Ulcerative Colitis Symptoms, Diagnosis & Treatment

Ulcerative colitis is a chronic, inflammatory disorder that affects the large intestine and rectum, causing abdominal pain, cramping and diarrhea. According to the Crohn’s and Colitis Foundation of America, nearly 1.5 million people in the United States suffer from inflammatory bowel disease. In addition, ulcerative colitis is sometimes mistaken for other bowel disorders, which is why many people go undiagnosed for years before receiving a proper diagnosis.

About Ulcerative Colitis

To understand ulcerative colitis and other bowel disorders, it is important to understand the way your digestive system works.

After you eat, food moves through the different parts of the digestive system. These different parts help break down the food you eat for maximum absorption of minerals, nutrients and vitamins that are essential to stay healthy. Once this absorption takes place in the stomach and small intestine, food is moved into the large intestine (bowel) where it and other waste products are eliminated through the rectum. This is an important part of your digestion because toxins are also eliminated from the body through the bowel and rectum. Ulcerative colitis interferes with this process by inflaming the bowel and causing painful ulcers in the lining of the large intestine and rectum.

Like most other digestive disorders, there isn’t a lot of information on how many years ulcerative colitis has affected people. However, the term ulcerative colitis was first used by Dr. Samuel Wilks in an 1875 case report involving a group of patients with inflamed intestinal tracts and accompanying gastrointestinal symptoms. Before Dr. Wilks report, all digestive disorders were believed to develop from infections. In addition, the only forms of treatment used for ulcerative colitis at that time were dietary changes and surgery. Without the knowledge of infection control and sterilization, many of these surgeries caused infections that resulted in death. Today, many different treatments are available for people with ulcerative colitis and other digestive disorders.

Causes and Risk Factors

Although the definite cause of ulcerative colitis has not yet been discovered, scientists believe that the immune system malfunctions in some way, causing immune cells to attack the inner lining of the colon and rectum. This immune response causes inflammation that results in patches of ulcerated tissue. However, scientists have not yet discovered what triggers this immune-related response. Other studies indicate that genes may play a role, because you are more likely to develop ulcerative colitis if a close relative has the digestive disorder. Men and women are affected equally, although the condition is diagnosed most frequently in people 30 to 37 years of age. However, anyone can be diagnosed with ulcerative colitis. People of Caucasian and Jewish decent are also at an increased risk for UC.

Signs and Symptoms

Ulcerative colitis is often confused with other digestive disorders because of similar symptoms. However, bloody diarrhea is the hallmark of ulcerative colitis, and can help distinguish the condition from other bowel disorders. Other common symptoms include:

• Abdominal pain
• Abdominal cramps
• Loss of appetite
• Weight loss
• Fatigue
• Malnutrition
• Bloody diarrhea
• Anemia

Although bloody diarrhea is the most common sign of ulcerative colitis, many people report milder symptoms, such as nausea and fatigue. In fact, the Crohn’s and Colitis Foundation of America reports that about half of patients with ulcerative colitis have mild symptoms. In some people, symptoms start out mild but worsen over time. More systemic symptoms associated with ulcerative colitis include arthritis, mouth sores, skin rashes and eye inflammation. However, these symptoms are more common in people with severe disease.

Types of UC

There are several different types of ulcerative colitis, but most kinds cause abdominal cramping, stomach pain and diarrhea. The complications and symptoms of ulcerative colitis greatly depend on what part of the colon is most affected, which is why it is important to understand the different types of UC.

The lower segment of the colon that attaches to the rectum is called the sigmoid colon. Proctosigmoiditis most commonly affects this area, from the lower bowel to the end of the rectum. Common symptoms include moderate pain on the lower left side of the abdomen accompanied by bloody diarrhea, abdominal cramping and feeling as though the colon is full even though you have gone to the bathroom already.

Left-sided colitis is a type of colitis that begins at the rectum and extends down to a bend in the colon near the spleen called the splenic flexure. Common symptoms include loss of appetite, weight loss, diarrhea, blood loss and severe pain in the left side of the abdomen. In fact, pain may be severe enough that the person is misdiagnosed with more acute conditions, such as appendicitis, gastritis and gall bladder disease.

Pan-ulcerative colitis is oftentimes called total colitis because it affects the entire colon. For this reason, symptoms and complications with pan-ulcerative colitis are usually more severe and therefore, treated more aggressively. Common symptoms include diarrhea, bloody stools, severe abdominal pain, cramping and extensive weight loss that often results in nutritional deficiencies. The person may also be diagnosed with malnourishment disorders and anemia due to malnutrition. Complications of total colitis can be life-threatening, requiring surgery to repair a ruptured or perforated bowel. A condition called toxic megacolon may also occur, causing acute dilation of the colon and a tear in the wall of the bowel. This type of colitis should be monitored carefully and treated aggressively to prevent serious complications.

Complications and Diagnosis

There is no specific test for diagnosing ulcerative colitis, but a doctor who specializes in gastrointestinal disorders can order tests that help achieve a diagnosis of ulcerative colitis. In most cases, a colonoscopy with a biopsy of the lining of the colon is the best diagnostic tool to identify the ulcerated lesions so commonly seen with ulcerative colitis. Various blood tests can also help with a diagnosis because they may reveal nutritional deficiencies, anemia, systemic inflammation and other lab abnormalities.

Being diagnosed with ulcerative colitis increases your risk for developing colon cancer. This is most likely because of constant inflammation and open sores in the colon’s lining that can develop into cancer in some people. Repeated inflammation and swelling in the colon and rectum can also lead to scar tissue that may result in blockages. Severe infection and tissue death are also dangerous complications of ulcerative colitis, especially if you have severe disease. Because inflammatory bowel disorders, like ulcerative colitis, can cause nutritional deficiencies, children with UC may experience delayed growth, impaired development and malnourishment diseases.

Treatment of Ulcerative Colitis

If you suspect that you may have ulcerative colitis, it is understandable why you might be scared. However, the symptoms of ulcerative colitis are manageable with medication and dietary changes.

The medications used to control ulcerative colitis work by suppressing the inflammatory response of the immune system. There are 5 major drug classes prescribed to treat symptoms and reduce the damage caused by ulcerative colitis.

Aminosalicylates – This class of anti-inflammatory drugs contains aspirin derivatives, and is usually prescribed for mild to moderate disease. Aminosalicylates work by suppressing inflammation caused by ulcerative colitis. When inflammation is suppressed, the symptoms of ulcerative colitis are greatly reduced and damage is slowed substantially. Common oral medicines in the aminosalicylate drug class are Sulfasalazine, Asacol, Lialda and Pentasa. Canasa and Rowasa are also aminosalicylates, but they are administered rectally.

Immune Modulators – This drug class was specifically designed to reduce colon damage by modifying the way your immune system works. Because people with ulcerative colitis have an overactive immune system, modifying the immune response is very effective for treating ulcerative colitis. However, immune modulators also increase your risk for infection, including tuberculosis and fungal infections. For this reason, routine lab work and doctor’s visits are essential for monitoring your health. Common immune- modulating drugs include Imuran, Purinethol and methotrexate. These medicines often take several weeks to work, so your doctor may order short-term medication to relieve symptoms and get inflammation under control.

Corticosteroids – This class of medicine contains powerful anti-inflammatory properties, and is often used during disease flares when disease activity increases. Corticosteroids are also used to reduce symptoms caused by inflammation when you are waiting for long-term treatments to begin working. At one time, corticosteroids were prescribed as a long-term treatment, but dangerous side effects were discovered, such as bone thinning, puffy face, fluid retention and elevated blood pressure. Some people may also suffer a relapse of symptoms after discontinuing corticosteroid therapy, which is another reason corticosteroids are used for short-term treatment rather than as a maintenance drug.

Biological Therapy – This class of medicines is very new and works by suppressing key immune cells that are commonly elevated in people with inflammatory bowel disorders. Remicade is the most popular drug in this category, and is prescribed intravenously for people with moderate to severe ulcerative colitis. However, biological drugs suppress your immune system much like immune modulators, and can increase your risk for serious infections. Biological medications can also cause abnormalities in lab values, so periodical blood tests are a necessary part of treatment. Remicade is approved by the Food and Drug Administration for patients 6 years of age and older.

Antibiotic Therapy – It is unknown exactly why antibiotics work for immune-related disorders like ulcerative colitis, but research shows that certain antibiotics may help symptoms by reducing systemic inflammation. Antibiotics that help ulcerative colitis symptoms include metronidazole, ampicillin, ciprofloxacin and others.

Another important part of treatment for ulcerative colitis is dietary changes that help reduce inflammation in the colon tract. Choosing the right foods also helps prevent irritation of the ulcers in the bowel and rectum. For example, it’s important to avoid spicy foods that can further irritate and inflame the colon. High-fiber foods cause bulk in the colon and increase the urge to go, which can irritate symptoms further.

In addition to recognizing what irritates your colon, it is also important to eat nutritious meals to avoid nutritional deficiencies commonly seen in patients with inflammatory bowel disease. Protein is especially important, so include lots of lean meats and low-fat dairy products in your diet. Fruits and vegetables are also important, and should be eaten several times a day for vital phytonutrients. If necessary, keep a food diary of what foods help soothe your colon and what foods irritate your ulcerative colitis.

Surgery

For some people, surgery may be necessary to repair the damage caused by ulcerative colitis. In fact, medical treatment alone is not sufficiently effective for up to one-third of UC patients, according to the Crohn’s and Colitis Foundation of America. For these individuals, surgery is sometimes recommended to remove diseased parts of the colon. Although surgery may seem extreme, surgery is sometimes a necessary treatment to avoid future complications that can be life-threatening. There is no cure for ulcerative colitis, but symptoms and inflammation are controllable with treatment.