Understanding Ulcerative Colitis
What if you were passing blood in your stool no matter what you ate? Couple that with frequent bouts of sharp pain and this is a description of ulcerative colitis, a disease that affects millions of people.
Ulcerative colitis is an inflammatory disease of the colon or large intestine. This disease can cause debilitating abdominal pain and diarrhea and it may substantially increase your risk of colon cancer.
Our large intestines contains trillions of bacteria. Normally, tissue lining the intestine prevents the bacteria from infecting the intestinal wall. But when the intestinal lining fails, bacteria that usually are harmless can activate your immune system.
Ulcerative colitis (UC) is an autoimmune disease. In such diseases, the immune system—which is there to defend us against foreign invaders—instead attacks our own tissues. In the case of UC, the immune system mistakenly attacks the intestine, causing inflammation and injury. Over time, UC wears away the lining of the rectum and colon; it leaves ulcers that may bleed or ooze.
UC can cause abdominal cramping, bloody diarrhea, and urgent bowel movements. Some other symptoms of this disease include rectal pain, rectal bleeding, urgency to defecate, inability to defecate despite urgency, weight loss, fatigue, fever, and failure to grow (in children). You may be able to ease these symptoms by avoiding foods that may trigger flare-ups. Some common culprits may be spicy foods and dairy products.
According to the Centers for Disease Control and Prevention, in 2015, an estimated 1.3 percent (3 million) of United States adults reported being diagnosed with inflammatory bowel disease (either Crohn’s disease or ulcerative colitis). Most people are diagnosed with inflammatory bowel disease in their 20s and 30s. Inflammatory bowel diseases are more prevalent in women compared with men. UC tends to run in families with about 20 percent of UC patients having a family member with the condition. UC is not caused by an infection and is a lifelong disease. The cause of UC is unknown and can affect anyone at any age, though it was thought that those with Jewish ancestry may be more at risk.
The inflammation in UC usually starts in the rectum, which is close to the anus. The inflammation can then spread to a portion of or the entire colon. Doctors classify UC based on its location. For instance, inflammation confined closest to the anus is referred to as ulcerative proctitis. Other types of UC include proctosigmoiditis which refers to inflammation that affects the rectum and the sigmoid colon (lower end of the colon); left sided colitis which refers to inflammation that extends from the rectum up through the sigmoid colon and the descending colon; and pancolitis which refers to inflammation that affects the entire colon.
UC may be associated with other conditions as well such as arthritis, inflammation of the eye, liver disease and osteoporosis, which may be caused by inflammation of the immune system. Some of these conditions may be alleviated once the colitis is treated.
UC is diagnosed through lab tests such as blood tests, stool sample studies and procedures like a colonoscopy, where a thin flexible tube with a camera on the end is inserted into the rectum. Your doctor may also want to perform flexible sigmoidoscopy where a slender flexible lighted tube is used to examine the rectum and the sigmoid colon instead of a full colonoscopy. Your physician may perform other exams including an X-ray, a computerized tomography (CT) scan, and computerized tomography enterography and magnetic resonance enterography to check out if there is any inflammation in the small intestine.
UC is treated with anti-inflammatory drugs initially such as 5-aminosalicylates and corticosteroids. Your doctor may prescribe immune system suppressors like azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). Another treatment option are biologics such as infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi). Other recommended medications include anti-diarrheal medications, pain relievers, antispasmodics, and iron supplements. Surgery may be another option to remove the entire colon and rectum if needed. And because of increased risk of cancer, your doctor may recommend a follow-up colonoscopy every one to two years.
Your doctor may recommend some lifestyle changes like limiting dairy products, eating smaller meals, drinking plenty of liquids, and talking to a dietician regarding other food choices that won’t trigger flare-ups of the disease (for example, some research indicates probiotics may be beneficial for UC patients. Learn ways to manage your stress such as engaging in an exercise regimen, relaxation and breathing exercises like yoga and meditation.
While there is no cure for UC, the goal of any treatment is to experience remission and keep flare-ups limited or nonexistent. With the right course of action, UC patients can remain in remission for an indefinite period of time and resume a sense of normalcy.
