Overview
Ulcerative colitis is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in the digestive tract, specifically affecting the innermost lining of the large intestine, colon, and rectum. Symptoms may include diarrhea with blood or pus, rectal bleeding, abdominal pain, urgency to defecate, inability to defecate despite urgency, weight loss, and fatigue. Ulcerative colitis usually begins before the age of 30 but can occur at any age, with no known cure. However, new treatments can greatly reduce symptoms and bring about long-term remission. Risk factors include age, race or ethnicity, family history, and gender. Complications can be severe and may include severe bleeding, dehydration, colon swelling, colon perforation, blood clots, inflammation of other body parts, increased risk of colon cancer, bone loss, and more.
Understanding the disease
Symptoms
The symptoms of ulcerative colitis can vary depending on the severity of inflammation and where it occurs. Common symptoms include diarrhea, often with blood or pus; rectal bleeding; abdominal pain and cramping; rectal pain; urgency to defecate; inability to defecate despite urgency; weight loss; fatigue; and fever. Children with ulcerative colitis may also experience failure to grow. The course of ulcerative colitis may vary, with some people having long periods of remission.
Risk Factors
The risk factors for developing ulcerative colitis may include age, family history, and race or ethnicity. The disease usually begins before the age of 30, but it can occur at any age. People of Ashkenazi Jewish descent have a higher risk of developing ulcerative colitis. If you have a close relative, such as a parent, sibling, or child, with the disease, your risk is also higher. Although white people have the highest risk of the disease, it can occur in any race.
Development
Ulcerative colitis (UC) develops as a result of chronic inflammation and ulcers in the digestive tract, particularly in the colon and rectum. The exact cause of UC is unknown, but it is believed to be an autoimmune disorder, where the immune system mistakenly attacks the healthy cells in the lining of the intestines. There are several types of UC, which are classified based on their location and symptoms. These include ulcerative proctitis, proctosigmoiditis, and pancolitis. In most cases, symptoms of UC develop gradually over time and can vary in severity. While there is no known cure for UC, treatment options can help manage symptoms and reduce inflammation, aiming to achieve long-term remission.
Assessment and Diagnosis
Triage
You should see a doctor if you experience persistent changes in your bowel habits or if you have signs and symptoms such as abdominal pain, blood in your stool, ongoing diarrhea that doesn't respond to nonprescription medications, diarrhea that awakens you from sleep, or an unexplained fever lasting more than a day or two. Although ulcerative colitis usually isn't fatal, it's a serious disease and may cause life-threatening complications.
Diagnosis
To diagnose ulcerative colitis, endoscopic procedures with tissue biopsy are necessary. Other tests can help rule out complications or other forms of inflammatory bowel disease, such as Crohn's disease. Some of the tests that may be performed include blood tests, stool studies, CT scan, CT enterography, and MR enterography. A complete medical history and physical examination can also help determine if other conditions may be contributing to the symptoms.
Management and Treatment
Complications
Potential complications of ulcerative colitis include severe bleeding, severe dehydration, a rapidly swelling colon (toxic megacolon), a hole in the colon (perforated colon), increased risk of blood clots in veins and arteries, inflammation of the skin, joints, and eyes, an increased risk of colon cancer, and bone loss (osteoporosis).
Treatment
There are several new treatments for ulcerative colitis that can greatly reduce symptoms and bring about long-term remission. However, the specific treatments depend on the severity of the symptoms and the location of the inflammation. Some common treatments for ulcerative colitis include:
- Aminosalicylates: These medications help reduce inflammation and are often used to treat mild to moderate ulcerative colitis. Examples include sulfasalazine, mesalamine, and olsalazine.
- Corticosteroids: These medications can help reduce inflammation and are often used to treat moderate to severe ulcerative colitis. Examples include prednisone, hydrocortisone, and methylprednisolone.
- Immunomodulators: These medications help regulate the immune system and are often used to treat moderate to severe ulcerative colitis. Examples include azathioprine, mercaptopurine, and methotrexate.
- Biologics: These medications target specific immune system proteins and are often used for people with moderate to severe ulcerative colitis who haven't responded to other treatments. Examples include infliximab, adalimumab, and vedolizumab. In addition to medications, lifestyle changes like following a low-residue diet, managing stress, and quitting smoking can help improve symptoms. Always consult with a healthcare professional for personalized advice and treatment recommendations.
Preparing for medical consultation
To prepare for an appointment for ulcerative colitis, you should:
- Be aware of any pre-appointment restrictions and ask if there's anything you need to do in advance, such as restricting your diet.
- Write down any symptoms you're experiencing, including those that may seem unrelated to the reason for your appointment.
- Write down key personal information, such as major stresses or recent life changes.
- Make a list of all medications, vitamins, or supplements you're taking.
- Bring a family member or friend to the appointment to help remember important information.
- Prepare a list of questions to ask your healthcare provider, prioritizing the most important questions first. Some basic questions to ask include:
- What's the most likely cause of my symptoms?
- Are there other possible causes for my symptoms?
- What kinds of tests do I need? Do these tests require any special preparation?
- Is this condition temporary or long-lasting? Remember to discuss these questions and any other concerns with your healthcare provider during the appointment.