Understanding Ulcerative Colitis (UC)

What is Ulcerative Colitis?

UC is a chronic disease that may cause rectal inflammation, diarrhea, and rectal bleeding. UC can be called several things, depending on how the disease affects the large intestine, also known as the colon:

• Pancolitis, in which inflammation is present throughout the entire large intestine
• Distal colitis, which consists of left-sided colitis, ulcerative proctitis (UP), and ulcerative proctosigmoiditis (UPS)
  • UP is confined to the rectum
  • UPS reaches higher into the colon

Ulcerative colitis only affects the colon. A similar disease, Crohn's disease, can affect any part of the digestive tract.

Prevalence and Symptoms of Ulcerative Colitis

Up to 20 people per 100,000 are diagnosed with UC every year—typically when they are in their late teens or twenties.

The most common symptoms of UC are diarrhea and rectal bleeding. Other symptoms of UC may include

• Fever
• Abdominal pain
• Weight loss
• Fatigue
• Anemia
• Signs of malnutrition, such as weakness, irritability, or dizziness
• Stunted growth in children and adolescents

UC symptoms come and go. It is very common for people to go months without experiencing symptoms. A span of time without symptoms is called remission. When symptoms return, it is called a flare.

Causes of Ulcerative Colitis

Experts are still trying to discover the causes of UC. Much progress has been made, but more research needs to be done. For now, only theories exist.

Many experts believe that UC is caused by an abnormal immune system. A healthy immune system protects against harmful bacteria, but experts believe that the immune system of a person with UC may react abnormally to otherwise normal bacteria in the digestive tract as well as to the lining of the intestines.

UC isn't caused by stress or certain foods—although these factors may trigger symptoms in some people. Genetics and certain environmental factors play roles in the development of UC. These environmental factors can include infections, smoking, where you live in the world, sanitation, and taking certain medications.^†

UC may be hereditary. Some people are genetically at risk for the condition, if the disease runs in their family.

^†First 3 paragraphs are adapted from Ulcerative Colitis for Dummies^® (2013); reproduced with permission from John Wiley & Sons, Inc.

Diagnosing Ulcerative Colitis

Because the symptoms of UC are similar to Crohn’s disease and other intestinal disorders, UC can be difficult to diagnose.

Diagnosis of UC usually starts with a physical exam and medical history. A series of tests may be performed to confirm UC and rule out other diseases.

• Flexible sigmoidoscopy and colonoscopy—these tests are the most accurate for diagnosing UC. They both involve inserting a flexible tube into the anus. A small camera on the tube sends a video feed back to the doctor. The doctor can see inflammation, bleeding, and ulcers on the colon wall. During these procedures, the doctor may choose to perform a biopsy in which he or she captures a piece of infected tissue. This tissue is examined by a lab to help make the diagnosis. Sigmoidoscopies and colonoscopies are performed at a hospital or outpatient center. A light sedative or pain medication is generally given to help you relax
• Barium enema—this test uses an x-ray to examine the large intestine. You are given barium (a dye) as an enema, which coats the lining of the large intestine and rectum and then an x-ray is taken to identify affected areas
• Small intestine x-ray—this test specifically examines the small intestine, which can’t be seen through a colonoscopy. You drink a barium “shake” and the doctor takes an x-ray of the small intestine. This test is used to help determine if you have UC or Crohn’s disease

Treatment for Ulcerative Colitis

UC can affect people differently, so there are a variety of treatment options that can be used to help keep symptoms under control. Although treatment options vary, the goal is always to lessen the impact of flares.

Medications

There are several types of medication that can be used to treat UC:

• Aminosalicylates (5-ASAs) are anti-inflammatories used to treat mild-to-moderate UC symptoms and prevent relapses
• Corticosteroids, commonly referred to as just "steroids," include prednisone, methylprednisone, hydrocortisone, and budesonide
• Immunomodulators are drugs that reduce the inflammation associated with UC by adjusting the immune system's response to the disease
• Biologic therapies are for people with moderate or severe UC. They bind to molecules and work to block inflammation

Below are additional therapies.

Surgery

In some cases, medication does not work in the treatment of UC. About one-quarter to almost half of people with UC need surgery that involves the removal of the colon. This is known as a colectomy. Depending on factors such as age and severity of the disease, one of two procedures may be performed. In the first procedure, the entire colon and rectum are removed and an ileostomy, or external stoma, is created. This is basically an opening in the abdomen through which wastes are emptied into an attached pouch. In the second procedure, the colon is removed, but a part of the anus remains intact so normal bowel function can be maintained.

Diet

In addition to therapy, you can actively manage your UC through an improved diet. Many people with UC find that a low-fiber, low-fat diet reduces the incidence of diarrhea and potential flares. Eating fruits and vegetables that are rich in antioxidants, like blueberries, cherries, and squash, could also reduce the intensity of flares. Rich, flavorful foods that traditionally affect the digestive tract, like chocolate, beans, spicy foods, and fats, can be particularly aggravating.

Exercise

Exercise is an important component of everyone's health. It's vital that people with UC find an exercise routine that works for them. Before beginning an exercise routine, be sure to talk to your doctor about what activities would be best for you. Remember to drink plenty of water before, during, and after each workout.

Stress

For many, stress has a large impact on their UC symptoms. Relaxation techniques can help you gain control of your symptoms and provide a much-needed break from the day-to-day stresses of living with UC. Yoga, tai chi, and meditation may help reduce your response to stress. Deep breathing—breathing from your diaphragm—may also help relax your abdominal muscles and promote good intestinal health.