Ulcerative colitis is a disease that causes inflammation and sores (ulcers) in the lining of the large intestine (colon). It usually affects the lower section (sigmoid colon) and the rectum (proctitis). But it can affect the entire colon. In general, the more of the colon that's affected, the worse the symptoms will be.
The colon is the part of the digestive system where water is removed from undigested material, and the remaining waste material is stored. The rectum is the end of the colon adjacent to the anus.
Ulcerative colitis can affect people of any age. But most people who have it are diagnosed before the age of 30.
This disease is closely related to another condition of inflammation of the intestines called Crohn's disease. Together, they are frequently referred to as inflammatory bowel disease (IBD).
How is Ulcerative Colitis different from Crohn's Disease?
While ulcerative colitis causes inflammation only in the colon (colitis) and/or the rectum (proctitis), Crohn's disease may cause inflammation in the colon, rectum, small intestine (jejunum and ileum), and, occasionally, even the stomach, mouth, and oesophagus.
The patterns of inflammation in Crohn's disease are different from ulcerative colitis. Except in the most severe cases, the inflammation of ulcerative colitis tends to involve the superficial layers of the inner lining of the bowel. The inflammation also tends to be diffuse and uniform (all of the lining in the affected segment of the intestine is inflamed).
Unlike ulcerative colitis, the inflammation of Crohn's disease is concentrated in some areas more than others, and involves layers of the bowel that are deeper than the superficial inner layers. Therefore, the affected segment(s) of bowel in Crohn's disease often is studded with deeper ulcers along with normal lining between these ulcers.
What Causes Ulcerative Colitis?
The cause of ulcerative colitis is not known. To date, there has been no convincing evidence that it is caused by infection or is contagious.
Experts think it might be caused by the immune system overreacting to normal bacteria in the digestive tract. Or other kinds of bacteria and viruses may cause it.
You are more likely to get ulcerative colitis if other people in your family have it.
What are the Symptoms?
In patients with ulcerative colitis, ulcers and inflammation of the inner lining of the colon lead to symptoms of:
Belly pain or cramps
Rectal bleeding (bleeding from the rectum; passing small amount of blood with stool)
Some people also notice:
Urgency to defecate
Inability to defecate despite urgency
In children, failure to grow
In severe cases, people may have diarrhoea 10 to 20 times a day.
In most people, the symptoms come and go. Some people go for months or years without symptoms (remission). Then they will have a flare-up. About 5 to 10 out of 100 people with ulcerative colitis have symptoms all the time.
Possible complications of ulcerative colitis include:
A hole in the colon (perforated colon)
Liver disease (rare)
Bone loss (osteoporosis)
Inflammation of your skin, joints and eyes
An increased risk of colon cancer
A rapidly swelling colon (toxic megacolon)
Increased risk of blood clots in veins and arteries
How is Ulcerative Colitis Diagnosed?
Doctors ask about the symptoms, do a physical exam, and do a number of tests. Testing can help the doctor rule out other problems that can cause similar symptoms, such as Crohn's disease, irritable bowel syndrome, and diverticulitis.
Tests that may be done include:
A colonoscopy. In this test, a doctor uses a thin, lighted tool to look at the inside of your entire colon. At the same time, the doctor may take a sample (biopsy) of the lining of the colon.
Blood tests, which look for infection or inflammation.
Stool sample testing to look for blood, infection, and white blood cells.
Treatment of Ulcerative Colitis
Ulcerative colitis affects everyone differently. Your doctor will help you find treatments that reduce your symptoms and help you avoid new flare-ups.
Ulcerative colitis can be debilitating and can sometimes lead to life-threatening complications. While it has no known cure, treatment can greatly reduce signs and symptoms of the disease and even bring about long-term remission.
If you have severe symptoms and medicines don't help, you may need surgery to remove your colon. Removing the colon cures ulcerative colitis. It also prevents colon cancer.
Some people find that certain foods make their symptoms worse. If this happens to you, it makes sense not to eat those foods. But be sure to eat a healthy, varied diet to keep your weight up and to stay strong.
Here are some suggestions that may help:
Foods to limit or avoid
Limit dairy products. Many people with inflammatory bowel disease find that problems such as diarrhoea, abdominal pain and gas improve by limiting or eliminating dairy products. You may be lactose intolerant — that is, your body can't digest the milk sugar (lactose) in dairy foods. Using an enzyme product such as Lactaid may help as well.
Limit fibre, if it's a problem food. If you have inflammatory bowel disease, high-fibre foods, such as fresh fruits and vegetables and whole grains, may make your symptoms worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them.In general, you may have more problems with foods in the cabbage family, such as broccoli and cauliflower, and nuts, seeds, corn and popcorn.
Avoid other problem foods. Spicy foods, alcohol and caffeine may make your signs and symptoms worse.
Other dietary measures
Eat small meals. You may find you feel better eating five or six small meals a day rather than two or three larger ones.
Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhoea worse, while carbonated drinks frequently produce gas.
Talk to a dietician. If you begin to lose weight or your diet has become very limited, talk to a registered dietician.
Prognosis of Ulcerative Colitis
People who have ulcerative colitis for 8 years or longer also have a greater chance of getting colon cancer. The longer you have had ulcerative colitis, the greater your risk. Talk to your doctor about your need for cancer screening. These tests help find cancer early, when it is easier to treat.
Ulcerative colitis can be hard to live with. During a flare-up, it may seem like you are always running to the bathroom. This can be embarrassing. And it can take a toll on how you feel about yourself. Not knowing when the disease will strike next can be stressful.
If you are having a hard time, seek support from family, friends, or a counsellor. Or look for a support group. It can be a big help to talk to others who are coping with this disease.