What is Ulcerative Colitis?

Ulcerative colitis is a chronic disease of the large intestine, also known as the colon, in which the lining of the colon becomes inflamed and develops tiny open sores, or ulcers, that produce pus and mucous. The combination of inflammation and ulceration can cause abdominal discomfort and frequent emptying of the colon.

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Ulcerative colitis is the result of an abnormal response by your body’s immune system. Normally, the cells and proteins that make up the immune system protect you from infection. In people with IBD, however, the immune system mistakes food, bacteria, and other materials in the intestine for foreign or invading substances. When this happens, the body sends white blood cells into the lining of the intestines, where they produce chronic inflammation and ulcerations.

It’s important to understand the difference between ulcerative colitis and Crohn’s disease. Crohn’s disease can affect any part of the gastrointestinal (GI) tract, but ulcerative colitis affects only the colon. Additionally, while Crohn’s disease can affect all layers of the bowel wall, ulcerative colitis only affects the lining of the colon.

While both ulcerative colitis and Crohn’s disease are types of inflammatory bowel diseases (IBD), they should not be confused with irritable bowel Syndrome (IBS), a disorder that affects the muscle contractions of the colon. IBS is not characterized by intestinal inflammation.

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Causes

Ulcerative colitis is thought to be an autoimmune condition. This means the immune system – the body’s defense against infection – goes wrong and attacks healthy tissue.

The most popular theory is that the immune system mistakes harmless bacteria inside the colon for a threat and attacks the tissues of the colon, causing it to become inflamed.

Exactly what causes the immune system to behave in this way is unclear. Most experts think it’s a combination of genetic and environmental factors.

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One possible cause is an immune system malfunction. When your immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too.

Heredity also seems to play a role in that ulcerative colitis is more common in people who have family members with the disease. However, most people with ulcerative colitis don’t have this family history.

Ulcerative colitis may affect as many as 907,000 Americans. Men and women are equally likely to be affected, and most people are diagnosed in their mid-30s. The disease can occur at any age and older men are more likely to be diagnosed than older women.

What are the Signs and Symptoms?

Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs. Signs and symptoms may include:

  • bowel movements become looser and more urgent
  • persistent diarrhea accompanied by abdominal pain and blood in the stool
  • stool is generally bloody
  • Abdominal pain and cramping
  • Rectal pain
  • Urgency to defecate
  • Inability to defecate despite urgency
  • Fever

People suffering from ulcerative colitis often experience loss of appetite and may lose weight as a result. A feeling of low energy and fatigue is also common. Among younger children, ulcerative colitis may delay growth and development.

The symptoms of ulcerative colitis do tend to come and go, with fairly long periods in between flare-ups in which patients may experience no distress at all. These periods of remission can span months or even years, although symptoms do eventually return. The unpredictable course of ulcerative colitis may make it difficult for physicians to evaluate whether a particular course of treatment has been effective or not.

Moreover, doctors often classify ulcerative colitis according to its location. Types of ulcerative colitis include:

  • Ulcerative proctitis: Inflammation is confined to the area closest to the anus (rectum), and rectal bleeding may be the only sign of the disease. This form of ulcerative colitis tends to be the mildest.
  • Proctosigmoiditis: Inflammation involves the rectum and sigmoid colon (lower end of the colon). Signs and symptoms include bloody diarrhea, abdominal cramps and pain, and an inability to move the bowels in spite of the urge to do so (tenesmus).
  • Left-sided colitis: Inflammation extends from the rectum up through the sigmoid and descending colon. Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and unintended weight loss.
  • Pancolitis: Pancolitis often affects the entire colon and causes bouts of bloody diarrhea that may be severe, abdominal cramps and pain, fatigue, and significant weight loss.
  • Acute severe ulcerative colitis: This rare form of colitis affects the entire colon and causes severe pain, profuse diarrhea, bleeding, fever and inability to eat.

Treatment

The primary goal in treating ulcerative colitis is to help patients regulate their immune system better. Ulcerative colitis treatment usually involves either drug therapy, dietary changes or surgery.

Several categories of drugs may be effective in treating ulcerative colitis. The type you take will depend on the severity of your condition. The drugs that work well for some people may not work for others, so it may take time to find a medication that helps you. In addition, because some drugs have serious side effects, you’ll need to weigh the benefits and risks of any treatment.

Diet

Food doesn’t cause ulcerative colitis, but some types can make your symptoms worse. You might find that soft, bland food doesn’t bother you as much as spicy or high-fiber dishes. If you can’t digest the sugar in milk called lactose (meaning you’re lactose intolerant), your doctor may tell you to avoid dairy products. To make sure you get enough vitamins and nutrientsfrom your meals and snacks, your doctor may recommend a high-protein, high-calorie eating plan that is low in fiber.

Medicine

Your doctor may prescribe a few different kinds of drugs, including:

  • Antibiotics to fight infections and let your large intestine heal
  • Medicine to lower inflammation in your colon and control your symptoms. You may start by taking one type, called aminosalicylates. If those don’t work or your symptoms are more severe, your doctor may prescribe another type of anti-inflammatory drug, a corticosteroid.
  • Meds to help stop your immune system’s attack on your colon
  • Biologics are drugs made from proteins in living cells instead of chemicals. They are for people with more severe ulcerative colitis.

Surgery

If medications aren’t effective at controlling your symptoms, or your quality of life is significantly affected by your condition, surgery to remove your colon may be an option.

During surgery, your small intestine will either be diverted out of an opening in your abdomen (known as an ileostomy), or used to create an internal pouch that’s connected to your anus (known as an ileo-anal pouch).