Understanding Ulcerative Colitis: Symptoms, Causes, & Treatments
Overview
Ulcerative colitis (UC) is the most prevalent type of inflammatory bowel disease (IBD). Typically, the disease begins in the rectum and spreads upward continuously through the colon. It causes inflammation and ulcers in the digestive tract, leading to a variety of uncomfortable and sometimes debilitating symptoms. This condition mainly impacts the colon, but symptoms can also appear in other parts of the body, known as extra-intestinal manifestations. Ulcerative colitis is most frequently diagnosed in individuals aged 15–30, with a smaller rise in cases among those aged 50–70.
This article aims to provide an in-depth understanding of ulcerative colitis, including its symptoms, causes, diagnosis, treatment options, and lifestyle management strategies.
What is Ulcerative Colitis?
Ulcerative colitis is a chronic inflammatory condition of unknown origin that affects the large intestine (colon).
- It is a type of inflammatory bowel disease that results in swelling and ulceration in the colon’s innermost lining.
- Individuals with ulcerative colitis go through cycles of symptom flare-ups, followed by times of remission when they have no symptoms.
- This condition causes symptoms such as abdominal pain and cramps, bloating, bloody stool, and diarrhoea.
Although it is a life-long disorder with no current cure, medications and lifestyle changes can help manage it more effectively.
Ulcerative Colitis vs. Crohn’s Disease
Crohn’s disease is different type of inflammatory bowel disease. While ulcerative colitis only affects the colon and rectum, Crohn’s disease can affect any part of the digestive system, including the large intestine, small intestine, stomach, oesophagus, and mouth.
Key differences between Ulcerative Colitis and Crohn’s Disease
Some key differences between ulcerative colitis and Crohn’s disease include:
- Ulcerative colitis primarily affects only the innermost layer of the large intestine, while Crohn’s disease affects all the layers of the intestine.
- Rectal bleeding occurs more frequently in ulcerative colitis compared to Crohn’s disease.
- In ulcerative colitis, inflammation is continuous, whereas in Crohn’s disease, it is patchy, with healthy areas in between.
- In ulcerative colitis, people commonly experience pain in the lower left abdomen, while in Crohn’s disease, pain is more frequently found in the lower right abdomen
Inflammatory bowel disease (IBD) should not be confused with irritable bowel syndrome (IBS). IBD results from the chronic inflammation of digestive tract, whereas IBS affects bowel movements without involving inflammation of the gastrointestinal tract.
Causes and Risk factors of Ulcerative Colitis
What causes ulcerative colitis?
The cause of ulcerative colitis remains unclear till date. Researchers believe that the cause of ulcerative colitis is complex and involves multiple risk factors. Most agree that it is linked to an overactive immune response. The immune system’s role is to defend the body against germs and other harmful substances. However, sometimes the immune system mistakenly attacks the body’s own tissues, leading to inflammation and tissue damage.
What are the risk factors of ulcerative colitis?
Anyone can develop ulcerative colitis, but some factors that increase the risk of developing the disease include:
Age: Most people are diagnosed with UC between the ages of 15 and 30, or after 60.
Race and ethnicity: UC is more common in white people, especially those of Ashkenazi Jewish descent.
Genetics: Ulcerative colitis has a hereditary component, but it doesn’t pass directly from parent to child. Although most individuals do not have a family history of the disease, about 8-14% of individuals with ulcerative colitis do have a relative with inflammatory bowel disease (IBD).
Environmental Factors: Some environmental risk factors that contribute to the development of IBD include:
- Diet and lifestyle
- Geography (higher occurrence in developed countries)
- Smoking
- Use of non-steroidal anti-inflammatory drugs (NSAIDs)
- Air pollution
Microbiome: The microbiome consists of the community of microbes, such as bacteria, viruses, and fungi, that naturally inhabit the intestinal tract. Research indicates that individuals with IBD exhibit alterations in their microbiome compared to those without the condition. However, it is still unclear whether these changes precede the development of IBD or result from the disease itself.
Symptoms of Ulcerative Colitis
Some common signs and symptoms exhibited by individuals with ulcerative colitis include:
- Bloody stool with or without mucus
- Diarrhoea
- Abdominal pain
- Weight loss
- Fever
- Abdominal sounds (a gurgling or splashing noise heard over the intestine)
- Tenesmus (the urge to pass stools even when the bowels are empty)
Extraintestinal manifestations are the symptoms that affect parts of the digestive system other than large intestine, and they include:
- Joint pain
- Joint swelling
- Ankylosing spondylitis
- Itchy or burning eyes
- Mouth ulcers
- Skin rashes or ulcers
- Nausea and vomiting
Diagnosis and Medical tests for Ulcerative Colitis
How is ulcerative colitis diagnosed?
The healthcare provider conducts a physical examination and asks about symptoms and family medical history. Since ulcerative colitis can resemble other bowel diseases like Crohn’s disease, the doctor orders various medical tests to exclude other potential conditions.
Medical tests and diagnostic procedures performed to diagnose ulcerative colitis include:
- Blood Tests: Blood tests can reveal anaemia, suggesting possible bleeding in the colon or rectum, and can help exclude other causes like infections.
- Stool Samples: A doctor uses stool samples to detect signs of infection, parasites, and inflammatory markers.
- Imaging Tests: Doctors advise imaging tests in individuals to get a picture of the colon and rectum. Some common imaging tests are:
- Barium enema
- CT scan and MRI
- X-ray
- Endoscopic Tests: The most common endoscopic tests to detect ulcerative colitis are colonoscopy and sigmoidoscopy.
Treatment and Management
How is ulcerative colitis treated?
While there is no cure for ulcerative colitis, various treatments can help manage symptoms and induce and maintain remission. The goal of treatment is to manage acute flare-ups, prevent recurring attacks, and promote healing of the colon. Treatment options include medications and surgical procedures.
Medications
The doctor may prescribe medication depending upon the severity of the disease. Doctors commonly prescribe the following medications for patients with ulcerative colitis:
- Aminosalicylates: These are anti-inflammatory drugs that help control mild to moderate symptoms of the disease.
- Corticosteroids: Healthcare providers prescribe corticosteroids such as prednisone to be taken orally during flare-ups or inserted into the rectum. Due to their serious side effects, they recommend these medications for short-term use only.
- Immunosuppressants: Doctors may prescribe immunomodulators that affect the immune system, such as azathioprine and 6-MP, to be taken orally.
- Biologics: Biologic therapy is advisable in patients with severe colitis that don’t respond to other medications. Biologics, derived from antibodies, work to block inflammation in patients with moderate to severe symptoms of ulcerative colitis.
- Janus kinase (JAK) inhibitor: Medications like tofacitinib inhibit one of the enzymes in the body that triggers inflammation.
Surgical Procedures
Doctors recommend surgical procedures where colitis does not respond to comprehensive medical treatment, when changes in the colon lining indicate a higher cancer risk, or in severe situations such as colon rupture, severe bleeding, or toxic megacolon.
There are two types of surgery for ulcerative colitis, both involving a proctocolectomy, where doctors remove all or part of your colon and rectum.
- Proctocolectomy with ileal pouch: This is the most common procedure for ulcerative colitis. It involves removing the colon and rectum while leaving the anus intact. The surgeon then creates an ileal pouch from the small intestine, which functions as a new rectum and allows normal bowel movements after healing.
- Proctocolectomy and ileostomy: If an ileal pouch is not suitable, the healthcare team may recommend a permanent ileostomy. In this procedure, the surgeon removes the colon, rectum, and anus, then creates an opening in the abdomen (ileal stoma) that connects to an external pouch to collect stool. The patient will need to empty the pouch regularly.
Prevention of Ulcerative Colitis
How to prevent ulcerative colitis flare-ups?
Currently, there is no known way to prevent ulcerative colitis, as its exact cause is not fully understood. However, some strategies may help reduce the risk of the condition or manage the flare-ups more effectively in patients with ulcerative colitis:
Nutrition and Diet
Certain foods can worsen diarrhoea and gas, especially during active disease periods. Dietary recommendations include:
- Consuming small proportion of meal frequently throughout the day.
- Drinking small amounts of water regularly throughout the day.
- Avoiding high-fibre foods like bran, beans, nuts, seeds, and popcorn.
- Steering clear of fatty, greasy, or fried foods, as well as rich sauces such as butter, margarine, and heavy cream.
- Limiting dairy products if lactose intolerant, though they are a good source of protein and calcium.
No single meal plan prevents flare-ups, as food triggers can vary from person to person. Collaborate with your provider to create a personalized meal plan that avoids trigger foods while ensuring you get all the essential nutrients.
Stress Management
Manage stress by getting at least seven hours of sleep each night, exercising regularly, and finding healthy stress-relief methods like meditation.
Avoid non-steroidal anti-inflammatory drugs (NSAIDs)
Use acetaminophen for pain or fever instead of NSAIDs, as NSAIDs can aggravate ulcerative colitis symptoms.
Conclusion
Ulcerative colitis is a chronic inflammatory condition that primarily affects the colon and subsequently alters the bowel movements. It causes uncomfortable symptoms that can occasionally turn debilitating. Abdominal pain and cramps, bloody stool with or without mucus, and tenesmus are some of the commonly encountered symptoms in patients with ulcerative colitis. While there is no current cure for the disease, advancements in medical treatments and lifestyle modifications can help individuals with UC lead fulfilling lives. Early diagnosis, personalized treatment plans, and a proactive approach to managing symptoms are key to achieving and maintaining remission.
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- Ulcerative Colitis: Symptoms, Causes, Diagnosis & Treatment (clevelandclinic.org)
- Ulcerative Colitis - Symptoms and Causes | Penn Medicine
- What is ulcerative colitis? A Mayo Clinic expert explains - Mayo Clinic
- Official journal of the American College of Gastroenterology | ACG (lww.com)
