Coping with ulcerative colitis is no easy thing. The chronic disease, which may affect as many as 700,000 people in the United States, causes inflammation and sores in the lining of the colon and rectum. As the inflammation worsens, the cells that line these areas die off, resulting in bleeding, infection, and diarrhea. The condition can cause:
- joint pain
- appetite loss
- weight loss
- skin lesions
- nutritional deficiencies
- stunted growth (in children)
The exact cause of ulcerative colitis is unclear, though many experts believe it results from an abnormality of the immune system and an inability to handle bacteria in the digestive tract.
A doctor may request a blood test, stool samples, barium enema, and colonoscopy to determine whether your symptoms are being caused by ulcerative colitis rather than another condition like Crohn’s disease, diverticular disease, or cancer. Ulcerative colitis should be confirmed by biopsy (sampling) of tissue during colonoscopy.
If you’re diagnosed with ulcerative colitis, it’s vital to map out a treatment plan that controls and prevents attacks so that your colon can heal. Because the symptoms and effects of the disease vary, there’s no single treatment that works for everyone. According to the National Institute of Health, treatments center on four key areas:
Diet and Nutrition
It’s best to consume smaller amounts of food throughout the day and avoid raw and high-fiber foods such as:
- whole grains
Fatty and greasy foods also contribute to inflammation and pain. In general, safe foods include dairy, low-fiber grains, meats, and some raw fruits and vegetables. Sipping water throughout the day can aid in digestion and reduce inflammation.
Anxiety and nervousness can worsen symptoms. Exercise and relaxation techniques that help you manage and reduce your stress levels can prove helpful. These include:
A doctor may prescribe medication to induce or maintain remission. Although several types of medications exist, each drug falls into four primary categories.
These drugs contain 5-aminosalicyclic acid (5-ASA), which helps control inflammation in the intestine. They typically take three to six weeks to work. However, they may cause side effects, including:
This group of steroid drugs — including prednisone, budesonide, methylprednisolone, and hydrocortisone — reduce inflammation. They’re often used for patients suffering from moderate to severe ulcerative colitis, including those who haven’t responded favorably to 5-ASA drugs. Corticosteroids can be administered orally, intravenously, through an enema, or in a suppository. Side effects include:
- facial hair
- weight gain
- mood swings
- bone mass loss
- increased risk of infection
Consequently, steroids are ideally used on a short-term basis to temper a flare up of ulcerative colitis, rather than as a medication that is taken every day to control symptoms. Sometimes, when ulcerative colitis is very severe, patients end up on a daily dose of steroids to maintain a normal lifestyle.
These drugs, including azathioprine and 6-mercapto-purine (6-MP), reduce inflammation of the immune system — though they can take as long as six months to work effectively. Immunomodulators are administered orally and typically used for patients that don’t respond favorably to 5-ASAs or corticosteroids. Potential side effects include:
- reduced white blood cell count
- increased risk of infection
These are a newer class of drugs used to treat patients that haven’t responded well to other ulcerative colitis treatments. Biologics are different than other drugs because they target specific enzymes and proteins. This often means fewer side effects. They can be given through intravenous infusion or injections. Currently, there are four biologic medications:
- adalimumab (Humira)
- golimumab (Simponi)
- infliximab (Remicade)
- vedolizumab (Entyvio)
If other forms of treatment fail, you may be a candidate for surgery. An estimated 25 to 40 percent of ulcerative colitis patients eventually have their colons removed as a result of severe bleeding and illness — or increased risk of cancer. Two types of surgeries exist, total proctocolectomy with ileostomy and total proctocolectomy with ileal-anal pouch anastomosis:
- Total proctocolectomy with ileostomy: A surgeon creates a small opening, or stoma, in the abdomen and removes your large intestine and rectum. Your small intestine (ileum) is pulled through the surgical cut and sewn onto your stomach. A pouch at the beltline area will be attached to collect waste. The patient empties the pouch as it fills up.
- Total proctocolectomy and ileal pouch-anal anastomosis: A surgeon removes the colon along with the inside of the rectum. The outer muscles of the rectum remain intact. The surgeon creates a pouch from the ileum (a portion of the small intestine) so that the patient can pass waste through the anus. Possible side effects and complications include watery bowel movements and inflammation of the pouch.
If you’ve been diagnosed with ulcerative colitis, avoid nonsteroidal anti-inflammatory drugs (NSAIDs), which may make symptoms worse. In addition, make sure to map out a strategy with your doctor and get an exam every year or two due to an increased risk of cancer. With the right approach, it’s possible to cope with ulcerative colitis and live a normal lifestyle.