Ulcerative Colitis

1 What is Ulcerative Colitis?

Ulcerative colitis is a type of inflammatory bowel disease (IBD) characterized by chronic inflammation and ulcers (sores) in your large intestine (colon) and rectum.

Symptoms develop gradually and worsen over time. Ulcerative colitis is a debilitating condition that can result in life-threatening complications.

There's no cure for ulcerative colitis but treatment provides symptomatic relief, aiming to make day-to-day life easier for those who suffer from it.

Ulcerative colitis is common and there is a risk of developing long-term effects, even after symptoms have been properly managed. It is essential to learn as much as you can about ulcerative colitis treatment to ensure you are always doing the right thing for your body.

Ulcerative colitis (UC) affects millions of people around the world, especially in the United States. The Crohn’s and Colitis Foundation of America has found that the people who are suffering from the disease have moderate to critical status. Nearly 2% of these people have severe health problems at any given time, and about 20% have a moderate health problem.

Ulcerative colitis is highly unpredictable. Symptoms can flare up at any time, or they can completely disappear, leading the patient to think that perhaps his or her condition has been resolved. The symptoms are not easily detectable and it makes it difficult to diagnosis the disease at early stages. The symptoms vary from person to person, and the severity of the symptoms varies as well. Some people may be able to carry out their daily activities, while some others may be confined to the bathroom.

For someone suffering from ulcerative colitis, it is best to constantly keep track of symptoms, especially noting what aggravates or relieves them. This includes foods, activities, internal and external stressors, and sleeping habits. The most productive treatment for ulcerative colitis entirely depends on thorough knowledge of your own symptoms.

2 Symptoms

Symptoms of ulcerative colitis depend on the area of occurrence and the severity of inflammation.

Signs and symptoms usually include:

  • Loose stool accompanied by abdominal cramp and blood or pus
  • Rectal pain
  • Bleeding from rectum during defecation
  • Defecation urgency
  • Inability to defecate in spite of urgency
  • Weight loss
  • Extreme tiredness
  • Fever
  • Failure to grow (in children)

The symptoms of ulcerative colitis range from mild to moderate. People may experience flare ups of symptoms or no symptoms at all.

Ulcerative colitis is classified based on how much of your colon is affected. The condition can be mild and limited to the rectum (ulcerative proctitis). Or, it can affect additional parts of your colon, generally with more severe symptoms.

People who develop ulcerative colitis at a younger age are more likely to have severe symptoms. 

When should you see a doctor?

Make an appointment with your doctor if you experience a constant change in your bowel habits or if you experience the following signs and symptoms:

  • Abdominal pain
  • Bloody stool
  • Diarrhea unresponsive to over-the-counter medications
  • Diarrhea that awakens you from sleep
  • Fever without any cause that lasts more than a day or two

Ulcerative colitis usually isn’t fatal, but in some cases it can lead to life-threatening complications if the condition is not addressed.

3 Causes of ulcerative colitis

The specific root causes of ulcerative colitis have not yet been fully discovered. Diet and stress were believed to cause ulcerative colitis, but now these factors are believed to exacerbate ulcerative colitis.

Ulcerative colitis is thought to be due to an impaired immune system. In this case, the immune system, while trying to destroy virus or bacteria, attacks the normal cells of digestive tract, resulting in ulcerative colitis.

It is more common in people who have family history of ulcerative colitis. However, people who don’t have family history of ulcerative colitis may still suffer from the disease.

4 Making a diagnosis

Making a diagnosis of ulcerative colitis is done by performing several tests.

You may be referred to a gastroenterologist (doctor who treats disorder of digestive tract) by your general practitioner.

How to prepare yourself for the visit

Getting prepared for the visit can optimize treatment and help make the visit more beneficial, for both yourself and your doctor. Make a note of all of your symptoms, even those that you may not think are connected to your condition. Recall your complete medical history. Write down the names of all your medications, vitamins, or supplements.

Ask a friend or a family member to accompany you during the visit. Make a list of questions to ask your doctor.

Some typical questions can be:

  • What could be the most probable cause of my symptoms?
  • What tests are needed?
  • Do I need to prepare for these tests?
  • How long will my condition last?
  • What are the treatment options and side effects of each option?
  • Do I need to avoid any prescription or over-the-counter medications?
  • What sort of follow-up care do I need?
  • Will I need routine colonoscopies or another routine procedures from now on?
  • What foods do I need to avoid?
  • Can I continue my daily activities as usual?

What might your doctor want to know?

Prepare yourself to answer some essential questions from your doctor. If you do not understand something your doctor asks, make sure he or she clarifies properly.

Your doctor might ask you questions like:

  • When did the symptoms start appearing and how severe are they?
  • Do these symptoms occur continuously or they come and go?
  • Do you experience pain in your abdomen? When?
  • How often do you have diarrhea, if at all?
  • Have you noticed any change in your weight?
  • Does any factor improve or aggravate your symptoms?
  • Do you have liver problems, hepatitis, or symptoms of jaundice?
  • Do you have problems with your joints, eyes, skin rashes or sores, or have sores in your mouth?
  • Does diarrhea disturb your sleep?
  • Where have you traveled recently?
  • Is anyone else in your home suffering from diarrhea?
  • Have you recently been on antibiotic therapy?
  • How often do you take nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen?

Diagnosis of ulcerative colitis is done after other probable causes for your symptoms have been eliminated.

The following tests may be performed for diagnosis of ulcerative colitis:

  • Blood tests: Blood tests are performed to determine whether you have anemia (decreased hemoglobin count) or other signs of infection.
  • Stool sample: Presence of white blood cells in your stool confirms ulcerative colitis. Stool samples can be tested to detect other disorders, such as a bacterial or viral infection.
  • Colonoscopy: A thin, flexible, lighted tube attached with a camera is used to examine your colon. During a colonoscopy, your doctor may remove a sample of tissue (biopsy) for laboratory analysis.
  • Flexible sigmoidoscopy: A thin, flexible, lighted tube is used to view the last portion of your colon. This test is opted if your colon is severely inflamed.
  • X-ray: X-ray is performed if your symptoms are severe. It helps to rule out other complications, such as a perforated colon.
  • CT scan: A CT scan of abdomen or pelvis reveals the severity of inflammation in your colon.
  • Computed tomography (CT) enterography and magnetic resonance (MR) enterography: These are noninvasive and more sensitive compared to conventional imaging tests. MR Enterography offers a radiation-free diagnostic option.
  • Chromoendoscopy: This test is employed for colorectal cancer screening. Colorectal cancer is the most serious complication of ulcerative colitis. In Chromoendoscopy, the abnormal tissues are visualized by using a dye.

5 Treatment

The treatment option depends on the severity of your condition. While some drugs prove to be effective in some people, they may not show the same results for others.

Anti-inflammatory drugs

This is typically the first choice for treatment of inflammatory bowel disease.

These drugs include:

  • Aminosalicylates: Sulfasalazine can provide relief from symptoms of ulcerative colitis, but it can cause a number of side effects, such as digestive distress and headache. Mesalamine, balsalazide, and olsalazine are found in both oral and enema or suppository preparations. The type of preparation that you have to take depends on the region of your affected colon.
  • Corticosteroids: Corticosteroids, such as prednisone and hydrocortisone, are used for moderate to severe forms of ulcerative colitis that are unresponsive to other treatments. They can be given orally, intravenously, or by enema or suppository, which is guided by the area of the affected colon. Side effects include swollen face, excessive facial hair, night sweats, sleeplessness, hyperactivity, hypertension, diabetes, osteoporosis, bone fractures, cataracts, glaucoma, and a higher risk of infection. Note that long-term corticosteroids should not be used for a longer period of time than your doctor recommends.
  • Immune suppressors: Immune suppressing medications can be used in combination with other drugs to reduce inflammation. For instance, a combination of corticosteroids and immune suppressants has proved to be beneficial. Corticosteroids can decrease signs and symptoms whereas immunosuppressants can maintain it. Immunosuppressant drugs are:
    • Azathioprine and mercaptopurine: They are most commonly used to treat inflammatory bowel disease. Side effects include liver and pancreatic problems, increased risk of infection, and developing cancer, such as lymphoma and skin cancers.
    • Cyclosporine: It may be used for a short period when other treatments have failed. Side effects include kidney and liver damage, seizures, and serious infections. There's also a risk of developing cancer, so tell your doctor if you have a personal or family history of cancers.
    • Infliximab, adalimumab and golimumab: These medications, also known as tumor necrosis factor (TNF)-alpha inhibitors, are immune suppressants. They are used to treat moderate to severe ulcerative colitis unresponsive to other treatments. These drugs can increase your risk of tuberculosis and other serious infections, and certain cancers such as lymphoma and skin cancers.
    • Vedolizumab: This medication is opted for people who are unresponsive to other treatments. It inhibits the inflammatory cells to reach the area of infection. It may increase the risk of infection and cancer.

Other medications

Other medication may be needed to control symptoms of ulcerative colitis.

The following drugs may be prescribed:

  • Antibiotics: Antibiotics are given to prevent or control infection if people suffering from ulcerative colitis have a fever.
  • Anti-diarrheal medications: Loperamide is given for severe diarrhea. Anti-diarrheal drugs should be used cautiously as they are likely to cause toxic megacolon.
  • Pain relievers: Your doctor may suggest acetaminophen if you have mild pain. Ibuprofen, naproxen, and diclofenac can exacerbate the symptoms and your condition.
  • Iron supplements: If you have persistent intestinal bleeding, you are likely to develop anemia and your doctor may recommend iron supplements.
  • Surgery: A surgical procedure involves removal of your entire colon and rectum (proctocolectomy). In ileoanal anastomosis, the end of the small intestine (ileum) is attached to the anus that permits the normal excretion of wastes. After this procedure, there is no need to wear a bag to collect stool. But in some cases a bag may be attached to a permanent opening in your abdomen (ileal stoma) for collecting feces.
  • Cancer surveillance: Ulcerative colitis increases your risk of colon cancer. Therefore, you will be frequently examined to look for signs of cancer. The schedule for checkups depends on the duration of your disease as well as the region affected by ulcerative colitis. If your disease affects parts beyond the rectum, colonoscopy surveillance is performed every year or two. If ulcerative colitis involves most of the colon, your first surveillance colonoscopy will be performed after eight years of diagnosis whereas it will performed after 10 years if only the left side of your colon is affected. If you suffer from ulcerative colitis and primary sclerosing cholangitis, a surveillance colonoscopy will be performed every one to two years after being diagnosed with ulcerative colitis.

6 Alternative and homeopathic remedies

Commonly used complementary and alternative (CAM) remedies for ulcerative colitis are:

  • Herbal and nutritional supplements: Most of these supplements aren't regulated by the FDA. Make sure you speak with your doctor before starting any herbal or nutritional supplements.
  • Probiotics: Probiotics (beneficial bacteria normally found in the digestive tract) may be helpful in ulcerative colitis, as they are typically helpful in creating a healthy environment within your digestive tract. However, there is no evidence that probiotics along with other medications are effective.
  • Fish oil: Fish oil has an anti-inflammatory property. But adding fish oil to aminosalicylates has not proved to be beneficial. Also, fish oil can cause diarrhea.
  • Aloe vera: Aloe vera gel that possesses anti-inflammatory effects can be given to people with ulcerative colitis, but it is associated with diarrhea.
  • Acupuncture: More studies are required to establish beneficial role of acupuncture in ulcerative colitis.
  • Turmeric: Curcumin, a compound found in turmeric, may be useful as an anti-inflammatory agent, but more research is required to establish it as standard treatment option.

Before you begin any homeopathic remedies for ulcerative colitis, speak with your doctor thoroughly to determine whether or not it is right for you. Like each treatment your doctor administers, alternative remedies for ulcerative colitis may provide undesired side effects and complications.

7 Lifestyle and coping

Managing your diet and lifestyle can control your symptoms and reduce remission of ulcerative colitis. Learn to recognize the foods that worsen your symptoms so you can be sure to avoid them completely.

The following tips may be helpful:

  • Keep a food journal to record your side effects to certain foods.
  • Avoid dairy products as they can be highly disruptive to your digestive system.
  • Avoid using high-fat foods such as butter, margarine, cream sauces, and fried foods.
  • Limit high-fiber foods such as fresh fruits, vegetables, and whole grains. Steaming, baking, or stewing raw fruits and vegetables will make them easier to digest. Broccoli and cauliflower, nuts, seeds, corn, and popcorn might be problematic foods as well. If your bowel has narrowed (stricture) you may be advised to start a low fiber diet.
  • Spicy foods, alcohol, and caffeine may exacerbate your signs and symptoms.
  • You may also practice other dietary measures, such as:
    • Eating multiple small meals instead of large meals.
    • Drinking plenty of water daily. Avoid alcohol, carbonated, and caffeinated beverages.
    • Taking multivitamin pills if required. Ask your doctor if it's okay to take vitamins and mineral supplements.

To help yourself cope:

  • Manage stress accordingly. Make an effort each day to relax.
  • Exercise. Discuss with your doctor about an appropriate exercise plan, being sure to focus on avoiding overexertion. 
  • It might be helpful to try various relaxation and breathing exercises. Meditation and yoga might also be useful.

8 Risks and complications

There are several risks and complications associated with ulcerative colitis, some which may be life-threatening.

Risks

  • Age: Normally, ulcerative colitis develops before the age of 30. But it can develop at any age, even after the age of 60.
  • Race or ethnicity: White people are at an increased risk of the disease, although it can affect any race. If you're of Ashkenazi Jewish descent, your chances of developing this disease increase.
  • Family history: Your risk of ulcerative colitis increases if anyone from your family has the disease.
  • Isotretinoin use: Isotretinoin, used for treating scarring cystic acne or acne, is considered to be a risk factor for IBD. However, no link has been officially established.

Complications

  • Excessive bleeding
  • Rupture in the colon
  • Severe dehydration
  • Rarely, liver disease
  • Osteoporosis (weak bones)
  • Inflammation of your skin, joints, and eyes
  • Sores in the lining of your mouth
  • Increased risk of colon cancer
  • Toxic megacolon (rapid inflammation of colon)
  • Increased risk of blood clots in veins and arteries

9 Discussion with a patient suffering from ulcerative colitis

Here is a sample interview of someone suffering from ulcerative colitis. In this case, the patient has been suffering for several years.

Reading this may help you better understand what to expect when speaking with your doctor or when starting treatment.

Question: When was the disease diagnosed?
Answer: The disease was diagnosed about seven years ago.

Q: How did you face the situation and manage the symptoms?
A: In the first round of treatment, where I was given suppositories, there was a lot of pain, but I knew I had to undergo this treatment. During the next few times, I was treated with rounds of prednisone and mesalamine (Asacol). The treatment was uncomfortable and still very painful. I had trouble moving around, but eventually I felt better. Currently I am being treated with both azathioprine and escitalopram (Lexapro), and I feel the treatment is working well. Generally, I feel better and happy.

Q: What are the other treatments you have taken so far?
A: I have started a series of homeopathic treatments under the observation of an expert in homeopathy. The treatment includes a diet that is gluten-free and starch-free. It has a minor effect on the disease, and though the disease remains a critical condition, there is less pain. I also started yoga and meditation, which helps me to be positive during these critical stages, and also it helps me to overcome pain and discomfort. In general, shifting to a positive way of living has helped me to overcome the initial fear about the disease. Exercising regularly helps in fighting against this autoimmune disease and also helps improve my digestive system. Through my experience, I learned that if I don’t keep my body in control and my metabolism higher, which keeps my heart rate up and active, my condition becomes more difficult to handle.

Q: What advice do you have for those suffering from ulcerative colitis?
A: Don’t feel embarrassed about your symptoms, and don’t get stressed about them. If you hide your symptoms and try to act as if you are not having any health issue, then it could lead to a serious problem later in life. Trying to hide symptoms from friends and family will cause more confusion, anxiety, and pain to you. Never lose hope and always be positive about life. You have to be patient when it comes to treatment, but always believe in yourself and trust the people around you, especially your doctors.

Q: Would you suggest any particular food, medication, or lifestyle?
A: The only lifestyle I can suggest is to be positive. Never let yourself down. The moment you let yourself down, you are out. Always maintain a healthy diet that gives you more strength and is easy to digest. Never have fried food and stay away from excess dairy. To stay calm and positive, do light physical exercises of your choice. Trust that your treatments have been chosen because your doctor believes they will help, and also be patient and honest if they do not work as intended. Some treatments are effective only when you do them for a longer amount of time.

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