Ulcerative colitis is a common inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. It affects the innermost lining of your large intestine, also called the colon, and rectum.
In most people, symptoms usually develop over time. The disease can be draining and may lead to life-threatening complications. While there is no known cure, there are several new treatments that can reduce its signs and symptoms and bring about long-term remission.
The exact cause of the disease remains unknown. Previously, diet and stress were suspected, but researchers now know that these factors may aggravate but not cause ulcerative colitis.
A possible cause is an immune system malfunction. When your immune system tries to fight off an invading virus or bacterium, an irregular immune response causes the immune system to attack the cells in the digestive tract.
Heredity also seems to play a role because ulcerative colitis is more common in people who have family members with the disease. However, most people with ulcerative colitis don’t have this family history.
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Signs and symptoms
Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs.
Most people with ulcerative colitis have mild to moderate symptoms. The course of ulcerative colitis may vary, with some people having long periods when it goes away. This is called remission.
Signs and symptoms may include:
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Diarrhoea, often with blood or pus
Rectal bleeding – passing small amount of blood with stool
Abdominal pain and cramping
Rectal pain
Urgency to defecate
Inability to defecate despite urgency
Weight loss
Fatigue
Fever
A failure to grow in children.
Doctors often classify ulcerative colitis according to its location. Symptoms of each type often overlap.
Types of ulcerative colitis:
Ulcerative proctitis. Inflammation is confined to the area closest to the anus, also called the rectum. Rectal bleeding may be the only sign of the disease.
Proctosigmoiditis. Inflammation involves the rectum and sigmoid colon – the lower end of the colon. Symptoms include bloody diarrhoea, abdominal cramps and pain and an inability to empty the bowels despite the urge to do so. This is called tenesmus.
Left-sided colitis. Inflammation extends from the rectum up through the sigmoid and descending portions of the colon. Symptoms include bloody diarrhoea, abdominal cramping and pain on the left side, and an urgent need to defecate.
Pancolitis. This often affects the entire colon and causes bouts of bloody diarrhoea that may be severe, abdominal cramps and pain, fatigue and significant weight loss.
Risk factors may include:
Age. Ulcerative colitis usually begins before the age of 30, but can occur at any age. Some people may not develop the disease until after the age of 60.
Race or ethnicity. Although white people have the highest risk of the disease, it can occur in any race.
Family history. You’re at higher risk if you have a close relative with the disease.
Possible complications include:
Severe bleeding
Severe dehydration
A rapidly swelling colon, also called a toxic megacolon
A hole in the colon, also called a perforated colon
Increased risk of blood clots in veins and arteries
Inflammation of the skin, joints and eyes
An increased risk of colon cancer
Bone loss, also called osteoporosis.
Endoscopic procedures with tissue biopsy are the only way to properly diagnose ulcerative colitis. Other types of tests can help rule out complications or other forms of inflammatory bowel disease like Crohn’s disease.
To help confirm a diagnosis, you may have one or more of these tests and procedures:
Blood tests. Blood tests to check for anaemia which is a condition in which there aren’t enough red blood cells to carry adequate oxygen to your tissues or to check for signs of infection or inflammation.
Stool studies. White blood cells or certain proteins in your stool can indicate ulcerative colitis. A stool sample can also help rule out other disorders such as infections caused by bacteria, viruses and parasites. Colonoscopy. This exam allows your doctor to view your entire colon using a thin, flexible, lighted tube with a camera on the end. During the procedure, tissue samples are taken for laboratory analysis. This is known as a tissue biopsy. A tissue sample is necessary to make the diagnosis.
Flexible sigmoidoscopy Your doctor uses a slender, flexible, lighted tube to examine the rectum and sigmoid colon which is the lower end of your colon. If your colon is severely inflamed, this test may be preferred instead of a full colonoscopy.
X-ray. If you have severe symptoms, your doctor may use a standard X-ray of your abdominal area to rule out serious complications such as a megacolon or a perforated colon.
CT scan. A CT scan of your abdomen or pelvis may be performed if a complication from ulcerative colitis is suspected. A CT scan may also reveal how much of the colon is inflamed.
Treatment
Ulcerative colitis treatment usually involves medication therapy or surgery. Several categories of medications may be effective in treating ulcerative colitis. The type you take will depend on the severity of your condition. It may take time to find a medication that helps you. Because some medications have serious side effects, you’ll need to weigh the benefits and risks of treatment.
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Anti-inflammatory medications are often the first step in the treatment of ulcerative colitis and are appropriate for most people with this condition. Corticosteroids, which include prednisone and budesonide, are generally reserved for moderate to severe ulcerative colitis that don’t respond to other treatments. Corticosteroids suppress the immune system. Due to the side effects, they are not usually given long term. Immune system suppressors can also help reduce inflammation.
