Ulcerative Colitis

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Ulcerative colitis is a type of inflammatory bowel disease that can occur when your body’s immune system attacks your own tissue, producing ulcers in your digestive tract. Treatment is important to address the symptoms, including bleeding, pain, urgent need to use the bathroom and more.   

What Is Ulcerative Colitis?

Ulcerative colitis is one of the two primary forms of inflammatory bowel disease, the other being Crohn’s disease. It occurs when the lining of the colon (your large intestine) or the rectum becomes inflamed. When that inflammation happens, small ulcers are formed on the lining of the colon.

UC is an autoimmune disorder, which is another way of saying that it happens when your body’s immune system produces a response to your own cells. Your immune system is great at fighting off foreign invaders, but when it attacks your own tissue, it can cause serious problems. 

Symptoms Of Ulcerative Colitis

The symptoms you experience may vary based on how extensive your ulcerative colitis is. The condition is usually divided into three main categories, depending on how far into the colon the inflammation reaches:

Proctitis

This type of UC is limited to the rectum – that’s just about 6 inches or so right at the end of your digestive tract.

Primary symptoms of proctitis:

  • Rectal bleeding or pus
  • Rectal pain
  • Frequent need to empty your bowels

Left-Sided Colitis

Also called distal colitis, this isan illustrated image showing the 3 types of ulcerative colitis: proctitis, left-sided colitis, extensive colitis. UC that extends beyond the rectum and up the left colon. If your condition doesn’t reach all the way through the left colon but only affects the lower portion – known as the sigmoid colon – what you have may be called proctosigmoiditis. 

Primary symptoms of left-sided colitis:

  • Loss of appetite
  • Unexpected weight loss
  • Rectal pain, bleeding or pus
  • Frequent need to empty your bowels
  • Frequent feeling that you have to go even when your bowels are empty
  • Diarrhea with blood, mucus or pus
  • Pain on the left side of the abdomen

Extensive Colitis

This is the type of UC you have when your entire colon is affected. 

Primary symptoms of extensive colitis

  • Loss of appetite
  • Unexpected weight loss
  • Rectal pain, bleeding or pus
  • Frequent need to empty your bowels
  • Frequent feeling that you have to go even when your bowels are empty
  • Diarrhea with blood, mucus or pus
  • Abdominal pain
  • Fever
  • Night sweats

Non-Digestive Symptoms

Outside of the intestine, there are a number of additional symptoms you may also experience: 

  • Burning, redness, itching and other problems of the eyes
  • Mouth ulcers and sores
  • Skin conditions, including nodules or lesions formed on the legs
  • Joint conditions, including various types of arthritis
  • Liver conditions, including inflammation of the bile ducts
  • Certain blood and endocrine disorders

Causes And Triggers

We don’t yet know nearly as much as we’d like about the causes of ulcerative colitis, but we believe that there are a number of factors that contribute to the condition:

  • Your genetics or family history. You’re more likey to have ulcerative colitis if you have an immediate relative wtih the disease. 
  • Your environment. While certainly not an exhaustive list, things like air pollution, stress, your diet, infections, sleep habits, medications or vitamins you may be taking, and your exercise routine may all trigger UC flares.
  • The particular microbes that you have in your intestines.  


What triggers UC may be a bacterial or viral infection in your colon. Normally, when your body is invaded by pathogens, you produce an immune response – your body generates immune cells and inflammation to attack the invaders. Once they’ve been eliminated, that inflammation dies down. In people with UC, however, the inflammation doesn’t go away. Instead, your body continues to react as if you’re being attacked, staying inflamed and producing ulcers. 

The condition can occur any time, but it’s typically diagnosed before the age of 35. Because UC is a progressive condition, it can worsen with age, so its especially important to seek treatment as soon as you suspect that there may be something wrong.

Diagnosis

Doctors will begin the diagnostic process for ulcerative colitis simply by talking with you, walking you through your symptoms, experiences, medical history, family background and more to help narrow down the range of conditions that you may have. Many of the symptoms of UC are similar to other diseases, including some potentially very dangerous ones, so it’s important to be thorough in the process. 

Once the doctor has a general sense of what you’ve been going through, he or she can recommend a number of tests to help get a much clearer picture of your exact condition. Some of the most common ones include:

  • Blood Tests – There is no single blood test that can directly tell whether or not you have UC, but there are a number of tests that can help a doctor better determine the nature of your condition. For example, simple blood tests can detect whether you have a deficiency in oxygen-carrying red blood cells or if you have an infection that may be causing problems. Other tests look for particular markers in your blood for inflammation, antibodies sometimes associated with IBD, vitamin deficiencies and more.
  • Stool Studies – Your doctor may test a stool sample to see if you have any irregularities in your stool, including blood or parasites.
  • Flexible Sigmoidoscopy – This is a procedure where your doctor will use a thin, lighted instrument to examine your rectum and sigmoid, which is the last part of your colon. This test may be performed in place of a full colonoscopy for patients who have significant inflammation.
  • Colonoscopy – A thin tube with a camera will be used to examine your colon for any signs of disease, and small tissue samples may be taken to further diagnose your condition.
  • Chromoendoscopy – As part of the colonoscopy procedure, your doctor may perform what’s called a chromoendoscopy. He or she will spray a dye into your colon that can identify variations in the lining of your intestine, highlighting polyps or areas that may be precancerous. 
  • Biopsy – Also as part of the colonoscopy, your doctor may remove small amounts of tissue to test for diseases like cancer. 
  • Upper Endoscopy – Here the doctor will use a flexible, lighted instrument to examine your upper gastrointestinal tract, including the esophagus, stomach and first part of your small intestine. This type of test is most common on patients who are experiencing nausea, vomiting, difficulty eating or pain in the upper abdomen.
  • Capsule Endoscopy – This is a procedure that may be performed if your doctor suspects Crohn’s disease related to your small intestine. The patient swallows a tiny capsule with a camera inside it (don’t worry – you’ll pass it as part of a normal bowel movement without any discomfort), and the images are used to develop a diagnosis.
  • Balloon-assisted Enteroscopy – In this procedure, the doctor uses an instrument to examine portions of your small bowel that are usually out of reach with other forms of examination.
  • X-rays – An x-ray of your abdomen may be helpful to rule out certain serious conditions like a perforated colon.
  • CT Scans – This imaging procedure can provide a detailed picture of your entire bowel and surrounding tissue. When particularly accurate images of the small bowel are needed, a type of CT scanning called CT enterography may be ordered.
  • MRIs – Magnetic Resonance Imaging is especially beneficial when it comes to examining organs and tissues around the anal area or in the small intestine. One benefit these offer over CT scanning is that there is no exposure to radiation.


Also note that some of these tests aren’t only used for the diagnosis of UC but also for ongoing monitoring of the condition, so don’t be surprised if you find yourself having to undergo some of these procedures at different points in your treatment path. 

Keeping a diary of your symptoms can help your doctor better understand what you’re experiencing and may help in recommending the tests needed to diagnose your condition. Click here to download a diary to record your symptoms. 

Treatment Options

Because ulcerative colitis is a progressive disease, it’s important to get treatment as early as possible – the longer you let it go on, the more damage it can do to your bowels. There is no cure for ulcerative colitis, however there are a range of treatment methods available that can help you manage your symptoms and take control of the condition. Here are some of the most common options you’ll come across:

Lifestyle

For many people, a good place to start is by altering their diet and lifestyle. That’s because, while the foods you eat do not cause UC, they can contribute to digestive distress.  

For example, try cutting out dairy. It’s a major cause of diarrhea, abdominal pain and gas, particularly for the 30 million Americans who are lactose intolerant. Another thing you may want to avoid is food that’s high in fiber. These may contribute to faster digestion and looser stool – just what you don’t need when suffering a flare up.

In fact, what you may want to consider is what’s called a low-residue diet. This is an eating plan that’s designed to slow down your digestion and reduce the amount of waste you pass. It includes lean meat and fish, eggs, white rice, refined grain products and vegetables without peels, seeds and stalks. It may sound like it’s exactly the opposite of all the healthy diets you’ve been recommended in the past, but that’s because it’s goals are entirely different than most other diets you’ve ever tried. Before you start, though, you should check with your doctor to make sure it’s right for you. 

One other thing to consider is keeping a food diary. That can help you better identify thee particular foods that trigger your symptoms – click here for your free downloadable food diary to track your own eating habits and symptoms.

Multivitamins

No matter what diet you follow, you need to make sure your body is getting all the nutrients it needs to function properly. That isn’t always easy when you suffer from a disease that prevents you from fully digesting your food. Supplementing with vitamins and minerals can be a helpful way to ensure that your body is getting everything it should – though you’ll want to check with your doctor first. Remember, not every vitamin is right for every patient.

Quit Smoking

 Smoking can aggravate inflammatory conditions like ulcerative colitis. We all know that quitting isn’t easy, but there are more products, programs and support systems available than ever before to help you kick the habit.

Reduce Stress

Many also believe that stress can aggravate your symptoms, so finding ways to reduce it, such as meditating and adhering to a regular exercise routine, are also often recommended. An added bonus is that, alongside whatever benefit they provide your digestion, these practices will help you live a healthier, happier life overall. (Read our tips for stress management.)

Medications

When it comes to pharmaceutical treatment for UC, there is a wide range of medications available, including a number of new drugs that have been generating excellent outcomes for many patients. Here are some of the most common ones that your physician may prescribe:  

  • Aminosalicylates – If you have mild-to-moderate ulcerative colitis, these medications can be taken to decrease inflammation in thee GI tract. They’re usually taken orally or rectally, and they are used to treat flareups as well as for ongoing maintenance. 
  • Immunosuppressants work on your immune system by reducing your body’s production of chemicals that promote inflammation. There are a variety of drugs to consider here, including corticosteroids and immunomodulators, but your doctor will want to be judicious with the way they’re prescribed. That’s because these medications aren’t specific in what they target – in other words, the affect the entire immune system, not just the colon – and there can be side effects that are significant. Still, for many patients, they bring real relief.  
  • Biologics. They’re a relatively new type of medication that works by neutralizing the activity of certain proteins that can produce inflammation. They’re typically administered either by injections that you can do yourself – and we promise it doesn’t hurt! – or by intravenous infusion that can be performed in your doctor’s office.
  • Small molecule medications are a new approach for adults with moderate-to-severely active UC. Unlike immunosuppressants, which act generally on the immune system, these can be targeted to only affect certain areas, so their activity can be more focused on inflammation in the intestines. 
  • Anti-diarrheal medications decrease the amount of fluid that flows to the bowel, helping you form bulkier stools.
  • Pain killers like ibuprofen, naproxen sodium, and diclofenac are sometimes prescribed to deal with mild discomfort.


Keep in mind that some of these medications can actually aggravate your symptoms – painkillers, for example, have been known to cause digestive issues – so you’ll want to monitor your response to them closely to see if they’re making things worse. 

Surgery

Ulcerative colitis can result in complications that aren’t simply uncomfortable but are potentially life-threatening. Tears in the wall of the colon, uncontrolled bleeding, rapid enlargement of the colon and other conditions can create situations where patients are in danger of massive infections and systemic shock, and in many cases, the only treatment available is surgery. In those situations, the usual procedure is called a proctocolectomy.

Proctocolectomy

Generally, a proctocolectomy involves having the colon, rectum, and sometimes the anus removed, though exactly how much is removed will depend on the particulars of your condition. With these gone, you’ll still need a way to eliminate waste, and there are a few options for accomplishing this. 

If the anus has been removed, the surgeon will create a small opening in the abdomen called an ostomy, and your remaining intestine will be connected to this. Patients with this procedure wear a small bag over the opening to collect waste. This is called an ostomy bag. 

J-Pouch Procedure

The more preferred method nowadays – where possible – is through what’s called the J-Pouch procedure. In conditions where the anus does not have to be removed, surgeons can remove the damaged colon and create an internal pouch that connects to the anus, so you can eliminate waste as you normally would.  

If the anus has been removed, the surgeon will create a small opening in the abdomen called an ostomy, and your remaining intestine will be connected to this. Patients with this procedure wear a small bag over the opening to collect waste. 

This is not an exhaustive list of the treatments you may be presented with. There are many options available that can vary by your symptoms, your current health status and other factors, including things like surgery for those who aren’t finding success with medication, diet and behavioral changes.

Talking With Your Doctor

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If you suspect you may have ulcerative colitis, talk to your doctor about your concerns. He or she may refer you to a specialist to investigate your symptoms and to perform the necessary tests to determine if you do in fact have the condition.

Your doctor will want to hear about all your symptoms, any changes in medication you’ve made and any stressful life changes that may have recently happened. Be sure to write down all your questions before your visit so that you don’t forget them during your appointment.

To make sure you don’t overlook anything important during your consultation, take a couple of minutes to write down the following information so you can be certain that you’ll review it in person:

  • Your symptoms – List anything that you believe may be a symptom of your condition, including how severe it is and how long you’ve been experiencing it. Even things that don’t seem like they’re obviously related to ulcerative colitis are worth taking note of, because the disease can affect many biological systems, including your skin, eyes, joints and more.  
  • Your medications – List all of the medications you’re taking. This doesn’t only include prescriptions; be sure to include any vitamins or supplements you’re taking, too.
  • Questions for the doctor – It’s easy to get flustered during an appointment, so writing out the following questions is a good way to ensure that you don’t forget to ask them:

    • What could be causing these symptoms?
    • What tests do I need to take?
    • Is this a temporary condition or something that may last a while? If so, how long does it usually last?
    • Are there things I can do on my own to help improve my condition? Diet, exercise, or behavioral changes that might make a difference?
    • What treatment options are available to me?
    • With medications and other therapies, are there side effects?
    • What results do these treatments usually produce?


Ulcerative colitis can be a difficult condition to live with, but by talking to your doctor and finding treatment, it can be managed. And if you need help finding a specialist near you, try our doctor finder!

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