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Ulcerative colitis

Inflammatory bowel disease - ulcerative colitis; IBD - ulcerative colitis

 

Ulcerative colitis is a condition in which the lining of the large intestine (colon) and rectum become inflamed. It is a form of inflammatory bowel disease (IBD). Crohn disease is a related condition.

Causes

 

The cause of ulcerative colitis is unknown. People with this condition have problems with the immune system. However, it is not clear if immune problems cause this illness. Stress and certain foods can trigger symptoms, but they do not cause ulcerative colitis.

Ulcerative colitis may affect any age group. There are peaks at ages 15 to 30 and then again at ages 50 to 70.

The disease can begin in the rectal area. It may involve the entire large intestine over time. It may also start in the rectum and other parts of the large intestine at the same time.

Risk factors include a family history of ulcerative colitis or other autoimmune diseases, or Jewish ancestry.

 

Symptoms

 

The symptoms can be more or less severe. They may start slowly or suddenly. Half of people only have mild symptoms. Others have more severe attacks that occur more often. Many factors can lead to attacks.

Symptoms may include:

  • Pain in the abdomen (belly area) and cramping.
  • A gurgling or splashing sound heard over the intestine.
  • Blood and possibly pus in the stools.
  • Diarrhea, from only a few episodes to very often.
  • Fever.
  • Feeling that you need to pass stools, even though your bowels are already empty. It may involve straining, pain, and cramping (tenesmus).
  • Weight loss.

Children's growth may slow.

Other symptoms that may occur with ulcerative colitis include the following:

  • Joint pain and swelling
  • Mouth sores (ulcers)
  • Nausea and vomiting
  • Skin lumps or ulcers

 

Exams and Tests

 

Colonoscopy with biopsy is most often used to diagnose ulcerative colitis. Colonoscopy is also used to screen people with ulcerative colitis for colon cancer.

Other tests that may be done to help diagnose this condition include:

  • Barium enema
  • Complete blood count (CBC)
  • C-reactive protein (CRP)
  • Erythrocyte sedimentation rate (ESR)

 

Treatment

 

The goals of treatment are to:

  • Control the acute attacks
  • Prevent repeated attacks
  • Help the colon heal

During a severe episode, you may need to be treated in the hospital for severe attacks. Your doctor may prescribe corticosteroids. You may be given nutrients through a vein (IV line).

DIET AND NUTRITION

Certain types of foods may worsen diarrhea and gas symptoms. This problem may be more severe during times of active disease. Diet suggestions include:

  • Eat small amounts of food throughout the day.
  • Drink plenty of water (drink small amounts throughout the day).
  • Avoid high-fiber foods (bran, beans, nuts, seeds, and popcorn).
  • Avoid fatty, greasy or fried foods and sauces (butter, margarine, and heavy cream).
  • Limit milk products if you are lactose intolerant. Dairy products are a good source of protein and calcium.

STRESS

You may feel worried, embarrassed, or even sad or depressed about having a bowel accident. Other stressful events in your life, such as moving, or losing a job or a loved one can cause worsening of digestive problems.

Ask your health care provider for tips on your to manage your stress.

MEDICINES

Medicines that may be used to decrease the number of attacks include:

  • 5-aminosalicylates such as mesalamine or sulfasalazine, which can help control moderate symptoms. Some forms of the drug are taken by mouth; others must be inserted into the rectum.
  • Medicines to quiet the immune system.
  • Corticosteroids such as prednisone. They may be taken by mouth during a flare-up or inserted into the rectum.
  • Biologic therapy, if you do not respond to other drugs.
  • Acetaminophen (Tylenol) may help relieve mild pain. Avoid drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). These can make your symptoms worse.

SURGERY

Surgery to remove the colon will cure ulcerative colitis and removes the threat of colon cancer. You may need surgery if you have:

  • Colitis that does not respond to complete medical therapy
  • Changes in the lining of the colon that can lead to cancer
  • Severe problems, such as rupture of the colon, severe bleeding, or toxic megacolon

Most of the time, the entire colon, including the rectum, is removed. After surgery, you may have:

  • An opening in your belly called the stoma (ileostomy). Stool will drain out through this opening.
  • A procedure that connects the small intestine to the anus to gain more normal bowel function.

 

Support Groups

 

Social support can often help with the stress of dealing with illness, and support group members may also have useful tips for finding the best treatment and coping with the condition.

The Crohn's and Colitis Foundation of America (CCFA) has information and links to support groups.

 

Outlook (Prognosis)

 

Symptoms are mild in about half of people with ulcerative colitis. More severe symptoms are less likely to respond well to medicines.

Cure is only possible through complete removal of the large intestine.

The risk of colon cancer increases in each decade after ulcerative colitis is diagnosed.

 

Possible Complications

 

You have a higher risk for small bowel and colon cancer if you have ulcerative colitis. At some point, your provider will recommend tests to screen for colon cancer.

More severe episodes that recur may cause the walls of the intestines to become thickened, leading to:

  • Colon narrowing or blockage
  • Episodes of severe bleeding
  • Severe infections
  • Sudden widening (dilation) of the large intestine within 1 to a few days
  • Tears or holes (perforation) in the colon

Problems absorbing nutrients may lead to:

  • Thinning of the bones (osteoporosis)
  • Problems maintaining a healthy weight
  • Slow growth and development in children

Less common problems that may occur include:

  • Type of arthritis that affects the bones and joints at the base of the spine, where it connects with the pelvis (ankylosing spondylitis)
  • Liver disease
  • Tender, red bumps (nodules) under the skin, which may turn into skin ulcers
  • Sores or swelling in the eye

 

When to Contact a Medical Professional

 

Call your provider if:

  • You develop ongoing abdominal pain, new or increased bleeding, fever that does not go away, or other symptoms of ulcerative colitis
  • You have ulcerative colitis and your symptoms worsen or do not improve with treatment
  • You develop new symptoms

 

Prevention

 

There is no known prevention for this condition.

 

 

References

Bressler B, Marshall JK, Bernstein CN, et al. Clinical practice guidelines for the medical management of nonhospitalized ulcerative colitis: the Toronto consensus. Gastroenterology. 2015;148(5):1035-1058. PMID: 25747596 www.ncbi.nlm.nih.gov/pubmed/25747596.

D'Haens GR, Panaccione R, Higgins PD, et al. The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn's and Colitis Organization: when to start, when to stop, which drug to choose, and how to predict response? Am J Gastroenterol. 2011;106(2):199-212. PMID: 21045814 www.ncbi.nlm.nih.gov/pubmed/21045814.

Kornbluth A, Sachar DB; Practice Parameters Committee of the American College of Gastroenterology. Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 2010;105(3):501-523. PMID: 20068560 www.ncbi.nlm.nih.gov/pubmed/20068560.

Mowat C, Cole A, Windsor A, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011;60(5):571-607. PMID: 21464096 www.ncbi.nlm.nih.gov/pubmed/21464096.

Osterman MT, Lichtenstein GR. Ulcerative colitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 116.

Ross H, Steele SR, Varma M, et al. Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum. 2014;57(1):5-22. PMID: 24316941 www.ncbi.nlm.nih.gov/pubmed/24316941.

 
  • Ulcerative colitis

    Animation

  •  

    Ulcerative colitis - Animation

    Living with ulcerative colitis can be a constant gamble. You run to the grocery store, hoping this won't be the day when your disease flares up. You might get lucky, or your disease could hit again in the middle of the store, leaving you in a search for a bathroom. Let's talk about ulcerative colitis. Ulcerative colitis is a type of inflammatory bowel disease. It's caused by a malfunction in the body's immune system. Normally, the immune system protects against bacteria and other foreign invaders. But in people with ulcerative colitis, it mistakenly attacks the rectum and intestines, causing them to swell up and thicken. As a result, people with ulcerative colitis have bouts of severe abdominal pain and diarrhea. They can lose weight without meaning to. If you've been experiencing any of these symptoms, your doctor can test for ulcerative colitis with a colonoscopy. Your doctor can take a sample of your intestines, to diagnose ulcerative colitis and check for colon cancer, a risk associated with ulcerative colitis. Medicines can help with the symptoms of ulcerative colitis. There are medicines to control diarrhea, and pain relievers to help with the abdominal cramps. There are also medicines that quiet the overactive immune response that causes ulcerative colitis. Changing your diet may help control your immune system from attacking your intestines. Changing your diet can limit diarrhea and gas, especially when you're having active attacks. Your doctor may recommend you eat small meals throughout the day, drink plenty of water, and avoid high-fiber foods and high-fat foods. You may feel worried, embarrassed, or even sad or depressed about having bowel accidents. Other stressful events in your life, such as losing a job or a loved one, may make your symptoms worse. Your doctor can help you manage your stress. If your symptoms are severe, surgery to remove your large intestine may be the best way to cure your ulcerative colitis. If you're experiencing any ulcerative colitis symptoms-like stomach pain, diarrhea, or unplanned weight loss, call your doctor. Although surgery is the only cure, treatments can relieve some of the uncomfortable symptoms, and help you to lead a more normal life-free from the constant stress of having to search for the bathroom.

  • Colonoscopy

    Colonoscopy - illustration

    There are 4 basic tests for colon cancer: a stool test (to check for blood), sigmoidoscopy (inspection of the lower colon, colonoscopy (inspection of the entire colon), and double contrast barium enema. All 4 are effective in catching cancers in the early stages, when treatment is most beneficial.

    Colonoscopy

    illustration

  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Ulcerative colitis

    Ulcerative colitis - illustration

    Ulcerative colitis is categorized according to location: Proctitis involves only the rectumProctosigmoiditis affects the rectum and sigmoid colonLeft-sided colitis encompasses the entire left side of the large intestinePancolitis inflames the entire colon Proctitis involves only the rectum Proctosigmoiditis affects the rectum and sigmoid colon Left-sided colitis encompasses the entire left side of the large intestine Pancolitis inflames the entire colon

    Ulcerative colitis

    illustration

  • Ulcerative colitis

    Animation

  •  

    Ulcerative colitis - Animation

    Living with ulcerative colitis can be a constant gamble. You run to the grocery store, hoping this won't be the day when your disease flares up. You might get lucky, or your disease could hit again in the middle of the store, leaving you in a search for a bathroom. Let's talk about ulcerative colitis. Ulcerative colitis is a type of inflammatory bowel disease. It's caused by a malfunction in the body's immune system. Normally, the immune system protects against bacteria and other foreign invaders. But in people with ulcerative colitis, it mistakenly attacks the rectum and intestines, causing them to swell up and thicken. As a result, people with ulcerative colitis have bouts of severe abdominal pain and diarrhea. They can lose weight without meaning to. If you've been experiencing any of these symptoms, your doctor can test for ulcerative colitis with a colonoscopy. Your doctor can take a sample of your intestines, to diagnose ulcerative colitis and check for colon cancer, a risk associated with ulcerative colitis. Medicines can help with the symptoms of ulcerative colitis. There are medicines to control diarrhea, and pain relievers to help with the abdominal cramps. There are also medicines that quiet the overactive immune response that causes ulcerative colitis. Changing your diet may help control your immune system from attacking your intestines. Changing your diet can limit diarrhea and gas, especially when you're having active attacks. Your doctor may recommend you eat small meals throughout the day, drink plenty of water, and avoid high-fiber foods and high-fat foods. You may feel worried, embarrassed, or even sad or depressed about having bowel accidents. Other stressful events in your life, such as losing a job or a loved one, may make your symptoms worse. Your doctor can help you manage your stress. If your symptoms are severe, surgery to remove your large intestine may be the best way to cure your ulcerative colitis. If you're experiencing any ulcerative colitis symptoms-like stomach pain, diarrhea, or unplanned weight loss, call your doctor. Although surgery is the only cure, treatments can relieve some of the uncomfortable symptoms, and help you to lead a more normal life-free from the constant stress of having to search for the bathroom.

  • Colonoscopy

    Colonoscopy - illustration

    There are 4 basic tests for colon cancer: a stool test (to check for blood), sigmoidoscopy (inspection of the lower colon, colonoscopy (inspection of the entire colon), and double contrast barium enema. All 4 are effective in catching cancers in the early stages, when treatment is most beneficial.

    Colonoscopy

    illustration

  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Ulcerative colitis

    Ulcerative colitis - illustration

    Ulcerative colitis is categorized according to location: Proctitis involves only the rectumProctosigmoiditis affects the rectum and sigmoid colonLeft-sided colitis encompasses the entire left side of the large intestinePancolitis inflames the entire colon Proctitis involves only the rectum Proctosigmoiditis affects the rectum and sigmoid colon Left-sided colitis encompasses the entire left side of the large intestine Pancolitis inflames the entire colon

    Ulcerative colitis

    illustration

A Closer Look

 

Self Care

 

Tests for Ulcerative colitis

 

 

Review Date: 8/14/2015

Reviewed By: Subodh K. Lal, MD, gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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