Ulcerative colitis is a condition causing chronic inflammation of the gastrointestinal tract, one of the inflammatory bowel diseases. Ulcerative colitis can cause chronic diarrhea, cramping and abdominal pain. Ulcerative colitis is different than other inflammatory bowel disease because it affects only the very inner lining of the gastrointestinal tract and begins at the end of the digestive tract (in the rectum and colon) and is continuous. This pattern is different than Crohn’s disease which affects deeper layers of the tissue and occurs sporadically throughout the digestive tract. Ulcerative colitis cannot be cured but can be treated medically. Risk factors for developing ulcerative colitis include a family history of inflammatory bowel disease, age around the thirties, being Caucasian or Jewish, and having used isotretinoin for acne. Ulcerative colitis can lead to serious complications, especially if not treated and followed closely. Some of the complications of ulcerative colitis include weight loss, poor nutrition, dehydration, bleeding, anemia (low blood counts), osteoporosis, increased risk of colon cancer, and a dangerous condition called toxic megacolon.
Diarrhea, abdominal pain, blood in stool, dark stool, foul-smelling stool, rectal pain, feeling of needing to have a bowel movement when you don’t, weight loss, fatigue
After taking a history and examining your abdomen, your doctor will want to do some additional testing. Your doctor will likely check your blood for a high white blood cell count, low blood counts, and possibly for antibodies that are indicative of ulcerative colitis. Your stool may also be checked for signs of blood or infection that can be confused with ulcerative colitis. You may see a gastroenterologist for a procedure called a colonoscopy or flexible sigmoidoscopy. The colonoscopy involves placing a thin tube with a camera at the end into the rectum while you are under anesthesia to look at the colon. If anything looks abnormal, you doctor can take biopsies (small samples) of the tissue to look at under a microscope to see what might be causing your symptoms. Your doctor may want to repeat your colonoscopy when your symptoms go away and the inflammation in the colon should be gone. Your doctor may also recommend x-rays of the abdomen after injecting barium into the rectum to look for abnormalities. Your doctor may also want a CT scan or MRI picture of your body.
Many treatments exist for ulcerative colitis. Most of these treatments aim to decrease inflammation which is the cause of the symptoms of ulcerative colitis. Everyone responds differently to the different medications available for ulcerative colitis, so being patient and trying different medications is essential to finding the best treatment. Many of these medications are available in pills, rectal creams, and injections. Medications that specifically decrease inflammation include sulfasalazine (Azulfidine), meselamine (Asacol, Rowasa), balsalazide (Colazal), olsalazine (Dipentum), and corticosteroids like prednisone (either taken by mouth or inserted locally in the rectum). Medications to moderate the immune system include azathioprine (Azasan, Imuran), mercaptopurine (Purinethol), cyclosporine (Gengraf, Neoral, Sadimmune), and infliximab (Remicade). Sometimes your gastroenterologist will also recommend nicotine patches which seem to help for mild, short-term relief. To relieve symptoms of ulcerative colitis like antibiotics, anti-diarrhea medications, pain relievers and iron supplements if your blood counts are low. If medications do not work to relieve your symptoms, surgery is an option. Ulcerative colitis is limited to the colon, so completely removing the colon (proctocolectomy) can remove the source of the symptoms. In ulcerative colitis, it is essential to remove the rectum as well as the colon, so the gastrointestinal tract needs to be attached to a hole made in the abdominal wall where a special bag can be attached to collect stool called an ileostomy. Your surgeon may be able to connect your small bowel to your anus (ileoanal anastomosis) though you will have more frequent and watery bowel movements. You will need to discuss with your gastroenterologist and surgeon the best treatment options for you.
