Ulcerative colitis is a type of inflammatory bowel disease. It causes ulcers and inflammation in the digestive tract. While there is no known cure for this disease, some treatment protocols can reduce symptoms and bring the patient into long-term remission. There are an estimated one million cases in the United States. Ulcerative colitis develops slowly. It is classified as an autoimmune disorder. The inflammation and ulcers appear in the innermost lining of the colon. Ulcerative colitis traditionally begins in the rectum before expanding into other areas of the large intestine. Symptoms vary from patient to patient depending on the location within the colon and the severity of the inflammation and ulcers.
Ulcerative colitis is classified by its location in the colon. Some types affect smaller regions and show minimal symptoms, while other types involve larger areas of the colon and can be extremely debilitating.
There are five types of ulcerative colitis:
With ulcerative proctitis, the inflammation and ulcers are limited to the part of the colon closest to the rectum. Patients suffering from this type of ulcerative colitis may only suffer from rectal bleeding and pain in the rectum.
Patients who suffer from proctosigmoiditis have inflammation and ulceration in the lower end of the colon. The rectum and sigmoid colon are the only areas affected. Those patients diagnosed with proctosigmoiditis present with abdominal pains, cramping, and bloody diarrhea. Proctosigmoiditis patients might also suffer from a condition known as tenesmus, where the patient will feel a strong urge to have a bowel movement but will be unable to defecate.
Patients who have left-sided colitis will experience inflammation and ulceration spanning the rectum, sigmoid colon, and descending colon. Keft0sided colitis presents with bloody diarrhea, severe abdominal pain, and cramping on the left side of the abdomen, as well as feeling an urgency to have a bowel movement.
Pancolitis is the most serious form of ulcerative colitis as it can affect the entire colon. Severe abdominal pain and cramping with bloody diarrhea are the most common symptoms. Patients with pancolitis will also commonly experience fatigue and significant weight loss.
Fulminant colitis is extremely rare. Those who suffer from this form of ulcerative colitis can experience extreme dehydration, severe abdominal pain and cramping, and extended bouts of bloody diarrhea. Occasionally, these symptoms become so severe that the patient will go into shock. Patients with fulminant colitis are at a higher risk for developing a perforated colon or a condition known as toxic megacolon, where there is rapid swelling of the colon. When a fulminant colitis patient is in a flare, they require hospitalization so that they can be treated with high dosages of intravenous antibiotics. If the patient does not respond to the antibiotics, a surgical intervention involving removing large segments of the colon is necessary to avoid a possible rupture of the colon.
There are seven primary symptoms of ulcerative colitis:
Ulcerative colitis was long believed to be caused by stress and diet. The exact cause is still unknown. Years of research show that while not the cause of ulcerative colitis, stress, and diet are exacerbating factors of the disease. This disease is now considered to be a malfunction of the body's immune system. Heredity can also be a factor even though only one in every four patients has the disease in their family history. Environmental factors also play a role as most ulcerative colitis patients are found among urban populations residing in countries with more advanced sewage systems.
Patients who are most at-risk for developing ulcerative colitis include those with a close relative who has the disease. Most patients develop the disease before the age of 30. However, the disease can occur at any age, with some patients not experiencing symptoms until they are over the age of 60. While ulcerative colitis affects people of all races, there is a higher risk of developing the disease if you are white.
Patients with ulcerative colitis may experience the following complications related to the disease:
Ulcerative colitis is diagnosed through a combination of tests and images, with a definitive diagnosis coming from either a colonoscopy or sigmoidoscopy that allows for biopsy of the affected tissue. Blood tests are used to check for signs of infection and anemia. Stool studies are used to rule out colon cancer and to check for the presence of white blood cells and proteins indicative of ulcerative colitis. Imaging in the form of CT scans, MRI, and plain x-rays is used to check for a perforated colon. The more detailed imagery obtained from CT and MRI scans can show the level of inflammation in the colon. Finally, a colonoscopy or sigmoidoscopy is performed to finalize your diagnosis.
No two ulcerative colitis cases are the same, so no two patients will have the same experiences. When your ulcerative colitis is in a flare, your physician will use various medications to treat your active symptoms. Dietary changes are usually incorporated into the treatment plan. While ulcerative colitis is a chronic disease with no permanent cure, it is a disease where the patients can spend long periods of time in remission where they are almost completely asymptomatic or showing no symptoms.
Ulcerative colitis is a debilitating disease, and there is clearly suffering when the patient is in a flare. Abdominal pain and cramping are two of the most common symptoms. These two symptoms differ from one another as abdominal pain is considered a constant state of pain, while abdominal cramping tends to come and go in waves. Loose bowel movements can be a constant for this disease, as is an urgency when defecation is imminent. When ulcerative colitis is in an active state, diarrhea tends to be bloody and shows signs of pus.
Despite the severity of the symptoms when the ulcerative colitis is in an active state, patients can live long and fulfilling lives. As time goes on, the patient will begin to recognize signs that they are going into a flare and get timely treatment to get it under control. It is important that the ulcerative colitis patient learns what kind of stress factors or foods bring on a flare. Once you can identify those factors, you can do your best to avoid these triggers. The greatest tool that ulcerative colitis patients can have is ongoing education into their disease. Do not be afraid to talk to your doctor about your symptoms, fears, or anything that factors into making your disease flare. You can also learn to recognize which treatments seem to work best to bring your ulcerative colitis back into remission. We mostly hear about the worst of this chronic disease, and the painful symptoms will be there. However, you are healthier when you focus more on the positive of getting your disease back into remission. A combination of medical intervention, dietary habits, living a healthy lifestyle, and avoiding stress can make ulcerative colitis a manageable condition.