Everything You Need to Know If You Have Ulcerative Colitis (UC) (original) (raw)

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD). Symptoms can range from mild to severe. In some cases, you may not have any symptoms. Treatment focuses on managing or reducing symptoms.

UC is most common in people between 15–30 years old, with a small increase in diagnosis between 50–70 years old.

Read on to learn about UC, its symptoms, causes, and treatment.

Colitis refers to inflammation of the inner lining of the colon. It causes symptoms such as abdominal pain, cramping, bloating, blood in the stool, and diarrhea.

An inflamed colon can be caused by several conditions, one of which is ulcerative colitis (UC). This is a type of inflammatory bowel disease (IBD), which is a term referring to a group of diseases affecting the gastrointestinal (GI) tract.

UC develops when the lining of the colon and rectum become inflamed. This creates ulcers on the colon’s lining, starting in the rectum and spreading upward, and can result in frequent bowel movements and discharge of mucus and pus.

Ulcerative colitis vs. Crohn’s disease vs. irritable bowel

IBD shouldn’t be confused with irritable bowel syndrome (IBS), which also affects bowel movement, but this isn’t caused by inflammation of the GI tract.

IBD also includes Crohn’s disease. The symptoms of UC and Crohn’s can overlap, but UC specifically affects the colon, whereas Crohn’s can cause inflammation anywhere in the GI tract.

The seriousness of UC symptoms varies among people who have the condition. 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 become severe. This is called a flare-up.

Common symptoms of UC include:

• abdominal pain
• increased abdominal sounds
• bloody stools
• diarrhea
• fever
• rectal pain
• weight loss
• malnutrition

UC may cause additional symptoms, such as:

• joint pain
• joint swelling
• nausea and decreased appetite
• skin problems
• mouth sores
• eye inflammation

Researchers believe that UC may be the result of an overactive immune system. However, it’s unclear why some immune systems respond by attacking the large intestines and others don’t.

Most people with UC don’t have a family history of the condition. However, about 8–14% of people with UC do have a family member with IBD.

UC can develop in a person of any race, but it’s more common in white people. If you’re of Ashkenazi Jewish descent, you have a greater chance of developing the condition than most other groups.

Other than your genes, factors that may play a role in who develops UC include other immune disorders you have and environmental factors like bacteria, viruses, or antigens that can trigger your immune system.

Oral contraceptives have been found to be associated with an increased risk of IBS.

UC can be categorized according to the parts of the GI tract that it affects.

• Ulcerative proctitis: In ulcerative proctitis, only the rectum is inflamed.
• Left-sided colitis: Left-sided colitis causes inflammation in the area between the splenic flexure (near the upper part of the colon, where it bends) and the last section of the colon. The last section of the colon, known as the distal colon, includes the descending colon and sigmoid colon. Left-sided colitis is also known as distal ulcerative colitis.
  • Proctosigmoiditis: Proctosigmoiditis is a form of left-sided colitis. It causes inflammation in the rectum and sigmoid colon.
• Extensive colitis: Extensive colitis, also known as pancolitis, causes inflammation past the left side of the colon, although it can include the entire colon. It’s considered a severe form of UC.

Different tests can help a doctor diagnose UC. It mimics other bowel diseases, such as Crohn’s disease. A doctor will order multiple tests to rule out other conditions.

Tests to diagnose UC often include:

• Blood tests: Blood tests are often useful in the diagnosis of UC. A complete blood count looks for signs of anemia (a low red blood cell count). Other tests indicate inflammation, such as a high C-reactive protein level and a high sedimentation rate. A doctor may also order specialized antibody tests.
• Stool test: A doctor examines your stool for certain inflammatory markers, bacteria, and parasites.
• CT scan: This is a specialized X-ray of your abdomen and pelvis.
• Endoscopy: A doctor uses a flexible tube to examine your stomach, esophagus, and small intestine to determine whether it’s ulcerative colitis or Crohn’s.
• Biopsy: A surgeon removes a tissue sample from your colon for analysis.
• Flexible sigmoidoscopy: Flexible sigmoidoscopy is a type of endoscopy. During this test, a doctor inserts a long, flexible tube into your rectum so that they can examine it, the sigmoid colon, and part of the descending colon. Flexible sigmoidoscopy is also known as sigmoidoscopy.
• Colonoscopy: During a colonoscopy, a doctor inserts a lighted scope called a colonoscope into your rectum to examine the inside of your colon.

If you’ve been diagnosed with UC, see a doctor if you experience symptoms such as:

• severe abdominal pain or cramping
• severe rectal bleeding
• chronic diarrhea that’s difficult to treat
• high fever
• swelling of areas such as the skin or joints
• dehydration

These symptoms are sometimes associated with UC complications.

If you haven’t been diagnosed with UC, see a doctor if you experience multiple symptoms of the condition. They can help determine whether you may have UC or another bowel disease.

UC is a chronic condition. The goal of treatment is to reduce the inflammation that causes your symptoms to prevent flare-ups and have longer periods of remission.

Medication

Which medication you’ll take will depend on your specific situation, including how severe your symptoms are.

For mild symptoms, your doctor may prescribe a medication to reduce inflammation and swelling. This will help alleviate many symptoms.

These types of medications include 5-aminosalicylates (5-ASA drugs) such as:

• mesalamine (Asacol HD, Lialda)
• sulfasalazine (Azulfidine)
• balsalazide (Colazal)
• olsalazine (Dipentum)

Some people may need corticosteroids to help reduce inflammation, but these can have adverse effects, so doctors try to limit their use. If an infection is present, you may need antibiotics.

If you have moderate to severe symptoms, a doctor may prescribe a type of medication known as a biologic. Biologics are made from antibodies, and help block inflammation. Taking these can help prevent a symptom flare-up.

Effective options for most people include:

• adalimumab (Humira)
• golimumab (Simponi)
• infliximab (Remicade)
• ustekinumab (Stelara)
• vedolizumab (Entyvio)

A doctor may also prescribe an immunomodulator. These change the way the immune system works. Examples include 5-ASA drugs.

In 2018, the Food and Drug Administration (FDA) approved the use of tofacitinib (Xeljanz) as a treatment for UC. Initially used to treat rheumatoid arthritis, this medication targets cells responsible for inflammation. It’s the first oral medication approved for the long-term treatment of UC.

Hospitalization

If your symptoms are severe, you’ll need to be hospitalized to correct the effects of dehydration and loss of electrolytes that diarrhea causes. You may also need to replace blood and treat any other complications.

Researchers continue to look for new treatments each year.

Ulcerative colitis surgery

Surgery is necessary if you experience:

• substantial blood loss
• chronic and debilitating symptoms
• perforation of your colon
• a severe blockage

A CT scan or colonoscopy can detect these serious problems. Surgery is also recommended for severe infections or in patients who do not respond to medical therapy or have a high risk of cancer.

Surgery typically involves removing your entire colon and rectum as well as creating a new pathway for waste. This pathway can be through a small opening in your abdominal wall.

To redirect waste through your abdominal wall, the surgeon will make a small opening in the wall. The tip of your lower small intestine, or the ileum, is then brought to the skin’s surface. Waste will drain through the opening into a bag. This is called an ostomy bag.

In other types of surgery, the surgeon removes the diseased part of your colon and rectum but retains the outer muscles of your rectum. The surgeon then attaches your small intestine to the rectum to form a small pouch. After this surgery, you’re able to pass stool through your rectum. Bowel movements will be more frequent and watery than normal.

In certain procedures, the anus is also removed.

Some of the medications prescribed to treat UC can have serious side effects. When traditional treatments are not well tolerated, some people turn to natural remedies to manage UC.

Natural remedies that may help relieve UC symptoms include:

• Boswellia: This herb is found in the resin underneath Boswellia serrata tree bark. Research suggests it stops some of the chemical reactions in the body that can cause inflammation.
• Bromelain: This enzyme mixture is found naturally in pineapples, but it’s also sold as a supplement. It may help ease symptoms of UC and reduce flares.
• Probiotics: Your intestines and stomach are home to billions of bacteria. When the bacteria are healthy, your body can better ward off inflammation and symptoms of UC. Eating foods with probiotics or taking probiotic supplements can help boost the health of the microbial flora in your gut.
• Psyllium: This fiber supplement can help keep bowel movements regular. This may alleviate symptoms, prevent constipation, and make eliminating waste easier. However, many people with IBD can experience worsening abdominal cramping, gas, and bloating when they consume fiber during a flare-up.
• Turmeric: This golden yellow spice is chock-full of curcumin, an antioxidant that’s been shown to reduce inflammation.

Keep in mind that these natural remedies have not undergone clinical trials and are not necessarily endorsed by professional organizations or their clinical guidelines.

Many of these natural remedies can be used in conjunction with other UC treatments.

UC increases your risk of developing colon cancer. The longer you have the disease, the higher your risk of this cancer.

Because of this increased risk, your doctor will perform a colonoscopy and check for cancer 8 years after you receive your diagnosis.

Repeat screenings every 1–3 years are recommended thereafter, according to the American Cancer Society. Regular screenings help lower your risk of colon cancer. Follow-up screenings can detect precancerous cells early.

People living with left-sided UC or pancolitis may need to be screened every 1–2 years.

Other complications of UC include:

• thickening of the intestinal wall
• intestinal bleeding
• sepsis, or blood infection
• severe dehydration
• toxic megacolon, or a rapidly swelling colon
• rupture of your colon
• inflammation of your skin, joints, and eyes
• kidney stones

Complications of UC are worse if the condition isn’t properly treated.

Is ulcerative colitis very serious?

If you have UC, a doctor will need to monitor your condition, and you’ll need to carefully follow your treatment plan throughout your life.

The only true cure for UC is the removal of the entire colon and rectum. Your doctor will usually begin with medical therapy unless you have a severe complication that requires surgery. Some people will eventually require surgery.

That said, UC is usually not a life threatening condition, and most people with it can live typical life spans. Serious complications such as a toxic megacolon or colon cancer are less common but can occur.

What foods can trigger ulcerative colitis?

There’s no solid evidence indicating that your diet affects whether you develop UC. That said, you may find that certain foods and drinks aggravate your symptoms when you have a flare-up, though.

A few general rules may be useful for people trying to avoid a flare-up:

• Eat a low fat diet: It’s not clear why a low fat diet is beneficial, but it’s known that foods high in fat commonly cause diarrhea, especially in people with IBD. Eating more low fat foods may delay flare-ups. When you do eat fat, pick healthier options like olive oil and omega-3 fatty acids.
• Eat more fiber: During a flare-up, bulky, slow-moving fiber is the last thing you want in your intestines. During remission, however, fiber can help you stay regular. It may also improve how easily you can eliminate waste products during bowel movements.

Is ulcerative colitis contagious?

UC is not contagious. Some causes of colitis or inflammation in the colon can be contagious, though. That includes inflammation caused by bacteria and viruses.

However, UC is not caused by anything that can be transmitted to another person.

How does ulcerative colitis affect children?

According to one study of IBD in the United States, 1 in 1,299 children 2–17 years old were affected by the condition in 2016. Crohn’s disease was twice as common as UC, and boys were more likely to have IBD than girls.

Like adults, children with UC may experience bloody diarrhea, abdominal pain and cramping, and fatigue.

They may also experience issues compounded by the condition, such as anemia, malnutrition, and weight loss.

Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) that causes inflammation in the lining of the colon and rectum.

Common symptoms associated with UC include frequent bowel movements, as well as mucus and pus discharge with varying levels of severity. With proper treatment, most people manage the condition and live normal lives.