Ulcerative colitis is an inflammatory bowel disease (IBD). IBD comprises a group of diseases that affect the gastrointestinal tract. Ulcerative colitis occurs when the lining of your large intestine (also called the colon), rectum, or both becomes inflamed. This inflammation produces tiny sores called ulcers on the lining of your colon. It usually begins in the rectum and spreads upward. It can involve your entire colon.
The inflammation causes your bowel to move its contents rapidly and empty frequently. As cells on the surface of the lining of your bowel die, ulcers form. The ulcers may cause bleeding and discharge of mucus and pus.
While this disease affects people of all ages, most people are diagnosed between the ages of 15 and 35. After age 50, another small increase in diagnosis for this disease is seen, usually in men.
Although the trigger for ulcerative colitis remains unclear, researchers understand that the immune system undergoes an abnormal response to the colon. Your genes, environment, and immune system all play a role.
Most people with ulcerative colitis don’t have a family history of the condition. However, you’re more likely to develop it if a parent or sibling also has the condition.
Ulcerative colitis can develop in a person of any race, but it’s more common in Caucasians. According to the Mayo Clinic, if you’re an Ashkenazi Jew, you have a greater chance of developing the condition than most other groups.
Some studies show a possible link between the use of the drug isotretinoin (Accutane, Amnesteem, Claravis, or Sotret) and ulcerative colitis. Isotretinoin treats cystic acne.
The seriousness of symptoms varies among affected people. According to Cedars-Sinai, about 50 percent of people diagnosed with ulcerative colitis have mild symptoms. However, symptoms can be severe. Common symptoms of ulcerative colitis include:
- abdominal pain
- increased abdominal sounds
- bloody stools
- rectal pain
- weight loss
Ulcerative colitis may cause additional conditions such as:
- joint pain
- joint swelling
- nausea and decreased appetite
- skin problems
- mouth sores
- eye inflammation
Ulcerative colitis increases your risk of colon cancer. The longer you have the disease, the higher your risk of this cancer. Because of this increased risk, your doctor will perform a colonoscopy and check for cancer when you receive your diagnosis. Regular screening helps lower your risk of colon cancer. Repeat screenings every one to three years are recommended thereafter. Follow-up screenings can detect precancerous cells early.
Other complications of ulcerative colitis include:
- thickening of the intestinal wall
- sepsis, or blood infection
- severe dehydration
- toxic megacolon, or a rapidly swelling colon
- liver disease (rare)
- intestinal bleeding
- kidney stones
- inflammation of your skin, joints, and eyes
- rupture of your colon
- ankylosing spondylitis, which involves inflammation of joints between your spinal bones
Different tests can help your doctor diagnose ulcerative colitis. This disorder mimics other bowel diseases such as Crohn’s disease. Your doctor will run multiple tests to rule out other conditions.
Tests to diagnose ulcerative colitis often include:
- Stool test: A doctor examines your stool for blood, bacteria, and parasites.
- Endoscopy: A doctor uses a flexible tube to examine your stomach, esophagus, and small intestine.
- Colonoscopy: This diagnostic test involves insertion of a long, flexible tube into your rectum to examine the inside of your colon.
- Biopsy: A surgeon removes a tissue sample from your colon for analysis.
- CT scan: This is a specialized X-ray of your abdomen and pelvis.
Blood tests are often useful in the diagnosis of ulcerative colitis. A complete blood count looks for signs of anemia (low blood count). Other tests indicate inflammation such as a high level of C-reactive protein and a high sedimentation rate. Your doctor may also order specialized antibody tests.
Ulcerative colitis is a chronic condition. Treatment usually involves drug therapy or surgery. The goal of treatment is to reduce the inflammation that causes your symptoms.
Your doctor may prescribe a medication to reduce inflammation and swelling. These types of medications include sulfasalazine (Azulfidine), mesalamine (Asacol and Lialda), balsalazide (Colazal), and olsalazine (Dipentum). Reducing inflammation will help alleviate many of your symptoms.
Tofacitinib (Xeljanz) is a newer option for treating moderate-to-severe ulcerative colitis. It's the first in a class of medications called a Janus kinase inhibitor. It works by reducing signals in the body that cause inflammation.
More severe cases may need corticosteroids, antibiotics, medications that suppress immune function, or antibody medications, called biologics, that help block inflammation in a different way.
If your symptoms are severe, you’ll need to be hospitalized to correct the effects of dehydration and loss of electrolytes that diarrhea causes and to treat any complications
Surgery is necessary when there is massive bleeding, chronic and debilitating symptoms, perforation of your colon, or a severe blockage. A CT scan or colonoscopy can detect these serious problems.
Surgery involves removing your entire colon with the creation of a new pathway for waste. This pathway can be out through a small opening in your abdominal wall or redirected back through the end of your rectum.
To redirect waste through your abdominal wall, your surgeon will make a small opening in your abdominal wall. The tip of your lower small intestine, or the ileum, is then brought to the skin’s surface. Waste will drain through the opening into a bag.
If waste is able to be redirected through your rectum, your surgeon removes the diseased part of your colon and rectum, but retains the outer muscles of your rectum. The surgeon then attaches your small intestine to the rectum to form a small pouch. After this surgery, you’re able to pass stool through your rectum. Bowel movements will be more frequent and watery than normal.
There is no solid evidence that indicates what you eat affects ulcerative colitis. You may find that certain foods aggravate your symptoms when you have a flare-up. Practices that may help include:
- drinking small amounts of water throughout the day
- eating smaller meals throughout the day
- limiting your intake of high-fiber foods
- avoiding fatty foods
- lowering your intake of milk if you’re lactose intolerant
Also, ask your doctor if you should take a multivitamin.
The only cure for ulcerative colitis is removal of the entire colon and rectum. Your doctor will usually begin with medical therapy unless you have a severe complication initially that requires surgery. Some may do well with medical therapy, but many will eventually require surgery.
If you have this condition, your doctor will need to monitor it, and you’ll need to carefully follow your treatment plan throughout your life.