bloody diarrhea, nausea, and severe abdominal cramps. Experts say that UC can also cause problems such as joint pain, eye irritation, kidney stones, liver disease, and osteoporosis. The exact reason for these complications isn’t known, but it may be the result of inflammation triggered by the immune system.
More common symptoms include:
- Weight loss
- Loss of appetite
- Rectal bleeding
- Loss of body fluids and nutrients
- Skin lesions
- Growth failure in children
UC tends to go between periods of flare-ups and periods of remission. About 10% of people have serious complications (such as perforation or massive bleeding) after their first flare-up. Approximately 10% never have another flare-up after their first one. Anywhere from 10% to 40% of patients with ulcerative colitis will require surgery to treat their disease. Surgery always involves the complete removal of the colon; partial removals are not done because the colitis will recur in the portion of the colon that remains.
Colon cancer develops in about 5% of people with UC. Risk is increased when the entire colon is affected over a period of years. According to the NDDIC, if only the lower colon and rectum are involved, the risk of cancer is no higher than that of a person without UC. Dysplasia, the accelerated growth of a concentration of abnormal cells, is often a precursor to colon cancer in patients with UC. UC patients are regularly monitored for dysplasia, and the removal of polyp growths can prevent the development of cancer in some cases.
Living With Ulcerative Colitis
In addition to taking medication as prescribed, there are a number of ways to help you live better with UC.
Diet is important for symptom management—though there is no one diet that either causes UC or eliminates it. But it may help to:
- Eat small meals. Eating five or six smaller meals a day, rather than three main meals, may be less taxing on your colon.
- Drink plenty of fluids. Since you lose a lot of fluid when you have diarrhea, it’s a good practice to drink a lot of water.
- Avoid caffeine and alcohol. These can make your diarrhea worse.
- Reduce or eliminate certain foods that may irritate the colon, such as highly fibrous fruits and vegetables, seeds, and hulls.
- Keep a food diary. You may discover you can tolerate some foods while others make your symptoms worse.
Stress doesn’t necessarily cause UC, but managing it may help to reduce the frequency of flare-ups. It may help to:
- Exercise. This has been proven to reduce stress and boost your mood. Your doctor care team can advise on a suitable exercise plan
- Relaxation techniques. Breathing exercises, meditation and yoga are good ways of teaching yourself to relax
- Communication. Living with ulcerative colitis can be frustrating and isolating. Talking to others with the condition can help.
There are no known ways to present ulcerative colitis, and because of its relatively rare rates of occurrence, regular screening for the disease is not done across all practices. Those who visit the doctor and report experiencing any of the many symptoms of colitis may undergo diagnostic testing for the disease.
There is no known prevention for ulcerative colitis because the cause is unknown.
Medication And Treatment
Even though there’s no known cure for UC, a combination of treatments including medications may be able to help you stay in control of the disease.
There are five major classes of medication used to treat ulcerative colitis:
Aminosalicylates (5-ASA) work on the level of the lining of the GI tract to decrease inflammation. A medication known as sulfasalazine (Azulfidine), combines sulfapyridine and 5-ASA, the NDDIC says. The sulfapyridine component carries the anti-inflammatory 5-ASA to the intestine. However, experts caution that sulfapyridine may lead to side effects such as nausea, vomiting, heartburn, diarrhea, and headache. 5-Asa can also be combined with other complimentary agents, such as olsalazine (Dipentum), mesalamine (Asacol, Canasa, Lialda, Rowasa), and balsalazide (Colazal), which cause fewer side effects and can be used by people who cannot take sulfasalazine. Depending on which parts of the colon and rectum are affected by UC, 5-ASAs can be given orally; through a rectal suppository, a small plug of medication inserted in the rectum; or through an enema—liquid medication put into the rectum. Unless the UC symptoms are severe, aminosalicylates are usually the first line of treatment for UC sufferers. These medications are also used when symptoms return after a period of remission.
Corticosteroids suppress the immune system and are used to treat moderate to severely active UC. Corticosteroids have a number of side effects, including weight gain, the growth of facial hair, mood swings, high blood pressure, type 2 diabetes, osteoporosis, bone fractures, glaucoma and a higher vulnerability to infections. These are usually prescribed only for patients with moderate to severe UC who haven’t responded to treatment, and aren’t for long-term use.
Immunomodulators modulate or suppress the body’s immune system response so it can no longer cause ongoing inflammation.. Immunomodulators may take several months to start working. These drugs include Azathioprine (Azasan, Imuran); mercaptopurine (Purinethol); Cyclosporine (Gengraf, Neoral, Sandimmune); infliximab (Remicade) and Adalimumab (Humira).
Antibiotics may be used when infections such as abscesses occur.
Anti-diarrheals. For severe diarrhea, loperamide (Imodium) may be effective. Use anti-diarrheal medications with great caution, however, because they increase the risk of toxic megacolon (a widening of the colon) that can cause septic shock and ultimately lead to perforation of the colon.
Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others). However, experts advise against using ibuprofen (Advil, Motrin, others), naproxen (Aleve) or aspirin. All these are likely to make symptoms worse.
Biologic therapies, also known as anti-TNF agents, are the latest class of therapy. Tumor necrosis factor (TNF) is a chemical produced by our bodies to cause inflammation. Antibodies are proteins produced to attach to these chemicals and allow the body to destroy the chemical and reduce the inflammation.
Surgery. About 25% to 33% of patients with UC are unresponsive to medical therapy or complications from treatment arise. Under these circumstances, surgery may be considered. This operation involves the removal of the colon (colectomy).
Complementary and Alternative Treatment
According to the National Center for Complementary and Alternative Medicine (NCCAM):
Mindfulness-based stress reduction (MBSR), a type of meditation, shows some promise as an approach to improve quality of life and decrease perceived stress in people with ulcerative colitis. These findings come from a small pilot study led by researchers at Rush University in Chicago.
Pineapple extract may help calm inflammation of the colon. The study showing the extract’s promise was funded by NCCAM, and led by researchers at Duke University.
Some dietary supplements are recommended because UC can potentially cause vitamin and mineral deficiencies, specifically:
- Vitamin B12
- Vitamin D
Speak with your doctor before taking any supplements.
Though the disruptive symptoms of ulcerative colitis can be out of your control, there are things you can do to try to minimize the severity and impact of the symptoms. These include:
- Be mindful of your diet. While ulcerative colitis is not caused by the foods you eat, you may find that once you have the disease, particular foods can aggravate it. Try to maintain a healthy and soothing diet that helps reduce your symptoms. Many people with ulcerative colitis find that soft, bland foods cause less discomfort than spicy or high-fiber foods.
- Drink liquids as directed. Adults should drink between 9 and 13 eight-ounce cups of liquid every day. Ask what amount is best for you. For most people, good liquids to drink are water, juice, and milk. Do not drink alcohol. This can make your symptoms worse.
- Get plenty of exercise. Talk to your doctor about the best exercise plan for you. Exercise can help decrease your blood pressure, and improve your overall health and mood.
- Manage stress. Stress may slow healing and contribute to a flare-up. Mind body techniques such as deep relaxation and breathing may be helpful.
- Take your drugs as prescribed by your doctor. Discuss any side effects.
- Know you’re not alone. The Crohn’s and Colitis Foundation of America (CCFA) offer an online community.
When To Contact A Doctor
Call a doctor immediately if you have been diagnosed with ulcerative colitis and you have:
- Fever over 101F (38.3C) or shaking chills
- Lightheadedness, passing out, or rapid heart rate
- Consistently bloody stools
- Severe dehydration, such as passing little or no urine for 12 or more hours
- Severe belly pain with or without bloating
- Pus draining from the area around the anus or pain and swelling in the anal area
- Repeated vomiting
- Not passing any stools or gas
Questions For Your Doctor
Based on your symptoms, your primary doctor will refer you to a gastroenterologist. This is a doctor who specializes in digestive disorders. If your condition requires a colostomy, you will be seen by a surgeon. A nutritionist or dietitian can help with a diet plan. You can also do some research of your own by visiting the website for the American Society for Gastrointestinal Endoscopy or the Society of American Gastrointestinal and Endoscopic Surgeons.
Questions For A Doctor
Receiving a diagnosis of ulcerative colitis can be scary. Feel free to discuss any questions you might have with your doctor. Here are some you may want to bring up:
- Could any condition other than my disease be causing my symptoms?
- What tests do I need to have to get to the root of my symptoms?
- Should I have these tests during the time of a flare – up or on a routine basis?
- What parts of my GI tract are affected?v
- How will I know if my medication needs to be adjusted?
- What are the side effects of the medication? What should I do if I notice them?
- What should I do if the symptoms return? What symptoms are considered an emergency?
- If I cannot schedule a visit right away, are there any over – the – counter medication options that can assist with my prescribed medication? If so, which ones?
- Should I change my diet or take nutritional supplements? If so, can you recommend a dietitian or any specific nutritional supplements?
- Do I need to make any other lifestyle changes?
World Crohn’s and Colitis Day is May 23rd. According to the Crohn’s and Colitis Foundation of America (CCFA) as many as 700,000 Americans may suffer with ulcerative colitis.
To get up-to-the-minute news on autoimmune diseases, including UC, sign up for a newsletter from: American Autoimmune Related Diseases Association, Inc. (AARDA).
You can get a global perspective on UC and other gastrointestinal disorders from the International Foundation for Functional Gastrointestinal Disorders (IFFGD). They also offers a library on digestive disorders.
For the latest federal statistics, studies and news about GI disorders, visit: National Institute of Diabetes, Digestive & Kidney Diseases, part of the National Institutes of Health.
If you’d like to find a good specialist in your town, or get in contact with an in-person or online support group, visit: Crohn’s and Colitis Foundation of America (CCFA).