An Overview of Ulcerative Colitis

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Ulcerative colitis is a form of inflammatory bowel disease (IBD), a chronic disease for which there is currently no known cure. The primary sign of ulcerative colitis is inflammation of the colon and rectum, which causes a variety of symptoms in the gastrointestinal tract, including pain and bloody stool. Lifestyle modifications may help, as can medications such as anti-inflammatories and antidiarrheals.

The disease can sometimes result in complications that affect other parts of the body, including the joints, skin, and eyes.

Types and Symptoms

There are several different types of ulcerative colitis and symptoms can overlap. Knowing which form you have will allow your doctor to provide the most suitable and effective treatments.

  • Ulcerative proctitis: Ulcerative proctitis is defined by inflammation that is located in the rectum, most commonly the last six inches or less. For about 30 percent of patients, their ulcerative colitis starts in this form. Symptoms include diarrhea, bloody stool, rectal pain, and an urgent need to move the bowels (tenesmus). With the inflammation limited to a smaller area than in the other forms of ulcerative colitis, ulcerative proctitis is considered a less severe type of the disease and usually has fewer complications.
  • Proctosigmoiditis: When inflammation is located in the rectum and sigmoid colon (the last section of the colon), it is known as proctosigmoiditis. Symptoms include diarrhea, bloody diarrhea, crampy pain, urgency, and pain on the left side of the abdomen.
  • Left-sided colitis: Also known as limited or distal colitis, left-sided colitis is when inflammation is on the left side of the colon (the rectum, sigmoid colon, and descending colon). Symptoms include diarrhea, bloody stools, weight loss, loss of appetite, and occasionally severe left-sided pain.
  • Pancolitis: Pancolitis is when there is inflammation throughout the whole colon. Symptoms include diarrhea, cramps, significant weight loss, and severe abdominal pain. Moderate to severe cases of this type of ulcerative colitis may require treatment in the hospital at times.

    Flares and Remission

    Ulcerative colitis symptoms come and go. When symptoms are active, it is called a flare-up. A flare-up can be severe for a few days or weeks and then go into remission, where there are few or no symptoms or little inflammation in the colon. Some people with ulcerative colitis will not experience remission but instead will have continuous, active disease. 

    For most people, symptoms continue to flare up on and off throughout their lives. (Approximately 10 percent of people never have another flare-up after their first one, however, potentially because the diagnosis of ulcerative colitis was incorrect.)

    Sometimes during a severe flare-up, your large intestine swells up and may develop a small perforation. A perforation lets stool leak into your abdomen, which can cause a life-threatening infection (peritonitis).

    Progression

    If you've had ulcerative colitis for a long time, you may experience symptoms in other areas of your body, including rashes, mouth sores, and joint pain.

    Approximately 5 percent of people with ulcerative colitis will eventually develop colon cancer. Your risk increases once you have had symptoms for eight to 10 years. Chronic inflammation of the colon stimulates changes in the cells in the intestinal lining; this cell "turnover" can eventually result in the formation of cancerous cells.

    Other factors, including a family history of cancer, can also raise the risk. Fortunately, most people with ulcerative colitis do not get colon cancer, and when caught early, the disease can be treated successfully. 

    Causes

    Ulcerative colitis is an idiopathic disease, meaning there is no known cause. There are, however, several theories about the origins of ulcerative colitis and conditions that may contribute to its development. Recent research suggests that more than 100 genes may be associated with the development of IBD. None of these theories are yet proven, however, and more studies will need to be done before there is a definitive answer.

    In the past, it was widely believed that there was a psychological component to IBD. Older studies that showed that stress and psychological problems played a role in the development of IBD have remained unconfirmed. More recent research has shown that earlier studies may have been flawed because their results cannot be reproduced. There is no direct connection between IBD and mental disorders. Unfortunately, many people still believe the IBD-stress connection.

    Diagnosis

    To help confirm a diagnosis of ulcerative colitis, your doctor will order one of the following tests:

    • Flexible sigmoidoscopy: In this procedure, a thin tube with a light and a camera are used to inspect the lower colon and the rectum. 
    • Colonoscopy with biopsy: The entire colon is examined during a colonoscopy a small amount of tissue is removed for evaluation.

    Your doctor may also consider ordering additional tests, though these alone cannot confirm ulcerative colitis:

    • Blood tests: A complete blood count (CBC) can reveal whether you are anemic or low in certain minerals, both possible side effects of diarrhea. Levels of C-reactive protein (CRP) measure the extent of inflammation in the body.
    • X-rays: These can detect an intestinal blockage or narrowing of the intestine.
    • CT scans: CT scans are used to check for complications, such as abscesses or fistulas.

    Treatment

    Most of the time, ulcerative colitis is treated with various prescription drugs, including immune system suppressors and anti-inflammatories; these medications are often used in combination.

    A certain portion of people with ulcerative colitis do not respond to drug therapy and continue to have symptoms even during treatment. Others may be at a high risk for colon cancer after having the disease for a number of years. In these cases, a type of surgery called ileal pouch-anal anastomosis (IPAA), more commonly known as a "J-pouch," may be done. If it's not a viable option, ileostomy surgery is another surgical option for ulcerative colitis.

    Over-the-counter medications, such as antidiarrheals, enemas, and acetaminophen, may be used to address specific symptoms, but are not able to manage the disease as a whole.

    A Word From Verywell

    If you are diagnosed with ulcerative colitis, you will face challenges—physical and emotional—as a result of the disease. The ups and downs of flare-ups and remission can be stressful, which is why keeping the inflammation under control and dealing with other health concerns as they crop up ​is key to having a good quality of life. See your gastroenterologist on a regular basis to report any new symptoms and to discuss a plan for maintenance therapy—a treatment strategy used even when you feel well to prevent future flare-ups.

    The good news is that there are more ulcerative colitis treatments available now than ever before and more are on the way.

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