Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that causes inflammation in the lining of the rectum and colon. Ulcers form where inflammation has injured the cells that usually line the colon, which then may bleed and create pus. This inflammation also causes the colon to empty frequently, producing diarrhea. Ulcerative colitis can be debilitating and sometimes lead to life-threatening complications.
Ulcerative colitis can be difficult to diagnose because symptoms such as abdominal pain and diarrhea are often seen in other intestinal disorders. About half the people diagnosed with ulcerative colitis have mild symptoms. Others may suffer frequent fever, bloody diarrhea, nausea and severe abdominal cramps. It may also cause problems such as arthritis, inflammation of the eye, liver disease and osteoporosis. It is not known why these problems occur outside the colon, but scientists think it may be the result of inflammation triggered by the immune system. Some of these problems go away when the ulcerative colitis is treated.
Symptoms of UC can also vary depending on the severity of inflammation and where it occurs. Doctors classify ulcerative colitis according to its location.
Classifications of Ulcerative Colitis and Their Symptoms
- Ulcerative proctitis: Inflammation is confined to the area closest to the anus (rectum). For some people rectal bleeding may be the only sign of the disease. Others may have rectal pain and a feeling of urgency (tenesmus). This form tends to be the mildest.
- Proctosigmoiditis: Involves the rectum and the lower end of the colon, known as the sigmoid colon. Bloody diarrhea, abdominal cramps and pain.
- Left-sided colitis: Inflammation extends from the rectum up through the sigmoid and descending colon, which are located in the upper left part of the abdomen. Bloody diarrhea, abdominal cramping and pain on the left side and unintentional weight loss.
- Pancolitis: Affects more than the left colon and often the entire colon. Bloody diarrhea that may be severe, abdominal cramps and pain, fatigue and significant weight loss
- Fulminant colitis: A rare, life-threatening form of colitis affects the entire colon and causes severe pain, profuse diarrhea and, sometimes, dehydration and shock. People with this condition are a risk of serious complications, including colon rupture and toxic megacolon, a condition that causes the colon to rapidly expand.
Causes of Ulcerative Colitis
The cause of ulcerative colitis is unknown. Researchers believed that stress was a possible cause, but they no longer believe that this is a viable explanation. However, stress can aggravate symptoms. There are now two possibilities for the cause of ulcerative colitis.
- Immune system: some scientists believe that a virus or bacterium may trigger ulcerative colitis. The digestive tract becomes inflamed when the immune system tries to fight off the invading pathogen. It is also possible that inflammation may stem from an autoimmune reaction.
- Hereditary: you’re more likely to develop ulcerative colitis if you have a parent or sibling with this disease. However, most people who have ulcerative colitis do not have a family history of ulcerative colitis.
Risk Factors of Ulcerative Colitis
- Age: While this disease can occur at any age, ulcerative colitis usually begins before the age of 30.
- Race or ethnicity: Although whites have the highest risk of the disease, it can occur in any race.
- Family history: You’re at a higher risk if you have a close relative, such as a parent, sibling or child with the disease.
- Isotretinoin use: Isotretinoin, formerly sold under the brand name Accutane, is a medication sometimes used to treat scarring cystic acne or acne that does not respond to other treatments. While there have been some connections between isotretinoin and ulcerative colitis, the reports are conflicting as to whether isotretinoin actually causes ulcerative colitis.
Complications of Ulcerative Colitis
- Severe bleeding
- Severe dehydration
- Liver disease (rare)
- Inflammation of your skin, joints and eyes
- An increased risk of colon cancer
- A rapidly swelling colon (toxic megacolon)
Tests to Diagnose Ulcerative Colitis
- Blood tests
- Flexible sigmoidoscopy
- Barium enema
- CT scan
Treatments for Ulcerative Colitis
There is no known cure for UC, but therapies are available that may dramatically reduce the signs and symptoms of UC and even bring about a long-term remission. This is either achieved through medications or surgery.
- Sulfasalazine (Azulfidine)
- Mesalamine (Asacol, Lialda)
- Balsalazide (Colazal)
- Olsalazine (Dipentum)
Immune System Suppressors
- Azathioprine (Azasan, Imuran)
- Mercaptopurine (Purinethol)
- Cyclosporine (Gengraf, Neoral, Sandimmune)
- Infliximab (Remicade)
- Adalimumab (Humira)
- Pain relievers
If diet and lifestyle changes, medications or other treatments do not relieve your symptoms, your doctor may recommend surgery. Surgery can often eliminate ulcerative colitis, but that usually means removing your entire colon and rectum.
Lifestyle Changes to Treat Ulcerative Colitis
You can make dietary and lifestyle changes to help alleviate symptoms and lengthen time between flare-ups.
While there is no evidence that says certain foods cause ulcerative colitis, there are certain foods that can aggravate your symptoms. Limiting dairy products and avoiding problem foods may help improve your symptoms. Problems foods can vary for each person, but you should also avoid “gassy” foods such as beans, cabbage and broccoli, raw fruits and fruits, popcorn, caffeine and carbonated beverages. Experiment with fiber. For some, adding more high-fiber foods can help with bowel issues; however, if you have an inflammatory bowel disease fiber may worsen your symptoms. Try eating five or six meals instead of two or three large ones and drink plenty of fluids, preferably water.
Avoiding stress is also a good way to alleviate your symptoms. Stress can aggravate your symptoms, so learning to better manage stress can help. Exercise, biofeedback, regular relaxation and breathing exercises are all ways you can manage stress.