Ulcerative Colitis


Ulcerative colitis is one of the forms of Inflammatory Bowel Disease (IBD). It happens when the lining of the colon (large bowel) or rectum becomes inflamed, causing problems such as abdominal pain, rectal bleeding and diarrhoea. Ulcerative colitis is an on-going (chronic) condition that requires careful management by a specialist.

Ulcerative Colitis Causes

The causes of ulcerative colitis aren’t fully understood, but we do know that it is associated with your immune system.

Ulcerative colitis seems to happen when your immune system starts attacking your own cells. It is not, however, a typical ‘autoimmune’ disorder where the body incorrectly sees normal healthy cells as foreign and then tried to destroy them. Instead, scientists believe that in ulcerative colitis, the inflammation could happen because the immune system gets confused by the good bacteria that live in your gut. One of the ways your immune system tries to defend you is by recruiting white blood cells to your gut, which causes inflammation. When you have an infection, this can help to get rid of the bad bacteria. However, if your immune system starts attacking the good bacteria that are always present in your digestive system, the immune response lasts longer than usual. The inflammation starts to cause problems for your digestion, and it keeps coming back every time your immune system is incorrectly stimulated.

Another theory is that the immune system is in fact triggered by an infection. It fights off the bad bacteria or virus, but it doesn’t stop. The immune response continues after the infection is gone, so your gut continues to suffer from inflammation.

While we still don’t know exactly what causes your immune system to malfunction, we do know that there are some factors that can affect your chances of developing IBD:

  • If other people in your family have IBD, you may be more likely to develop it yourself as there seems to be a genetic component
  • Lifestyle may also play a part, as ulcerative colitis is more common in Northern, urbanised countries such as the UK and the USA
  • Ulcerative colitis is most common in people of European descent and least common in people from Asian backgrounds

The symptoms of ulcerative colitis usually appear between the ages of about 15 and 25, but they can develop at any age.

Ulcerative Colitis Symptoms

The three most common symptoms of ulcerative colitis are abdominal pain or cramps, and needing to empty your bowels more often than normal (diarrhoea) that keeps coming back. You may also notice that your diarrhoea contains pus, mucus, or even blood. This is produced by small ulcers that can develop in the inflamed sections of your bowel.

In addition to these digestive symptoms, ulcerative colitis can also have an impact on your general wellbeing. You might find that when you are unwell, you lose your appetite, you lose weight without trying, or you feel tired even when you haven’t been doing anything strenuous.

Other less common symptoms can include:

  • Red or irritated eyes
  • Patches of redness or swelling on your skin
  • Pain and swelling in your joints
  • Mouth ulcers
  • Fever
  • Feeling short of breath
  • A fast or irregular heartbeat

The severity of these symptoms can vary, not just between people with ulcerative colitis, but for the same person over time. The symptoms may go away for a while and then return suddenly and unexpectedly. Sometimes your symptoms may be mild, but at other times they could be severe enough to prevent you from going to work or completing everyday activities.

The times when you are feeling well are known as remission. You may have mild digestive symptoms or none at all. When your symptoms return or worsen, it is known as a flare up or relapse. Although a flare up may be triggered by an infection or something stressful in your life, it is often impossible to identify the reason why they happen when they do. Some people with ulcerative colitis also suffer from constipation or irritable bowel syndrome. Trying to work out how to manage these symptoms often needs specialist input.

If you have ulcerative colitis, there is also a small chance of complications such as a ruptured bowel, arthritis due to inflammation in your joints, primary sclerosing cholangitis, or toxic megacolon. You also have a higher risk of developing bowel cancer, particularly if you have had your disease for a long time. Your doctor can explain the risks in detail and the tests andtreatments you might need to help to prevent these issues.

Ulcerative Colitis Diagnosis

If you’re experiencing symptoms that could be IBD, you should seek advice from a doctor, particularly if you have lost weight or noticed blood in your stool. It is important to find out what is causing these problems.

The doctor will usually ask about your symptoms before running some tests to confirm whether you have IBD. The results can also reveal whether your IBD is Crohn’s disease or ulcerative colitis. The two conditions can cause similar symptoms, but the inflammation caused by Crohn’s disease is more extensive. In ulcerative colitis, it is limited to the lining of the large intestine.

In order to provide a diagnosis, the doctor may need to perform the following checks:

  • A physical exam to look for signs of IBD such as abdominal tenderness or paleness caused by anaemia
  • A blood test to see if you are anaemic and to assess the amount of inflammation in your body
  • Testing a stool sample to rule out an infection, which could cause similar symptoms to ulcerative colitis
  • Testing the stool sample to check for inflammation. If none is present, it suggests that the symptoms may be due to irritable bowel syndrome. This may prevent the need for further tests
  • A sigmoidoscopy to assess the extent of inflammation in the lower part of your bowel
  • A colonoscopy to examine the entire colon for inflammation
  • Lab tests on biopsies taken during your sigmoidoscopy or colonoscopy, to confirm the presence of ulcerative colitis and help rule out Crohn’s disease
  • An X-ray or CT scan to check for any serious complications of IBD

If you are diagnosed with ulcerative colitis, you will get advice on your treatment options. You should contact your doctor again if your symptoms flare up badly or you need more advice on your condition.

Ulcerative Colitis Treatment

Unfortunately, there is not yet a cure for IBD, so your ulcerative colitis treatment will focus on preventing flare ups from happening so often and relieving the symptoms when they do.

The most common way we achieve this is by using medication. Three different drugs can be used to treat ulcerative colitis:

  • ASAs or aminosalicylates are the usual first line treatment for ulcerative colitis. They reduce inflammation and can be taken to control a flare up or in the long term to maintain remission.
  • Corticosteroids are only used when you have a flare up, either alongside or instead of ASAs. They also reduce inflammation, but they are more powerful than ASAs.
  • Immunosuppressants work by making your immune system less active. They can help to treat flare ups or to maintain remission, but it may take a few months for the effects to be noticeable and you’ll be slightly more vulnerable to infections while you’re taking them.

Although these medications can help to control your symptoms, there are potential side effects for each of them. Make sure that you understand the risks and benefits of each treatment option when you discuss them with your doctor.

You may need additional care if you have a severe flare up. In some cases, you might need to be admitted to hospital in order to prevent or treat complications such as dehydration. You could develop large ulcers or your colon might become stretched or even ruptured if your symptoms aren’t brought under control. In hospital, you can be given IV fluids to keep you hydrated and to administer medication such as corticosteroids or immunosuppressants. You can be given more powerful drugs than you would usually take at home.

In some cases, your doctor may suggest surgery to control your symptoms if the medication isn’t effective. The colon, which is the part of your intestine that is affected by ulcerative colitis, can be removed. Your digestive system would then need to be rerouted. It may be possible to connect the small intestine to an internal ileo-anal pouch that connects to your anus. However, sometimes it will be necessary to divert the small intestine to an opening made in your abdomen. You will then need to wear an external ileostomy bag. Having surgery can free you from the symptoms of ulcerative colitis, but it is a big step. It is important to discuss the risks and benefits in detail with your doctor. Thankfully, with the excellent medical treatments now available, the likelihood of needing surgery is lower than it used to be.

Living with Ulcerative Colitis

Getting the right treatment for ulcerative colitis can make a big difference to your symptoms, but there is more to living with IBD than just taking medication.

 It’s important to:

  • Eat a healthy diet and take supplements if necessary
  • Drink plenty of fluids, but avoid caffeine, alcohol and fizzy drinks
  • Have someone to talk to, whether it’s a friend, relative, or a local or online support group
  • Discuss the situation with your employer so that you can make adjustments when necessary
  • Find a way to manage stress and anxiety, which can make your symptoms worse. Exercise, yoga or mindfulness could help.

Living with ulcerative colitis can be difficult, especially because flare ups are so unpredictable. It’s important not to underestimate the emotional impact it can have. You’ll have to make some big changes in your life so make sure that you have the support you need from your doctor at the London Gastroenterology Centre as well as your friends and family.

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