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Ulcerative Colitis
Ulcerative colitis is a form of inflammatory bowel disease which causes swelling, ulceration and loss of function of the colon (large intestine) and rectum. It is a chronic (long-term) condition.
Ulcerative colitis most commonly affects the rectum and the lower part of the colon (the sigmoid colon) but can sometimes involve all of the colon.
Ulcerative colitis can begin at any age but most commonly occurs in young adults between the ages of 15 and 25 years. The condition also has an increased incidence between the ages of 50 and 70 years. Children are rarely affected. Women are more commonly affected by the condition than men.
The exact cause of ulcerative colitis is unknown. It has been hypothesised that it is an auto-immune disease but some experts believe there may be a genetic cause.
Factors such as stress and eating certain foods do not cause ulcerative colitis but may worsen the symptoms.
The most common symptoms of ulcerative colitis are episodes of bloody diarrhoea and pain in the lower abdomen. There may also be a sensation of urgent need to pass a bowel motion. The bowel motions may be explosive and may contain mucous or pus.
Other symptoms that may be experienced include:
- Fatigue
- Weakness
- A general feeling of ill health
- Weight loss
- Loss of appetite
- Bloating of the abdomen
Symptoms vary in frequency and severity. Approximately half of all sufferers will experience only mild symptoms. However for others, symptoms will be more severe. The severity of the symptoms tends to be related to how much of the colon is affected.
Ulcerative colitis is characterised by episodes where symptoms are problematic (“flare-ups”) and episodes where symptoms are absent (remissions).
Ulcerative colitis patients may experience signs or symptoms outside the colon, such as ulcers in the mouth, inflammation of the iris (eye), arthritis, skin lesions, blood clots and anaemia.
There is an increased risk of colorectal cancer in patients who have had extensive ulcerative colitis for a number of years.
Ulcerative colitis may be suspected when a person has experienced symptoms of rectal bleeding, intermittent diarrhoea and abdominal pain.
As part of the diagnosis the doctor will take a full medical history and conduct a physical examination. The doctor may request that blood tests and specimens of the bowel motion are taken.
In ulcerative colitis, blood test results will often indicate anaemia and signs of inflammation in the body. Samples of bowel motions will often indicate the presence of blood, pus and mucous.
If ulcerative colitis is suspected, a test called endoscopy may be recommended. Endoscopy is the most important diagnostic test used to diagnose ulcerative colitis.
During this test a small flexible tube (an endoscope) with a fibre-optic camera at its tip is passed into the rectum and colon. The doctor is able to see the lining of the rectum and colon on a television screen and can look for signs of inflammation and ulceration that may indicate ulcerative colitis. Small tissue samples (biopsies) from the lining of the colon and rectum can be taken for testing. Ulcerative colitis can be diagnosed by the characteristic abnormalities of this tissue.
X-ray tests using barium (a chalky liquid that is able to be seen on x-rays) can be helpful in determining how much of the colon is affected by ulcerative colitis. The barium is administered into the rectum and colon via a tube inserted through the anus. A series of x-rays is taken, showing the outline of the inside of the colon and highlighting any abnormalities.
Treatment for ulcerative colitis aims to prevent complications of the condition by reducing inflammation and maintaining periods of remission.
The type of treatment recommended will depend on the extent and severity of the condition. A person’s age, general health, lifestyle and personal choice will also be taken into account.
In very mild cases, modification of the diet and stress reduction may be all that are required to effectively manage symptoms. However in severe cases, surgery to remove the colon and rectum may be required.
Treatment options include:
Stress reduction
While stress does not cause ulcerative colitis, it can worsen symptoms in some people. Developing techniques to reduce stress can be helpful in managing the condition.
Diet
Some foods can worsen symptoms in some people. Keeping a food diary can be helpful in identifying which foods are problematic. Once identified, these foods should be avoided during flare-ups.
It may be recommended that vitamin and mineral supplements, such as iron and calcium, are added to the diet.
Alternative therapies
Some people have found that therapies such as massage, yoga, acupuncture and naturopathy have helped to manage their condition. It is advisable to discuss these with the doctor before starting them.
Medications
Treatment for ulcerative colitis usually involves the use of anti-inflammatory medications containing a medication known as 5-aminosalicylic acid (5-ASA). Examples of these medications include Salazopyrin®, Pentasa®, Asacol® and Dipentum®. These reduce inflammation in the colon and rectum leading to a reduction in symptoms. These medications are usually taken on a long-term basis and can help prevent flare-ups.
Medications to suppress the immune system may be recommended. Examples of these include Azathioprine and Cyclosporin.
Severe flare-ups of ulcerative colitis may require hospitalisation. Steroidal medications, such as prednisone, may be required and can be given either by mouth (orally), through a drip (intravenously) or into the rectum (as an enema or suppository). Antibiotics may be required if infection in colon is present.
Dehydration caused by profuse diarrhoea may need to be treated by giving fluids through a drip. Medications to relieve pain and diarrhoea may also be given.
Loss of blood through the rectum over a long period of time can lead to anaemia. Iron tablets may be prescribed to correct the anaemia and prevent its recurrence. In cases of severe blood loss, blood transfusions may be required.
Surgery
In severe cases, where medication and supportive treatment have not been successful in controlling the condition, or where the side effects of medications are intolerable, surgery may be required. Approximately 30% of all people with extensive ulcerative colitis will require surgery at some stage.
There are three main surgical techniques for the treatment of ulcerative colitis.
Total proctocolectomy and ileostomy
This involves removing the entire colon and rectum. The end of the small intestine is brought out onto the wall of the abdomen. A collection bag is placed over the opening and faecal matter will pass into it. The bag is emptied by the person as required. The ileostomy is permanent. This type of surgery offers a permanent cure for ulcerative colitis.
Sub-total colectomy and ileorectal anastamosis
This is where most of the colon is removed, but the rectum is retained. The lower end of the small intestine is joined to the upper end of the rectum.
Ileoanal anastomosis (“Pouch operation”)
The entire colon and rectum are removed. A section of the small intestine is used to make a small pouch where faecal matter can be stored. The pouch is then attached to the anus. This surgical technique does not require a permanent ileostomy.
For further support and information contact the following:
The Crohn’s and Ulcerative Colitis Support Group (CCSG) Inc.
P O Box 28487
Auckland
Freephone: 0508 2274 69
E-mail: ccsg@clear.net.nz
Website: www.ccsg.org.nz
Carson De-Witt, R. (2006) Ulcerative Colitis. The Gale Encyclopaedia of Medicine. Third Edition. Jacqueline L. Longe, Editor. Farmington Hills, MI. Thompson Gale.
Crohn’s and Ulcerative Colitis Support Group (1999) Ulcerative colitis. Leaflet. Crohn’s and Ulcerative Colitis Support Group (Inc). Auckland.
Crohn’s and Ulcerative Colitis Support Group (1999) Surgery. Leaflet. Crohn’s and Ulcerative Colitis Support Group (Inc). Auckland.
Glanze, W.D., Anderson, K.N. & Anderson, L.E. (Eds.) (2006) Mosby’s medical, nursing and allied health dictionary (6th ed.) St.Louis: The C.V. Mosby Company
Last Reviewed – 17/09/07
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