Ulcerative colitis is a type of inflammatory bowel disease that impacts specific areas of the digestive system. It causes very fine ulcers and inflammation in the mucosal lining of different areas in the colon (also known as the large bowel or large intestine) and rectum (the last several inches of the large intestine which ends at the anus).
It is a chronic and sometimes debilitating disease, but it is highly treatable. Symptoms are progressive and tend to increase in severity over a long period of time if left untreated.
What are the Symptoms?
Symptoms and their level of severity are highly varied and depend on the area of the digestive tract that is affected. Some people experience inflammation and swelling in their rectum, and some have issues with both the rectum and colon. Depending on the location of the symptoms and the degree of discomfort, ulcerative colitis is diagnosed as one of four types.
The range of symptoms for all types of ulcerative colitis include diarrhea with blood or pus, abdominal pain, abdominal cramps, rectal pain, rectal bleeding, urgency to defecate, constipation, weight loss, fatigue, and fever.
The 4 Types of Ulcerative Colitis
This type of colitis is considered a mild form that impacts less than six inches of the rectum and does not extend into the upper areas the large intestine. The cause has not been confirmed, but research indicates the state of intestinal flora, environmental factors, immune system irregularities, and genetics play a role. There is an increased level of diagnoses in children as well as in those aged 40 – 50 years old. This type can progress to a more severe form that affects a larger area of the colon.
Symptoms: blood in the stool (which is a key symptom and occurs in nearly every patient), diarrhea, constipation, urgency to defecate, discomfort after a bowel movement, feeling of incomplete emptying of bowels, rectal irritation, hemorrhoids
This type of colitis extends beyond the rectum to the sigmoid colon (lower end of the colon). The sigmoid colon connects the rectum to the rest of the large intestine. Proctosigmoiditis affects just a bit more of the colon than proctitis, but symptoms cause much discomfort. About half of all ulcerative colitis diagnoses are either proctitis or proctosigmoiditis.
Symptoms: bloody diarrhea, abdominal pain, abdominal cramps, urgency to defecate without the ability to do so
This type of colitis is found in the left side of the colon, as its name suggests. The left side of the colon includes the sigmoid and descending colons. In this type, inflammation extends from the rectum to the splenic flexure, which is part of the colon that neighbors the spleen. Left-sided colitis makes of about 30% of ulcerative colitis diagnoses.
Symptoms: loss of appetite, weight loss, bloody diarrhea, pain on the left side of the belly
Pancolitis extends throughout the entire colon, from the rectum to beyond the splenic flexure. In many cases, other types of colitis are diagnosed first, which then progress to pancolitis over time. This type of colitis accounts for about 20% of all ulcerative colitis diagnoses. Children who have pancolitis may have issues with growth. Medical attention should be sought promptly if they experience any of the more severe symptoms.
Symptoms: weight loss, loss of appetite, bloody diarrhea, abdominal pain, cramps, fatigue, fever
How is it Diagnosed?
Diagnosis begins with a detailed medical history and general physical exam. If ulcerative colitis is suspected, your doctor may perform a colonoscopy. This diagnostic procedure involves insertion of an endoscope (a device with a small camera and a light) into the anus. The endoscope can travel through the colon, illuminating and exposing structures of the digestive tract. This allows the physician to get a good look at the bowel lining and to collect biopsies of the inflamed tissue to test for other possible causes. It also allows the doctor to see how far the inflammation extends, which will determine the specific type of colitis. Your physician may also request a stool sample or x-rays.
Treatment is focused on symptom management and reduction of inflammation. Therapies may differ depending on the type and severity of ulcerative colitis, but options include:
Inflammation and discomfort may lead to avoidance of some foods, so nutritional deficiencies should be monitored and addressed. Since those suffering from ulcerative colitis tend to have sensitive digestive tracts, alterations in diet can help to ease symptoms. A dietician can help to ensure a patient is receiving the balanced nutrition required for optimum healing, while avoiding intestinal irritants.
Some recommendation to reduce symptoms are to avoid dairy, carbonated beverages, caffeine, and alcohol. It is also helpful to increase water consumption and take multivitamins if you feel you are at risk for nutritional deficiencies.
Stress can trigger inflammatory bowel flare ups, so it is important to mange it well. Exercise is a great way to reduce stress and improve digestive tract function. Your doctor can help you to devise an appropriate plan, but some good low-impact choices are walking, yoga, and swimming.
Medication options include anti-diarrheal medications, pain relievers, iron supplements for those with excessive bleeding, 5-aminosalicylates, and anti-inflammatory medications such as corticosteroids. Some medications may be delivered orally, but others are delivered via enema.
During severe bouts of diarrhea or bleeding, you may need to be hospitalized so that intravenous fluids may be administered. The most severe cases may require surgery to remove damaged parts of the colon. This can greatly reduce symptoms for the most destructive types of colitis, but it is not a cure and the inflammation can spread to other areas.
Many complications are associated with ulcerative colitis. Some patients may experience anemia from the excessive bleeding, dehydration, a perforation in the colon, or toxic megacolon. Toxic megacolon is a rare but life-threatening abnormal dilation of the large intestine. It develops rapidly and requires immediate medical attention. Patients with ulcerative colitis are also at greater risk for developing colon cancer.
The ulcers experienced in ulcerative colitis are not related to ulcers in the stomach. The most common condition associated with ulcerative colitis is Crohn's disease. The symptoms are very similar, but the ulcers caused by Crohn's disease are much deeper and impact the bowel muscle wall, not just the mucosal lining as in ulcerative colitis. Crohn's disease also affects more areas in the digestive tract. It is important to work with your physician to determine the correct diagnosis and follow the most appropriate treatment plan.