What Is Ulcerative Colitis?
Ulcerative colitis is a type of inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your gastrointestinal (GI) tract. The other type of IBD is called Crohn’s disease. The large intestine and anus are part of the GI tract. Ulcerative colitis affects the rectum or the innermost lining of the large intestine (colon). The inflammation starts in the rectum and may spread to the colon. Proper treatment may help reduce the symptoms and the risk of life-threatening complications.
What Causes Ulcerative Colitis?
Researchers view ulcerative colitis as a complex disease that may not have a single cause. They believe it may stem from an overactive immune response. This makes your immune system produce more inflammation than necessary to protect you from infection caused by viruses and bacteria. Excess inflammation leads to tissue damage and triggers autoimmune conditions such as irritable bowel syndrome.
Types of Ulcerative Colitis
Ulcerative colitis is classified according to the part of the rectum or colon affected. Common types include:
- Ulcerative proctitis: Inflammation starts and remains in the lower part of the colon closest to the anus (rectum). Common possible causes of proctitis include sexually transmitted diseases (STDs) such as gonorrhea, antibiotics, bacteria from food, trauma to the rectum and anus, and radiation therapy.
- Proctosigmoiditis: Inflammation is confined to the rectum and the sigmoid or lower end of the colon. A family history of the disease, a high-fat diet, antibiotics, and oral contraceptives are suspected to cause this type of ulcerative colitis.
- Left-sided colitis: Also called limited or distal colitis. Inflammation spreads from the rectum up through the sigmoid to the splenic flexure (the bend between your transverse colon and descending colon). It may reach the descending colon in some cases. Genetics and a history of infection with bacteria, such as salmonella, are potential causes of left-sided colitis.
- Pancolitis: Also known as intensive or total colitis. This type involves inflammation of the entire colon. It starts at the rectum and extends beyond the splenic flexure. Possible causes include genetics, another type of irritable bowel syndrome, inflammatory disorders such as rheumatoid arthritis, and infections from bacteria such as C. difficile.
Who Is at Risk of Ulcerative Colitis?
The following can make some people more likely to develop ulcerative colitis:
- Genetics: People with a family history of ulcerative colitis have an increased risk.
- Age: People aged 45 years or older are more often affected.
- Race or ethnicity: You may be more at risk if you are Hispanic, Caucasian, or Jewish.
- Geographical location: People born in the United States or who live in the suburbs tend to have a higher risk of developing UC.
- Environmental factors: Bacteria or chemicals in your environment may trigger the body to make excessive inflammation in the gastrointestinal tract.
- Diet and Lifestyle: Consuming foods rich in artificial trans fats and saturated fats may contribute to digestive problems linked to IBD and ulcerative colitis. Smoking and lack of physical activity are other factors that may contribute to poor gastrointestinal health and chronic inflammation.
Ulcerative Colitis Symptoms
Ulcerative colitis is diagnosed by a doctor through various tests. However, you may suspect you have the disease based on certain symptoms. UC symptoms can also range from mild to severe and may vary based on the type.
Rectal bleeding may be the only sign of the disease in patients with ulcerative proctitis. Some patients may also experience:
- Rectal fullness or pain
- Abdominal cramps
- Frequent urges to move their bowels
- Frequent diarrhea or loose, watery stools
- Bloody stools
- Mucus or pus discharge from the anus
- Anemia (reduced number of red blood cells)
Signs and symptoms include:
- Abdominal cramps and pain
- Rectal pain or spasms
- Tiredness or fatigue
- Weight loss
- Bloody diarrhea
- Tenesmus or trouble moving your bowels despite the urge to do so
Signs and symptoms include:
- Abdominal cramping and pain on the left side of the abdomen
- Urgency to move your bowels
- Bloody diarrhea
- Loss of appetite
- Weight loss
Sings and symptoms include:
- Stomach and abdominal pain and cramps
- An urgent need to empty your bowels
- Bloody or pus-filled diarrhea
- Anal bleeding
- Loss of appetite
- Unexplained weight loss
- Strong, frequent urges to move your bowels
- Trouble controlling bowel movements
When to See a Doctor
If you have these symptoms of ulcerative colitis, your doctor or gastroenterologist can try and confirm or rule out the disease. It may be time to see your doctor if the following applies to you:
- Abdominal pain
- Blood in your stool
- A sudden fever lasting more than 24-48 hours
- Diarrhea that frequently keeps you up at night
- Frequent diarrhea that does not stop after using over-the-counter medications
Ulcerative colitis is a serious gastrointestinal disease that may cause the following complications. Some may be life-threatening.
- Severe bleeding
- Severe dehydration
- Chronic inflammation of your joints, skin, or eyes
- A hole in the colon (perforated colon)
- Cracks in the lining of the anus (fissures)
- Bone loss (osteoporosis)
- Increased risk of colorectal cancer
- Increased risk of blood clotting in your veins or arteries
- Rapid colon swelling (toxic megacolon)
- Small intestinal bacterial overgrowth (SIBO)
Intestinal complications usually occur in cases where inflammation of your intestine is long-term (chronic), severe or widespread, or reaches beyond the inner lining of your large intestine.
How is Ulcerative Colitis Diagnosed?
To diagnose ulcerative colitis, your doctor or gastroenterologist will need to perform a physical exam along with lab tests, endoscopic procedures, and imaging scans. It all depends on the severity of your symptoms.
- Blood tests: Your doctor may run blood tests to look for signs of infection or anemia. Anemia causes low levels of iron in your blood and may indicate there is bleeding in your colon or rectum.
- Stool samples: Testing your feces helps detect signs of infection, parasites in your body, and inflammation. The presence of white blood cells or certain proteins in your stool may be a sign of ulcerative colitis.
- Imaging tests: Your doctor may take a picture of your abdomen, colon, and rectum by performing an x-ray, magnetic resonance imaging (MRI) scan, or computed tomography (CT) scan. These tests are done more on patients with severe ulcerative colitis symptoms.
- Endoscopic tests: Colonoscopy and sigmoidoscopy are the two most common endoscopic tests done to diagnose or rule out ulcerative colitis. A thin, flexible tube with a tiny camera called an endoscope is carefully passed into the intestine through the anus to check for signs of colitis of the rectum and colon.
Treatment Options for Ulcerative Colitis
Doctors usually treat ulcerative colitis with drug therapy or surgery. Your doctor will prescribe one or more drugs based on the severity of the disease. He or she will consider the current status of your health and potential side effects when deciding on which medication to prescribe.
Anti-inflammatory drugs are the first line of treatment to fight inflammation that causes ulcerative colitis. These drugs include:
- 5-aminosalicylates: These medications can be taken by mouth, as a suppository, or an enema depending on the location of the disease.
- Corticosteroids: These drugs, which include prednisone and budesonide, are usually prescribed as a short-term treatment for patients with moderate to severe ulcerative colitis and those who do respond to other treatments.
Your doctor may also treat you with pain relievers, anti-diarrheal medications, iron supplements (for anemia), and antispasmodics to help with abdominal cramping.
Immune system suppressors
These drugs are used to reduce inflammation by suppressing the immune system response that triggers inflammation.
Biological drugs are commonly used to target proteins made by the immune system in patients with ulcerative colitis. These drugs are reserved for people with severe symptoms who do not respond to or cannot tolerate other treatments. They generally work by blocking proteins and cells that activate the inflammation process.
Surgery can be a last resort in the treatment of ulcerative colitis. Proctocolectomy is a surgery done to eliminate the disease but involves removing the entire colon and rectum. A common procedure used, called ileoanal anastomosis (J-pouch) surgery, removed the need for the patient to wear a bag that collects stool. Instead, the surgeon will make a pouch from a part of the small intestine and attach it directly to the anus. This allows waste to leave the body similar to before the surgery. An alternative procedure is to create a permanent opening in the abdomen (ileal stoma) where stool passes through from the small intestine and is collected in a bag attached below the beltline.