What Is Ulcerative Colitis?
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Symptoms of ulcerative colitis vary among patients, depending on the severity of the inflammation and the area that is affected. The majority of patients with ulcerative colitis experience mild to moderate symptoms; some patients may have long periods where the disease goes into remission. Patients with ulcerative colitis may present with the following signs and symptoms:
- Diarrhea (may have pus or blood)
- Abdominal cramping and pain
- Pain in the rectum
- Bleeding from the rectum
- Urgency to defecate
- Inability to defecate
- Weight loss
Children with ulcerative colitis may not experience normal growth and development.
Complications that can occur in patients with ulcerative colitis include perforated colon, severe bleeding, osteoporosis, inflammation of the skin, joints, and eyes, oral sores, toxic megacolon, and liver disease (rare). Additionally, patients with ulcerative colitis have an increased risk of blood clots in arteries and veins, as well as an increased risk of colon cancer.
Diagnosis of ulcerative colitis is usually made after ruling out various other potential causes of a patient’s symptoms. Physicians will take a detailed history (including family history) and perform a thorough physical examination. Bloods tests may be ordered to check for infection or anemia. A stool sample may be requested to look for white blood cells in the stool, as this may be a sign of ulcerative colitis. A stool sample can also rule out other conditions, including infections caused by bacteria, parasites, and viruses. A colonoscopy may be recommended to visualize the colon and take a biopsy as this may help to confirm the diagnosis of ulcerative colitis. If the bowel is too inflamed, flexible sigmoidoscopy may be utilized instead of colonoscopy as it uses a small, flexible tube to visualize the last part of the colon.
X-rays of the abdomen are recommended for patients with severe symptoms as they can help to rule out serious complications (i.e. perforated colon). Computed tomography (CT) scans may also be used in this patient population to rule out complications or inflammation of the small intestine. A CT is also a useful tool to visualize the extent of colon inflammation.
What Causes Ulcerative Colitis?
The exact cause of ulcerative colitis is not known. One potential cause is an abnormal immune system response whereby the immune system mistakenly attacks the healthy cells of the gastrointestinal tract.
Furthermore, genetics may play a role in the disease, as ulcerative colitis is more common in individuals who have family members with the condition.
While the exact cause of ulcerative colitis remains unknown, certain risk factors have been identified that increase an individual’s risk of developing the disease, including:
- Age: While ulcerative colitis can occur at any age, it tends to begin before the age of 30
- Race: While ulcerative colitis can occur in any race, Caucasians have the highest risk of developing the disease (those of Ashkenazi Jewish decent are at an even higher risk)
- Genetics: Individuals who have a close relative (parent, sibling, or child) with ulcerative colitis are at a higher risk for developing the disease
- Isotretinoin use: Use of this medication (used to treat acne or scarring cystic acne) has been found to be a risk factor for developing IBD; however, a clear link between isotretinoin use and ulcerative colitis has not been clearly shown
Treatments For Ulcerative Colitis
Treatment for ulcerative colitis usually consists of pharmacologic management or surgery. Various medications have shown to be effective for the treatment of ulcerative colitis.
Anti-inflammatory medications are usually the first line treatment for ulcerative colitis. These drugs include aminosalicylates and corticosteroids. Aminosalicylates are available in oral and enema forms; the form that is prescribed depends on the area of the colon that is affected. Aminosalicylates have been associated with pancreas and kidney problems (rarely).
Corticosteroids are available in oral, IV, or enema form; the form that is prescribed depends on the area of the colon that is affected. Corticosteroids are usually used to treat moderate to severe cases of ulcerative colitis, or for cases that have been unresponsive to other treatments. Corticosteroids are usually used for short-term relief, as they are associated with various side effects including facial puffiness, excessive facial hair, insomnia, night sweats, and hyperactivity. Additionally, serious side effects can occur with corticosteroid use including hypertension, diabetes, osteoporosis, fractures, cataracts, glaucoma, and an increased risk of infection.
Immune system suppressors are used for the treatment of ulcerative colitis as they help to reduce inflammation by suppressing the response of the immune system that starts the inflammation process. Often a combination of immune system suppressor medications provides optimal relief. At times, an immune system suppressor may be used in combination with a corticosteroid; this combination allows for maintained remission of the condition.
Other medications may be utilized to manage specific ulcerative colitis symptoms. These additional drugs include antibiotics (to help prevent and control infections), anti-diarrheal medications (to slow or stop diarrhea), pain relievers (to treat mild pain), and iron supplements (to treat iron deficiency anemia). Anti-diarrheal medications should only be used for short-term management as prolonged use increases the risk of toxic megacolon. Additionally, ulcerative colitis patients should avoid using ibuprofen, naproxen, or aspirin for pain relief as these pain relievers may actually worsen symptoms of ulcerative colitis.
Surgery is sometimes necessary to relieve symptoms of ulcerative colitis. Surgery usually involves the removal of the entire colon and rectum (proctocolectomy). When this procedure is performed, the surgeon usually performs an ileoanal anastomosis to eliminate the need for a bag to be attached for stool collection. An ileoanal anastomosis involves constructing a pouch from the end of the small intestine and attaching it directly to the anus, allowing for somewhat normal waste elimination. In cases where an ileoanal anastomosis is not possible, the surgeon will create a permanent ileal stoma that is attached to a collection bag for waste removal.
Ulcerative colitis is a form of inflammatory bowel disease (IBD) that results in ulcers and inflammation of the gastrointestinal tract. Symptoms of ulcerative colitis vary dramatically among patients, depending on the severity of inflammation and area affected. Many patients with ulcerative colitis present with diarrhea, abdominal cramping and pain, pain in the rectum, bleeding from the rectum, urgency to defecate, inability to defecate, fatigue, fever, and weight loss.
Diagnosis of ulcerative colitis is often a diagnosis of exclusion. Various pharmacological treatments exist for patients with ulcerative colitis; although most patient’s symptoms can be managed with medications, some require surgical management. Patients suffering with symptoms of ulcerative colitis should consult with their physician about potential diagnostic and treatment options for their case.
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