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Ulcerative Colitis: Symptoms & Treatment

colon, colonoscopy, colon cancer risk
Credit: Sebastian Kaulitzki | Dreamstime

Ulcerative colitis, a type of inflammatory bowel disease (IBD), causes inflammation and sores, or ulcers, in the lining of the large intestine or colon. Generally, ulcerative colitis affects the sigmoid colon (the lower colon) and the rectum. However, it can affect any area in the large intestine/colon. The more area that is affected by ulcerative colitis, the more severe the symptoms.

Ulcerative colitis affects only the top layer of the large intestine, causing swelling and open sores or ulcers to form on the surface of the lining. These ulcers can rupture, expelling blood and pus. In severe cases, the ulcers can weaken the intestinal wall to the point of causing a hole, leaking the contents of the large intestine into the abdominal cavity. This can lead to serious infection and requires immediate surgery.

Though the causes of ulcerative colitis are unknown, doctors theorize that the immune system is attacking the digestive tract because of the normal bacteria that exists there. It runs in families and is generally diagnosed before the age of 30.

Symptoms of ulcerative colitis include belly pain or cramps, diarrhea, and rectal bleeding. Ulcerative colitis can also be accompanied by a fever, diminished appetite, and weight loss. Because the patient has a hard time absorbing nutrients from food, it can cause other symptoms like joint pain, eye problems, and liver disease.

Like other forms of inflammatory bowel disease (IBD), patients can suffer from symptoms all the time, or they can go weeks or months without a flare up (known as remission). Roughly 5-10 percent of ulcerative colitis patients suffer from chronic symptoms. In severe cases, patients can suffer from diarrhea 10-20 times a day.

To diagnose ulcerative colitis, doctors must rule out diseases and conditions with similar symptoms, like Crohn’s disease, irritable bowel syndrome and diverticulitis. To do so, they will conduct tests like colonoscopies, sigmoidoscopies, blood tests and stool samples.

Because ulcerative colitis affects everyone differently, each patient must work with his or her doctor to reduce symptoms and minimize flare-ups. Some patients with mild symptoms can take Imodium or other anti-diarrhea medications. Others with more serious symptoms will use prescription medications, like aminosalicylates, steroid medicines or other immunosuppressants. Since the immune system is causing many of the related symptoms, suppressing it will also suppress symptoms.

Some patients will notice a correlation between a specific food and flare-ups. While this varies from person to person, it makes sense to avoid the foods that can worsen ulcerative colitis. But it’s important for patients to eat a healthy diet to keep their weights up.

Patients with severe symptoms may require surgery to remove their colons. 25 to 40 percent of people with ulcerative colitis need surgery at some point. Removing the colon completely cures ulcerative colitis, and can also prevent colon cancer. But because it is a drastic step, this is not a surgery to be taken lightly.

After the large intestine has been removed, surgeons need to allow the body to get rid of food waste. In one procedure, a small opening is made at the front of the abdomen, then the end of the ileum brought through the hole, allowing waste to drain out of the body. An external pouch is fitted over the opening, collecting the waste. The patient empties the pouch several times a day.

Another way some doctors approach this is to attach the ileum to the inside of the anus where the rectum was, creating an internal pouch for waste. Waste collects in this pouch and is eventually passed out of the anus, in the usual manner.

Like other forms of IBD, ulcerative colitis takes an emotional toll on the patient. In addition to the debilitating symptoms, sometimes the anxiety or fear of an accident can make symptoms worse. The isolation, embarrassment and anxiety can lead to depression. But there are organizations that can help. The Crohn’s and Colitis Foundation of America have chapters across America, providing support and a sense of community. Counseling and therapy may also help with the emotional difficulties that IBD can cause.

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