Ulcerative colitis: causes, symptoms, diagnosis, and treatment

What is ulcerative colitis

Ulcerative colitis is an inflammatory bowel disease (IBD) that causes inflammation and ulcers in the digestive system. This disease affects the large intestine (colon) and the rectum. Symptoms usually develop over time and not suddenly. Find out more about Ulcerative colitis: causes, symptoms, diagnosis, and treatment below.

It is not uncommon for ulcerative colitis to cause serious complications and even death. There is no known cure, but treatment can significantly reduce the signs and symptoms of the disease and lead to long-term remission.

Symptoms Of Ulcerative Colitis

Ulcerative colitis can cause a variety of symptoms depending on the severity and location of the inflammation. Signs and symptoms include:

• Bloody diarrhoea often with pus
• Abdominal cramps
• Anal pain
• Bleeding from the rectum – a small amount of blood in the stool
• Having an urgency to pass stool

• Constipation in spite of urgent need for a bowel movement
• Malaise
• heat

Ulcerative colitis usually causes mild to moderate symptoms. The course of ulcerative colitis varies, and some people experience prolonged remission.

Types of Ulcerative Colitis

In most cases, ulcerative colitis is classified according to its location. Types of ulcerative colitis include:

Ulcerative proctitis. Inflammation is localized to the area closest to the anus (rectum), and rectal bleeding may be the only sign of the disease.

Rectal colitis. Inflammation of the rectum and sigmoid colon (lower colon). Signs and symptoms include bloody diarrhoea, abdominal cramps and pain, and an inability to move the bowel despite the urge to do so (tenesmus).

Left-sided Colitis. Inflammation spreads from the rectum to the sigmoid and descending colon. Signs and symptoms include bloody diarrhoea, abdominal cramps and left-sided pain, and an urge to defecate.

Extensive Colitis. This type often affects the entire colon and causes bouts of bloody diarrhoea which can be severe, cramping, abdominal pain, fatigue, and severe weight loss.

Proctosigmoiditis. This is similar to UC on the left side but does not affect the colon as often. This condition affects only the rectum and the lower part of the colon – the sigmoid colon. The symptoms are similar to UC of the left side, including loss of appetite, unexplained weight loss, and bloody diarrhoea.

When do you consult a doctor?

See your doctor if you experience a persistent change in your bowel habits or if you develop signs and symptoms such as:

• Stomach ache
• Blood in the stool
• Persistent diarrhoea that does not respond to over-the-counter medications
• Diarrhoea that wakes you from sleep
• Fever persisting longer than a couple of days with no apparent cause

In some cases, ulcerative colitis can lead to life-threatening complications even though it is usually not fatal.

Causes of Ulcerative Colitis

The exact cause of ulcerative colitis remains unknown. In the past, diet and stress were suspected, but doctors now know that while these factors can make things worse, they do not cause ulcerative colitis.

One of the possible causes is immune system dysfunction. When your immune system tries to fight off an invading virus or bacteria, the immune system also attacks the cells of the digestive tract, triggering an abnormal immune response. Heredity also seems to play a role, as ulcerative colitis is more common in people with relatives who have the disease. Most people with ulcerative colitis, however, do not have a family history of the disease.

Risk factors include:

Age. The onset of ulcerative colitis usually occurs before the age of 30. However, it can develop at any age, and some people don’t develop it until after the age of 60.

Race or ethnicity. Although white people are more at risk of developing this disease, it can occur in any race. The risk is higher if you are of Ashkenazi Jewish descent.

Family history. You are at higher risk if a close relative such as a parent, sibling or child has the disease.

Sex. There are as many women as men who suffer from ulcerative colitis.

Complications of Ulcerative Colitis

Possible complications of ulcerative colitis include:

• Heavy bleeding
• Perforated colon (hole in the colon)
• Severe dehydration
• Bone loss (osteoporosis)
• Inflamed skin, joints, and eyes
• Increased risk of colon cancer
• Rapidly inflamed colon (toxic megacolon)
• Blood clots in veins and arteries are more likely to occur

Diagnosis of Ulcerative Colitis

Ulcerative colitis can only be successfully diagnosed with endoscopic procedures and tissue biopsy. Other types of tests help rule out complications and other forms of inflammatory bowel disease, such as Crohn’s disease. One or more of the following tests and procedures may be done to help confirm a diagnosis of ulcerative colitis.

• Blood test. Your doctor may suggest blood tests to check for anaemia (a condition in which there aren’t enough red blood cells to carry enough oxygen to tissues) or signs of infection.

• Stool studies. White blood cells or certain proteins in the stool may indicate ulcerative colitis. A sample can also help rule out other disorders, such as bacterial, viral, or parasitic infections.

• Colonoscopy. This test allows the doctor to see the entire colon using a thin, flexible, lighted tube with a camera on the end. During the procedure, the doctor may take a small sample of tissue (biopsy) for laboratory analysis.

• Flexible sigmoidoscopy. Doctors use a thin, flexible, illuminated tube to examine the rectum and the lower part of the colon, the sigmoid colon. If your colon is severely inflamed, your doctor may recommend this test instead of a full colonoscopy.

• Radiography. If you have severe symptoms, your doctor may use a standard x-ray of the abdomen to rule out serious complications such as a perforation of the colon.

• Computed tomography (CT) scan. If doctors suspect complications of ulcerative colitis, they may do a CT scan of the abdomen or pelvis. A CT scan can also show the amount of colitis.
• Magnetic resonance imaging (MR) of the intestine. If your doctor is trying to rule out inflammation of the small intestine, he or she may recommend one of these non-invasive tests. These tests are more sensitive than conventional imaging tests to detect intestinal inflammation. MRI is an alternative that does not use radiation.

Common treatments for ulcerative colitis

There is no cure for ulcerative colitis, but you can manage the symptoms with diet, medication, and/or surgery. Your consultant will discuss options with you based on your symptoms and the severity of your bowel inflammation. It may be necessary to admit the patient to the hospital in severe cases.

Dietary changes

Making small changes to your daily diet can ease your symptoms. Try:

• Going from three main meals a day to five or six small meals a day
• Stay hydrated by drinking a lot of water
• Drink less of carbonated beverages, caffeine, and alcohol

Additionally, your consultant may recommend taking dietary supplements to replace nutrients lost as a result of frequent diarrhoea. You may also be referred to a dietitian, who will help you follow an ulcerative colitis diet.

Medication

Your consultant can prescribe these treatments to prevent symptoms from recurring or to relieve symptoms during a flare-up:

• amino salicylates
• immunosuppressants
• biologics
• corticosteroids

Surgery

In severe cases of ulcerative colitis, surgery may be recommended by your doctor if other treatments have not been effective.

Depending on several factors, including the severity of the disease, age, and overall health of the patient, one of two surgical options may be recommended. The first involves the removal of the entire colon and rectum, by creating a n ileostomy (an opening in the stomach through which waste is emptied into an external pouch, which is applied to the skin with adhesive).

A new surgical procedure, which was developed to provide another option also requires removal of the bowel but avoids an ileostomy. By creating an internal pouch from the small intestine and connecting it to the anal sphincter, the surgeon can save the patient’s needs to wear an external structure.