Ulcerative colitis, a long-term bowel disease, is characterised by the inflammation of colon and rectum.[i]
The large intestines or bowel is referred to as colon while the lower area of bowel (where stools are stored) is called as rectum. The swelling and ulceration of these two areas is generally known as ulcerative colitis. Development of small ulcers on the lining of colon can cause pus formation and bleeding.
Ulcerative colitis, a chronic inflammatory bowel disease (IBD), occurs when abnormal reactions of a person’s immune system lead to inflammation and formation of ulcers in inner lining of large intestine. Although it can develop at any age, but people between of 15 to 30 years are more at risk of this disease.[ii]
Symptoms of Ulcerative Colitis
The symptoms of this condition can vary, depending on different factors including the severity of inflammation and the location where inflammation occurs. The sign and symptoms one might experience may include:
- Bloody stools
- Weight loss
- Pain in abdomen
- Rectal bleeding and pain
Types of UC
Ulcerative colitis is classified according to the location where it occurs. Different types of UC include:
- If the inflammation is close to the rectum and rectal bleeding occurs as an only sign, then the UC is called as Ulcerative proctitis.
- If the inflammation involves both rectum and sigmoid colon (lower end of colon) and symptoms such as pain, bloody diarrhea or abdominal cramps occur then this type is called as Proctosigmoiditis.
- If the swelling extends from rectum to sigmoid and descending colon and pain on the left side occurs then the type is referred to as Left-sided colitis.
- If entire colon is affected and bouts of severe bloody diarrhea and significant weight loss happens then this type is classified as pancolitis.
Causes of Ulcerative colitis
The exact causative factor of this disease is unknown but it might be a result of an auto-immune condition. It can also be inherited from a family member and some environmental may also be involved in the development of this disease.
About the same number of men and women are affected by ulcerative colitis. The risk factors that might trigger this disease include:
Age: people usually get UC before the age of 30 years but some individuals might not get this disease until 60 years.
Family History: ulcerative colitis may run through generations. Close relatives including parents, children and sibling are at a higher risk.
Race: It has been studied that white people have the highest risk of developing UC regardless of that it can occur to people of any race.
A definite diagnosis of UC can only be given by performing endoscopic procedures and tissue biopsy. However, some other tests can help in ruling out other complications or other inflammatory bowel diseases like Crohn’s disease.
Lab tests – Blood tests can be done to check the patient for anemia or any infection. Stool studies may also indicate the disease on finding certain proteins or white blood cells.
Endoscopic procedures – Procedures like colonoscopy or flexible sigmoidoscopy may be performed to examine the colon and rectum.
Imaging procedures – X-ray, CT-scan and CT enterography can also help in the diagnosis of UC.
Ulcerative colitis can treated by either drug therapy or surgery.
Different categories of drugs can be effective in treating UC. The doctor recommends the type that is most suitable for the patient depending upon severity and type of disease.
Anti-inflammatory drugs – these are usually the first treatment given for UC. These help to relieve the pain and inflammation. The anti-inflammatory drugs usually include 5-aminosalicylates (sulfasalazine and mesalamine), Corticosteroids (prednisone and budesonide) and Immunosuppressants like Azathioprine and mercaptopurine. Cyclosporine is generally reserved for individuals who have not responded to other medicines. It is not used for a long period as it has serious side effects. Tofacitinib stops the process of inflammation. FDA has warned the tofacitinib has an increased risk of causing cancer and serious heart-related problems
Biologics – like infliximab and vedolizumab target proteins formed by immune system.
Other medications – additional medications such as pain killers, anti-diarrheal, and antispasmodics can be used to manage the specific symptoms of UC. Iron supplements – chronic intestinal bleeding can lead to iron deficiency and anemia. So iron supplements may be given to such patients.
Surgery – proctocolectomy may be performed to remove the area of colon or rectum severely damaged by ulcerative colitis. [iii]
Lifestyle and home remedies
Changes in the way you live and what you intake is one of the best way to control the symptoms of ulcerative colitis and to increase the period between flare-ups. Although there is no firm evidence that your eating habits or your food intake can cause inflammatory bowel disease but there are certain foods and beverages which can actually aggravate the signs and symptoms of this disease especially during a flare-up.
A food diary can be helpful in keeping track of what a person is eating and what he is feeling when he eats it. You can simply try to eliminate the foods or beverages that are not making you feel good.
Some general diet suggestions that can help in managing ulcerative colitis are as follows:
Stop or the limit the use of dairy products like butter or cheese. Most people feel better when they stop using these. Dairy products contain lactose which cannot be digested by the body in some people which causes diarrhea or bloating. In such cases enzyme products like Lactaid can be used.
If you intake small meals after short intervals rather than larger meals at a single time you may feel much better.
Drinking plenty of liquids daily can be helpful in ulcerative colitis. Limit the use of alcohol or beverages containing caffeine as they stimulate the intestines thus making the diarrhea worse.
Take an advice from a dietitian if you are losing weight or it your diet is becoming limited.
Stress can trigger a lot of disease. Although it is not directly related to inflammatory bowel disease but it can worsen the signs and symptoms of UC.