Ulcerative colitis is an inflammatory bowel disease (IBD) and an auto-immune disorder that causes your body’s immune system to create inflammation in your colon and rectum causing bleeding and ulcers. The result is a chronic illness with no known cure, because essentially your body’s own immune system is experiencing confusion and attacking your digestive tract. When you have ulcerative colitis your digestive tract is inflamed and has holes in the lining of your colon and rectum called ulcers, which seep pus and mucus.
Symptoms usually develop over time, and can be debilitating and even life-threatening. While there is no-known cure, treatment and diet can greatly improve symptoms and induce long term remission. The cause of ulcerative colitis is not fully understood by western medicine, much like many other auto-immune disorders. Suspected causes of ulcerative colitis are genetics, imbalances in your gut’s microbiome, issues stemming from the immune system, or environmental factors. Research suggests that this condition comes about when triggered by an infection in the colon, causing the body’s immune system to start focusing on sending white blood cells to that part of the body but having a misfire once the infection is gone.
You can learn more about ulcerative colitis research here. Read on to discover whether you may have ulcerative colitis.
Symptoms of Ulcerative Colitis
There are various symptoms of ulcerative colitis (UC). Many people with this condition experience very mild symptoms, so if you notice you are experiencing any of the following symptoms, even mildly, make sure to contact your doctor for a check-up.
- Loose, frequent, or urgent bowel movements
- Bloody stool
- Abdominal cramps and pain
- Persistent diarrhea
- Weight loss
Additionally, you may experience a fever, sometimes a skin rash, or mouth sores. Some UC patients experience joint pain, suffer from loss of fluids and nutrients, experience painful, red eyes, and be diagnosed with liver disease. In pediatric ulcerative colitis, symptoms are similar but may include delayed or poor growth.
Diagnosing Ulcerative Colitis
To diagnose ulcerative colitis, your doctor will have to rule out other illnesses. Your physician will proceed with a physical exam, then may order blood tests, stool samples, imaging tests, or endoscopic tests. Blood tests show signs of infection or anemia, if they exist. Anemia is the low level of iron in your blood, which can mean you have internal bleeding in your colon or rectum. Stool samples may show signs of infection, parasites, or inflammation. Imaging can be a great way to get immediate proven results. MRI (magnetic resonance imaging) scans or CT (computed tomography) scans show the provider pictures of your colon and rectum exposing ulcers if they are there. An endoscopic test is when the provider uses an endoscope, a thin flexible tube with a tiny camera, through the anus to check the health of the rectum and colon.
Your regular healthcare provider will probably refer you to a gastroenterologist. This is a doctor who specializes in the digestive system, in order to diagnose you properly if you show signs of ulcerative colitis.
Treatment for Ulcerative Colitis
There is no cure for ulcerative colitis, but treatments calm inflammation and induce remission which help you to function in your day-to-day life. Treatment depends on the severity of your condition and the individual’s make-up. Usually, the disease is managed with medications, however other factors such as allergies contribute to your auto-immune response or an active infection, so it is helpful to search out underlying conditions. If there is an underlying condition or cause, dietary changes or treating the underlying infection will be steps to take before medication for treating the inflammation directly.
The goal of ulcerative colitis medication is to induce remission and improve quality of life. There are several types of medication healthcare providers use to calm inflammation in the colon and reducing swelling and inflammation helps the large intestine’s tissue heal. Some medications your provider may suggest are as follows:
- Aminosalicylates: For mild to moderate ulcerative colitis, your healthcare provider might suggest sulfasalazine. If you are allergic to sulfa you may be prescribed a sulfa-free option instead, such as mesalamine. These medications come in pill form, enema, or suppository form which can better reach the inflammation in the large intestine or colon.
- Corticosteroids: If you have a severe form of ulcerative colitis you may be prescribed a corticosteroid such as prednisone or budesonide. Corticosteroids have serious side effects such as fluid retention, high blood pressure, mood swings and psychological effects, and weight gain, so healthcare providers only recommend them for short-term use until remission is induced.
- Immunomodulators: Immunomodulators may include medications like 6-mercaptopurine, azathioprine, or methotrexate. These drugs work on the immune system by turning down some proteins and turning up others, causing an effect on the immune system response causing the inflammation.
- Biologics: Biologics treat moderate to severe ulcerative colitis by targeting parts of the immune system to quell the auto-immune response causing inflammation. Medications in this category that may be prescribed are infiximab, adalimumab, golimumab, or vedolizumab.
- Janus kinase (JAK) inhibitors: this category includes drugs such as tofacitinib which stop one of your body’s enzymes from triggering inflammation.
In extreme cases, you might need surgery that removes your colon and rectum to avoid medication side effects, stop uncontrollable symptoms, prevent or treat colon cancer, or eliminate life-threatening complications such as bleeding. These surgeries are called proctocolectomy and ileoanal pouch. This surgery process includes removing your colon and your anus then forming a pouch from part of your small intestine, called an ileoanal pouch to create a new rectum.
While your body and pouch heal, your surgeon will perform a temporary ileostomy which creates an opening (stoma) in your lower stomach to which will connect an ostomy bag to collect waste. You will have to empty this bag throughout the day. Once your pouch heals, this bag will be removed and the stoma closed, but without the length of your large intestine, you will have more frequent bowel movements throughout the day.