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Digestive Disorders > IBD > Ulcerative Colitis

Ulcerative Colitis: All You Need to Know

Elizabeth Oliver, PhD

Elizabeth Oliver, PhD

What is ulcerative colitis?

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD). It causes inflammation and ulcers of the large bowel (colon) leading to severe diarrhea and abdominal pain. Ulcerative colitis often develops in young adulthood (between the ages of 20 and 40 years). But the condition can occur at any age, with some experiencing a late onset after the age of 60. Even though there is currently no cure for ulcerative colitis, it can be effectively managed with medication.

Causes of ulcerative colitis

It is still not exactly clear why ulcerative colitis develops. Some experts suspect an interaction between genetics and environmental factors such as bacteria and viruses. An overactive immune response may also play an important role in the development of ulcerative colitis. Men and women are equally likely to be affected.

Types of ulcerative colitis

Ulcerative colitis typically affects the large intestine. It causes inflammation resulting in damage (ulcerations) to the inner lining (mucosa and submucosa). Inflammation begins in the rectum, the last section of the large intestine before the anus (the opening where the digestive systems ends), and spreads upwards. Only rarely does the inflammation spread from the large intestine to the small intestine (terminal ileum).

Ulcerative colitis is often categorised according to the area of the intestine that is affected:

  • Ulcerative proctitis. Inflammation of the rectum.
  • Proctosigmoiditis. Inflammation in the rectum and the sigmoid colon (the S-shaped lower segment of colon located right above the rectum).
  • Left-sided colitis (also known as distal colitis). Inflammation that begins at the rectum and extends as far as a bend in the colon near the spleen called the splenic flexure.
  • Extensive colitis. Affects most of the colon.
  • Pancolitis. Inflammation of the entire colon.

Symptoms of ulcerative colitis

Ulcerative colitis symptoms can vary depending on the severity of inflammation and where it occurs.

Common symptoms of ulcerative colitis include:

  • Diarrhea containing blood and mucus
  • Greatly increased stool frequency (more than five times per day)
  • Urgent bowel movements
  • Abdominal pain, often left-sided
  • Fever

Other signs and symptoms of ulcerative colitis

In addition to the intestine, ulcerative colitis can also affect other organs. In 2 to 8 percent of individuals affected, inflammation of the liver and bile ducts can occur. This leads to tissue scarring and is known as primary sclerosing cholangitis. Anemia (a lack of red blood cells) can also develop with ulcerative colitis. In rare cases the skin, eyes, or joints can be affected leading to the following complaints:

  • Painful joints
  • Sores in the mouth (known as canker sores or aphthous ulcers)
  • Painful inflammatory rashes and skin lesions
  • Inflammation of the eyes

In up to 20 percent of those with ulcerative colitis, ileitis (inflammation of the ileum) occurs. Ileitis may be a result of backwash of intestinal content from the colon back into the end of the small intestine. Ileitis is more commonly associated with Crohn’s disease, because of this symptoms of ileitis in ulcerative colitis can make distinguishing between the two conditions difficult.

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What are the different forms of ulcerative colitis?

The course of ulcerative colitis varies between individuals. People with ulcerative colitis usually experience an intermittent course, with periods of active symptoms followed by periods of fewer symptoms or no symptoms at all. This is known as flare-up and remission. Remission can be temporary or long-lasting. This phase can also be achieved by medication.

The table shows an overview of the different forms of ulcerative colitis.

Course of ulcerative colitis Description Frequency
Chronic relapsing or intermittent Alternating periods of complete remission and active symptoms (flare-ups) 80%
Chronic continuous Variable symptom severity but an absence of complete remission 10-15%
Fulminant Sudden onset of particularly severe symptoms 5%

Diagnosing ulcerative colitis

Your physician will diagnose ulcerative colitis by ruling out other possible causes for your symptoms. This will be done by collecting information about your medical history. You will also have a physical examination. To help confirm a diagnosis of ulcerative colitis, your physician may perform a number of tests and procedures.

The colonoscopy is one of the most important diagnostic methods. Using this your physician can look at the inner lining (mucosa) of your large intestine and remove a small tissue sample (biopsy) for laboratory analysis. This investigation method can confirm the diagnosis.

Examination Findings with ulcerative colitis
Blood test - Signs of inflammation

Further examinations:

- Complete blood count

- Iron test

- Kidney function

- Liver values (transaminases and cholestasis)

- In individual cases: Antibody tests

Stool analysis - Exclusion of infection by microbiological examination

- Proof of mucosal inflammation and follow-up of disease activity

Sonography and other imaging techniques - Thickening of the large intestine (colon) wall

- Only the large intestine affected

Colonoscopy - Reddened and swollen mucosa

- Mucosa bleeding on contact

- Disappearance of the normal blood vessel pattern in the mucosa

- Sores (ulcers)

- Change in mucosal structure

- Only large intestine affected (in most of the cases)

Biopsy - Inflammatory cells in the mucosa

Treatment for ulcerative colitis

Ulcerative colitis is a chronic condition. This means that the goal of treatment is to reduce the inflammation that causes your symptoms in order to prevent flare-ups and maintain longer periods of remission.

Treatment options for ulcerative colitis usually include either medication or surgery.

Ulcerative colitis is primarily treated by medication. Several categories of drugs may be effective in treating ulcerative colitis. The type you take will depend on the severity of your condition and location.

If other treatments don’t work or your UC is severe, you might need surgery to remove your colon (colectomy) or colon and rectum (proctocolectomy).

Ulcerative colitis can have a negative impact on general well-being and mental health. Joining a self-help group can be beneficial for additional support. In some cases, psychotherapy may also be recommended.

Ulcerative colitis diet

No specific diet for ulcerative colitis exists, but changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups. Some suggestions that may help include:

  • Limit fiber. During a flare-up, high-fiber foods, such as fresh fruits and vegetables and whole grains, may make your symptoms worse. However during remission, fiber can help you stay regular.
  • **Limit dairy products. **If you can’t digest the sugar in milk called lactose, your doctor may tell you to stop eating dairy products
  • Avoid problem foods. Spicy foods, alcohol and caffeine may make your signs and symptoms worse.
  • Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best.

Complications of ulcerative colitis

Ulcerative colitis is treatable. Most people with this condition can have a full life expectancy. However, complications may reduce life expectancy.

Ulcerative colitis increases your risk of 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 when you receive your diagnosis. Regular screenings help lower your risk of colon cancer. Depending on your risk profile your doctor may recommend that a colonoscopy be performed every four years.

Do I need to consider ulcerative colitis when trying to have children?

Couples who wish to become pregnant may be concerned about how ulcerative colitis will affect their chances of getting pregnant and the health of their future children.

Having ulcerative colitis does not necessarily affect the ability to have children. With the careful supervision of both a gastroenterologist and obstetrician most people with ulcerative colitis can have a healthy pregnancy and a healthy baby. People of all genders may need to take into consideration the impact of some medications before conceiving. The type of medication or dosage may also be altered during pregnancy.

While there is a genetic component to ulcerative colitis, this does not necessarily mean your child will have it too. Only 5 percent of children with a parent suffering from ulcerative colitis will develop the condition.

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Elizabeth Oliver, PhD

Elizabeth Oliver, PhD

Elizabeth Oliver is a researcher and freelance writer with a passion for health sciences. She completed her degree in pharmacology at the University of Edinburgh and PhD in reproductive health at Imperial College London. She currently works as a researcher at the Karolinska Institutet Stockholm.

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