Ulcerative Colitis

Ulcerative colitis is one of the most common inflammatory bowel diseases. This lifelong condition causes inflammation and ulcers in the digestive tract. It affects the lining of the large intestines. Ulcerative colitis can range from being mild to moderate or severe. There are different types of ulcerative colitis. Ulcerative proctitis is inflammation that affects the rectum. There is inflammation that affects the rectum and sigmoid colon. Left sided colitis causes inflammation on the left side of the colon. Pancolitis is inflammation that affects the whole colon.

Symptoms

Symptoms usually develop overtime instead of all at once. Flare ups can occur followed by long times of remission. Some people may only experience one or two flare ups and then be in remission the rest of their life. Other people may struggle with moderate to severe symptoms for an extended amount of time. Symptoms can vary per person. Severity of symptoms can also vary per person and per flare up. Symptoms that usually arise at first are diarrhea that may or may not have blood, an increased number of bowel movements, urgent bowel movements, tenesmus, and mild abdominal cramping. Later symptoms may become more moderate to severe causing severe belly cramping, blood, mucus, or pus in stool, fatigue, sudden weight loss, nausea, or fever. Inflammation can spread throughout the body causing other symptoms outside of the gastrointestinal tract like joint pain or swelling, red, burning eyes, or a painful rash.

Risk Factors

Risk factors are being between the ages of 15 and 30 or over the age of 60, being white, or having a family member who has ulcerative colitis. People who have ulcerative colitis also have a different gut microbiome than other people. The exact cause of ulcerative colitis is unknown. There seems to be a relation between having a family member with the condition and also having an overactive immune system response. When your immune system goes to fight off an invading virus or bacteria it may also attack your digestive tract.

Complications

Ulcerative colitis is usually not life-threatening. Severe symptoms, or not getting treatment can lead to some complications of the condition. Complications include severe dehydration, anemia, osteoporosis, inflammation, higher risk of colon cancer, toxic megacolon, high risk of blood clots, or delayed growth and development in children.

Diagnosis & Treatment

You should see a doctor if you have any of the symptoms of ulcerative colitis as well as if you experience belly pain, blood in your stool, ongoing diarrhea, diarrhea that awakens you in the evening, or unexplained fevers that last more than two days.

When first seeing your doctor they will want to do a physical exam of you. They will also want to know all your symptoms, as well as family history of inflammatory bowel diseases. Your doctor will then likely want to run some tests. Your doctor can run blood tests to check for infection or other causes of your symptoms. Stool samples can also help identify ulcerative colitis. Imaging tests such as an X-ray, CT scan, or MRI can show inflammation in the colon. Endoscopic tests may also be done to look at your colon or be able to take samples of your lining. These tests could be either a colonoscopy or a sigmoidoscopy.

Since ulcerative colitis is a chronic condition there is no cure. The goal of treatment is to put you into remission. There are two ways that you can be treated for ulcerative colitis, medication or surgery.

Medications are usually where your doctor will start you with, and surgery is done if other forms of treatment are not working. Medications can include anti-inflammatory medications, or corticosteroids. Immunomodulators help suppress the immune system response to start the inflammation process, these can be used in trying to calm the immune system. Examples of immunomodulators are Azathioprine, mercaptopurine, or cyclosporine. Biologics are used for moderate to severe ulcerative colitis. These biologics help calm parts of the immune response. Examples are Humira or Stelara.

Surgery is done if medications are working. About 30% of people with ulcerative colitis will need surgery at some point with having the disease. One of the surgical treatments is a proctocolectomy and ileal pouch. This is when a surgeon removes your colon and rectum, using a portion of your small intestines and a pouch to connect to your anus where you will then have bowel movements like normal. Another surgical option is an proctocolectomy with ileostomy, this is the removal of the colon, rectum, and anus. Your doctor will connect a pouch outside of your belly to collect your stools that you will empty regularly.

Prevention

There is no way to prevent yourself from having ulcerative colitis. You can learn to manage stress which will help with flare ups. Avoiding NSAIDs like ibuprofen or Motrin can also help stop flare ups from occurring. If you need over the counter pain relief or fever reducer switch to Tylenol. Avoid food triggers like dairy or high fiber foods. Food triggers can vary from person to person with ulcerative colitis. Finding what your triggers are will help you be able to manage your condition better.