Ulcerative Colitis is an inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers in your digestive tract.
Ulcerative colitis (UC) is a chronic idiopathic inflammatory disorder of the GI tract characterized by mucosal inflammation of the rectum that extends proximally through the colon, in a continuous fashion, but to a variable extent.
Although ulcerative colitis is usually only in the innermost lining of the large intestine (colon) and rectum, its forms range from mild to severe.
The problem with having ulcerative colitis is that it puts a patient at increased risk of developing colon cancer in the long term.
In essence ulcerative colitis is a chronic disease of the colon, also known as the large intestine, in which the lining of the colon becomes inflamed and develops tiny open ulcers, or sores, that can eventually produce pus and mucous.
This combination of inflammation and ulceration can cause abdominal discomfort and frequent emptying of the colon for most people who suffer with ulcerative colitis.
What causes ulcerative colitis in a nutshell is that there is an abnormal response by your body’s immune system.
The cells and proteins that make up the immune system protect act to protect you from infection. This same system is what will ultimately cause ulcerative colitis.
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Ulcerative colitis can be hindering and occasionally can lead to life-threatening difficulties.
While ulcerative colitis has no known cure, treatment can greatly reduce the signs and symptoms of the disease and even bring about long-term remission.
Ulcerative Colitis Symptoms
Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs.
Therefore, doctors often classify ulcerative colitis according to its location.
About half of all patients with ulcerative colitis experience mild symptoms.
Be sure to consult your doctor if you experience any of the following symptoms:
- Bowel movements become looser and more urgent
- Persistent diarrhea accompanied by abdominal pain and blood in the stool
- Stool is generally bloody
- Cramping abdominal pain
- Rectal pain Rectal bleeding — passing small amount of blood with stool
- Urgency to defecate
- Inability to defecate despite urgency
- Weight loss Fatigue
- Fever In children
- Failure to grow
A feeling of low energy and fatigue is also common. Among younger children, ulcerative colitis may delay growth and development.
Individuals suffering from ulcerative colitis often have occurrence of loss of appetite and may lose weight as a result of the loss of appetite.
The symptoms of ulcerative colitis do tend to come and go, with fairly long periods in between outbreaks in which patients may experience no symptoms at all.
These periods of remission can span months or even years, although symptoms do eventually return and without warning.
The problem with the unpredictable course ulcerative colitis usually has may make it difficult for physicians to evaluate whether a particular course of treatment has been effective or not.
The type of ulcerative colitis is classified according to how much of your colon is affected.
The condition can be mild and limited to the rectum or it can affect additional parts of your colon, unfortunately with more severe symptoms.
People who develop ulcerative colitis at a younger age are more likely to have severe symptoms.
What Causes Ulcerative Colitis?
Although the exact cause of ulcerative colitis remains unknown, considerable research has been made in the IBD causes.
Previously, diet and stress were suspected, but now doctors know that these factors may aggravate but don’t actually cause ulcerative colitis.
Studies indicate that the inflammation in IBD involves a complex interaction of factors.
These factors state that the genes the person has inherited, the immune system, and something in the environment ultimately is what causes ulcerative colitis.
One of the possible causes is thought to be an immune system malfunction. In other words the same response of the immune system chooses to protect also can cause the problem.
In fact when your immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the cells in the digestive tract as well, causing ulcerative colitis.
Foreign substances in the environment may be the direct cause of the inflammation, or they may stimulate the body’s defenses to produce an inflammation that continues without control.
Researchers believe that once the IBD patient’s immune system is “turned on,” it does not know how to properly “turn off” at the right time.
As a result, inflammation damages the intestine and causes the symptoms of IBD.
Inheritance also seems to play a role in that ulcerative colitis is more common in people who have family members with the same disease.
However, in most cases people with ulcerative colitis don’t have this family history.
Other research sponsored by researchers has led many scientists to believe that ulcerative colitis may be the result of an interaction of a virus or bacterial infection of the colon and your body’s natural immune system response to that virus or bacterium. .
In normal cases your immune system will cause temporary inflammation to combat an illness or infection, and then the inflammation will be reduced as you regain health.
However in people with ulcerative colitis, this inflammation can persist long after your immune system should have finished its job, causing ulcerative colitis.
Research has shown that ulcerative colitis may affect as many as 700,000 Americans yearly.
Ulcerative colitis does not discriminate when it comes to the sex of who gets the diseases as men and women are equally likely to be affected.
The same studies have also shown that most people are diagnosed in their mid-30s.
The disease however can occur at any age and older men are more likely to be diagnosed than older women.
While ulcerative colitis tends to run in families, researchers have been unable to establish a clear pattern of inheritance.
Studies also have shown that up to 20 percent of people with ulcerative colitis will also have a close relative with the disease.
Risk factors of Ulcerative Colitis
The disease is more common among white people of European origin and among people of Jewish heritage.
Risk factors may include:
- Ulcerative colitis usually begins before the age of 30. But, it can occur at any age, and some people may not develop the disease until after age 60.
- Race or ethnicity. Although whites have the highest risk of the disease, it can occur in any race. If you’re of Ashkenazi Jewish descent, your risk is even higher.
- Family history. You’re at higher risk if you have a close relative, such as a parent, sibling or child, with the disease.
- Isotretinoin use. Isotretinoin (Amnesteem, Claravis, Sotret; formerly Accutane) is a medication sometimes used to treat scarring cystic acne or acne. Some studies suggest it is a risk factor for IBD, but a clear association between ulcerative colitis and isotretinoin has not been established.
Acute Ulcerative Colitis
Acute ulcerative colitis is a disorder characterized by a relapsing and remitting course of variable severity.
The majority of patients can sometimes present with a left-sided or distal disease of mild-to-moderate severity.
Most remain in remission for long periods with maintenance medical therapy.
10% of patients initially present with severe disease, additionally approximately 15% of patients will develop a severe flare during the course of their lifetime.
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Acute severe UC can be defined according to the original criteria set up by the researchers. This criteria which states that a person has acute ulcerative colitis if they present symptoms of six or more stools per day, with either a body temperature of more than 37.8°C, a pulse rate of more than 90 bpm, large amounts of blood per stool, a hemoglobin level of less than 10.5 g/dl or an erythrocyte sedimentation rate (ESR) of more than 30 mm/h.
In most cases patients with acute severe ulcerative colitis require hospitalization for optimal management to the degree of the seriousness of their illness.
Although rates of death in acute ulcerative colitis have dropped by up to 25% with the implementation of more aggressive monitoring and treatment, acute ulcerative colitis is still unfortunately associated with a measurable mortality.
Acute ulcerative colitis should be considered a medical emergency for all patients, and patients are required to have close monitoring of stool frequency and vitals symptoms.
Close observation acts to allow early identification of patients with complications (notably toxic dilatation and perforation), which require immediate colectomy a surgery.
The making of an early decision about either proceeding to surgery or stepping up to rescue medical therapy is a key aspect of ensuring favorable outcomes, so discussion of the options should be initiated at an early stage.
Early identification of patients who are likely to fail steroid therapy is also vitally crucial.
Most doctors and health care professionals have recognized for some time that monitoring of basic clinical and laboratory indices can be helpful in predicting which patients with acute ulcerative colitis are likely to require colectomy during the same hospital admission.
Medical treatment of steroid-refractory acute ulcerative colitis has expanded somewhat in recent years with the availability of both ciclosporin and infliximab as rescue agents.
In most cases however surgery still remains the only beneficial option.
Ulcerative Colitis Treatment
Ulcerative colitis treatment in most cases usually involves drug therapy or surgery, as well as a holistic approach for those who seek a natural approach.
When it comes to western medicine several categories of drugs may be effective in treating ulcerative colitis.
The type of medication you take will depend on the severity of your condition in response to ulcerative colitis.
In some cases the drugs that work well for some people may not work for others, so it may take time to find a medication that helps you.
In addition to the different forms of medicine, some drugs come with and have serious side effects.
Each person must decide and weigh the benefits and risks of any treatment for ulcerative colitis or acute ulcerative colitis.
Surgery for Ulcerative Colitis
Surgery can often eliminate ulcerative colitis. But that usually means removing your entire colon and rectum as well which can be tough for most people to consider.
In most cases, this involves a procedure called ileoanal anastomosis that eliminates the need to wear a bag to collect your stool.
Most surgeons and doctors will construct a pouch from the end of your small intestine.
The pouch is then attached directly to your anus, allowing you to expel waste relatively normally, rather then the usually way your body expels its waste.
In the cases that surgery is not possible surgeons instead create a permanent opening in your abdomen through which stool is passed for collection in an attached bag.
Anti-inflammatory drugs for Ulcerative Colitis
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease.
They include Aminosalicylates. Sulfasalazine can be effective in reducing symptoms of ulcerative colitis, but it has a number of side effects, including digestive distress and headache.
Certain 5-aminosalicylates, including mesalamine, balsalazide and olsalazine are available in both oral and enema or suppository forms.
Which form you take depends on the area of your colon that’s affected. Rarely, these medications have been associated with kidney and pancreas problems.
Another anti-inflammatory drug that is used to treat acute ulcerative colitis is Corticosteroids.
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These drugs, which include prednisone and hydrocortisone, are generally reserved for moderate to acute ulcerative colitis that doesn’t respond to other treatments.
Most patients are given the medication orally, intravenously, or by enema or suppository, depending on the location affected.
Corticosteroids unfortunately have numerous side effects, including a puffy face, excessive facial hair, night sweats, insomnia and hyperactivity.
More-serious side effects of Corticosteriods include high blood pressure, diabetes, osteoporosis, bone fractures, cataracts, glaucoma and increased chance of infection.
Another way ulcerative colitis is fought is with Immune system suppressors.
These drugs also reduce inflammation, but they do so by suppressing the immune system response that starts the process of inflammation.
Research has shown that for some people, a combination of these drugs works better than one drug alone.
Corticosteroids also may be used with an immune system suppressor, in which case the corticosteroids can induce remission, while the immune system suppressors can help maintain it.
Immunosuppressant drugs include Azathioprine and mercaptopurine. These are the most widely used immunosuppressant’s for treatment of inflammatory bowel disease as well as acute ulcerative colitis.
Taking these medications requires that you follow up closely with your doctor and have your blood checked regularly to look for side effects, including effects on the liver and pancreas.
Additional side effects include lowered resistance to infection and a small chance of developing cancers such as lymphoma and skin cancers.
This drug is normally reserved for people who haven’t responded well to other medications.
Cyclosporine has the potential for serious side effects, such as kidney and liver damage, seizures, and fatal infections, and is not for long-term use for majority of patients.
There’s also a small risk of cancer with some of these medications, so it is vital that you let your doctor know if you’ve previously had cancer.
They are for people with moderate to severe ulcerative colitis who don’t respond to or can’t tolerate other treatments.
People with certain conditions can’t take TNF-alpha inhibitors. Tuberculosis and other serious infections have been associated with the use of immunosuppressant drugs.
These drugs also are associated with a small risk of developing certain cancers such as lymphoma and skin cancers.
Alternative Treatment of Ulcerative Colitis
Herbal and alternative treatment plans can work to restore long-term remission of ulcerative colitis.
In fact there are a few herbal and lifestyle choices that can impact ulcerative colitis as well as the development or remission of it.
Probiotics for Ulcerative Colitis
Researchers suspect that adding more of the beneficial bacteria of probiotics that are normally found in the digestive tract might help combat the disease.
Although research is limited, there is some evidence that adding probiotics along with other medications may be helpful, but this has not been proved.
Fish oil acts as an anti-inflammatory, and there is some evidence that adding fish oil to aminosalicylates may be helpful, but this has not been proved. However a side effect is that Fish oil can cause diarrhea.
Aloe Vera gel may have an anti-inflammatory compounds that can have a positive effect for people with ulcerative colitis, but it also can cause diarrhea as a side effect.
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Curcumin, a compound found in the spice turmeric, has been combined with standard ulcerative colitis therapies in clinical trials. There is some evidence of benefit, but more research is needed and will be gathered as time progresses.
In essence ulcerative colitis is a chronic relapsing and remitting inflammatory bowl disorder that can generally be managed successfully with maintenance oral medications and lifestyle changes.
However, roughly 15% of all patients with ulcerative colitis will develop a severe exacerbation and require hospitalization.
While many patients with acute ulcerative colitis will respond to a short course of intravenous corticosteroids, up to a third will fail to improve.
In these patients with steroid-refractory colitis, the choice is between rescue medical therapy with ciclosporin or infliximab, or surgery.
Although surgery is unavoidable in some cases, it is however the treatment of choice for most of the other patients.
Have you dealt with ulcerative colitis? What worked or hasn’t worked for you? Leave a comment in the below comment sections, I would love to hear your experiences with Ulcerative Colitis.