Being given an ulcerative colitis diagnosis can be overwhelming, scary and downright world shaking. Feelings of anxiety, depression and defeat can all be mixed together and that’s not a place where anyone wants to live so how about some good news? Ulcerative colitis is a pain in the ass literally, (I hope you at least smiled at that bad attempt at humor). The good news is learning all you can about it will help you manage your ulcerative colitis symptoms and live a full and vibrant life. So let’s jump in.
What is Ulcerative Colitis?
Ulcerative colitis also known as colitis ulcerosa is a member of the inflammatory bowel disease or IBD family. It’s a a chronic inflammatory disease of the large intestine, also called the colon. It affects the lining of the colon and causes small sores, or ulcers, to form. It can affect not just the colon but also the rectal area.
The ulcers it forms produce pus and mucous, which cause abdominal pain and the need to frequently empty your colon. It usually affects the lower part of the colon and rectal area but it may spread to involve the entire colon.
What Causes Ulcerative Colitis?
There is not one silver bullet that causes ulcerative colitis. The current thought process is that its a combination of your genetics, immune system, microbiome and your environment. Research has suggested that ulcerative colitis could be triggered by an interaction between a virus or bacterial infection in the colon and body’s immune system.
Typically, the cells and proteins that make up your immune system protect you from infection by fighting and eradicating the bad guys and then going back to normal. After the offending virus or bacteria is gone the inflammation would then go away as you are healthy and free of the illness.
In ulcerative colitis patients, the inflammation persists long after the immune system should have finished its job. The body continues to send white blood cells into the lining of the intestines, where they produce chronic inflammation and ulcers.
Who is Affected?
Most people are diagnosed in their 30’s, but ulcerative colitis can occur at any age. Older men are more likely to be diagnosed with UC than older women. If you’re younger there is no gender bias one way or the other. You’re much more likely to get it with your chances being between 1.6 and 30 percent if you have a first degree relative with the disease. 1-3
Family history is the best indicator at this time but there is no guarantee you will get the disease if another family member has it. Ulcerative colitis can affect people of any racial or ethnic group.
So What’s the Difference Between Ulcerative Colitis and Crohn’s Disease?
The short answer is they are both members of the inflammatory bowel disease family (IBD) but they are different diseases and affect different areas of the GI tract.
Ulcerative Colitis affects the inner-most lining of the colon and rectum
Crohn’s disease can affect any part of the GI tract from the mouth to the anus and can affect the entire thickness of the bowel wall and not just the innermost lining.
Types of Ulcerative Colitis
The three types of Ulcerative Colitis are based on where the disease exists. They are as follows:
In the Rectum – Ulcerative Proctitis
This type is limited to the rectum and it typically affects less than six inches of the rectum area. We haven’t talked about the risks of cancer yet related to ulcerative colitis but this type does not pose an increased risk of cancer. Symptoms may include:
- Rectal Pain
- Rectal Bleeding
- Bowel Movement Urgency
For this form of ulcerative colitis there is continuous inflammation that begins at the rectum and extends into the colon near the spleen. The area is called the splenic flexure which in english is the bend in the colon near the spleen. Symptoms may include:
- Loss of appetite
- Weight loss
- Bloody diarrhea
- Pain on the left side of the abdomen
Like the heading says this type of ulcerative colitis affects the entire colon. Continuous inflammation begins at the rectum and extends beyond the bend in the road otherwise known as the splenic flexure. Symptoms may include:
- Loss of appetite
- Bloody diarrhea
- Abdominal pain
- Weight loss
Signs and Symptoms of Ulcerative Colitis
Ulcerative colitis can be challenging to diagnose as the symptoms vary from person to person and some are mild. It’s important to consult your healthcare practitioner for a diagnosis. If you experience any of the symptoms below it may be ulcerative colitis.
- Loose and urgent bowel movements
- Bloody stool
- Abdominal cramps and pain
- Persistent diarrhea accompanied by abdominal pain and blood in the stool
Ulcerative colitis can also affect your general health in the following ways:
- Loss of appetite
- Weight loss
- Low energy and fatigue
- Anemia (low red blood cell count)
- Delayed growth and development in children
Ulcerative Colitis Diagnosis and Testing
As we talked about earlier learning that you have a chronic disease can be overwhelming and scary. We’ve found the best thing you can do is learn about the disease and how you can live your best life while minimizing the symptoms. Let’s jump in and we’ll help you understand the entire process as well as provide tips on diet, lifestyle and nutrition that may help.
Testing and Evaluation
As part of your diagnosis your healthcare provider will do a physical exam and ask you questions about your health and the symptoms you’ve been experiencing. Diet, daily activities, family history and environmental factors are all a part of understanding what might be causing your symptoms.
What to Expect At Your Appointment
Write down your symptoms and questions for your doctor and bring it to your appointments so you won’t forget anything you’ve been experiencing
- Your doctor will likely recommend laboratory tests of your blood and fecal matter.
- The stool specimen will be analyzed to eliminate the possibility that symptoms are caused by bacteria, a virus, or a parasite.
- Bleeding is something you want to eliminate and blood tests can look for signs of infection as well as anemia, which could indicate bleeding in your colon or rectum.
- Testing may include X-rays and they may use a contrast chemical that helps your doctors see a more clear and detailed picture of your GI tract.
- Consider bringing a trusted family member or friend to your appointments. This can help ease your stress, provide you comfort and help you remember what your doctor said. It can also provide some helpful accountability for changes you may need to make like dietary choices.
Scopes and Biopsy…..Do I Have To?
No one likes things being stuck up their rear end. The system is made for things to come out and not come in. Regardless it’s very important that your healthcare provider be sure of what disease or condition that you may have. In many cases testing to look for signs of the disease in the colon is necessary.
Consider bringing a friend or family member with you as tests like this can be better with company even if they hang out in the waiting room.
An endoscopy allows doctors to examine the inside of your colon and rectum with a lighted tube inserted through your anus. There are two types of endoscopies used during ulcerative colitis testing:
- A sigmoidoscopy allows your doctor to examine the extent of the inflammation in your lower colon and rectum.
- A total colonoscopy is a similar to the sigmoidoscopy, but this procedure allows your doctor to examine your entire colon.
Colonoscopies require bowel preparation. Talk to your healthcare team about ways to prepare, and tips for making this preparation easier.
This technique is used during a colonoscopy to look for polyps or precancerous changes.
- During a chromoendoscopy, a blue liquid dye is sprayed into the colon to highlight and detect slight changes in the lining of your intestine.
- Polyps can then be removed and/or biopsied.
- It is common to have blue bowel movements following this procedure and that will go away after a few movements.
A biopsy may be needed. This procedure is where a small piece of tissue is removed from the inside of the intestine for further testing and analysis.
- Your biopsied tissue will be analyzed in a pathology laboratory and screened for disease. Biopsies are also used for colorectal cancer screening.
- There may be small amounts of blood in your stool after a biopsy.
- While a biopsy sounds scary, medical advances have made this procedure virtually painless.
Ulcerative Colitis Treatment Options
Ulcerative colitis is an autoimmune disease meaning the immune system attacks what would normally be considered healthy cells in the body causing inflammation and damage. Helping patients to regular their immune system is the key to managing ulcerative colitis. While there is currently no cure and flare ups may recur there are a combination of treatment options with medication, dietary changes, life style changes and nutritional supplements that can help you stay in control and live to your fullest.
Diet and Nutrition
Ulcerative colitis is not caused by eating certain foods but you may find that particular foods can aggravate your systems. It’s important that your diet doesn’t make your symptoms worse as the the goal is to maintain a soothing diet that reduces inflammation and promotes healing. Replacing lost nutrients is vitally important.
For people with ulcerative colitis the disease often reduces your appetite and increases your bodies energy needs. This is mainly because your body is constantly fighting inflammation and fighting takes energy. Regular symptoms such as diarrhea may reduce your body’s ability to absorb water, vitamins and minerals. It also reduces your ability to absorb protein, fats and carbohydrates.
Soft bland foods may cause less discomfort but many times these foods do not have the nutritional profile your body needs to stay healthy. A Medical Food such as UltrainflamX or Inflam-Eze may provide necessary nutrients and herbal support to reduce inflammation and bridge the nutritional gap.
Medication for ulcerative colitis can suppress the inflammation of the colon and allow for tissues to heal. Symptoms including diarrhea, bleeding, and abdominal pain can also be reduced and controlled with effective medication.
In addition to controlling and suppressing symptoms (inducing remission), medication can also be used to decrease the frequency of symptom flare ups to maintain remission. With proper treatment over time, periods of remission can be extended and periods of symptom flare ups can be reduced. Several types of medication are being used to treat ulcerative colitis today. Some medication examples would be Mesalamine, Sulfasalazine, Azathioprine and Mercaptopurine to name a few. Talk to your healthcare provider about what might be right for you.
In some circumstances, a health care provider may recommend adding an additional therapy that will work in combination with the initial therapy to increase its effectiveness. For example, combination therapy could include the addition of a biologic to an immunomodulator. As with all therapy, there are risks and benefits of combination therapy. Combining therapies can increase the effectiveness of IBD treatment, but there may also be an increased risk of additional side effects and toxicity. Your healthcare provider will identify the treatment option that is most effective for your individual health care needs.
In about 25% of patients with ulcerative colitis, medical therapy is not completely successful or complications arise. Under these circumstances, surgery may be considered. This operation involves the removal of the colon (colectomy).
There are a number of factors, including the extent of the disease and the patient’s age and overall health. Based on those one of two surgical approaches may be recommended. The first involves the removal of the entire colon and rectum, with the creation of an ileostomy or external stoma. A stoma is an opening on the abdomen through which wastes are emptied into a pouch, which is attached to the skin with adhesive.
Today, many people are able to take advantage of new surgical techniques, which have been developed to offer another option. This procedure also calls for removal of the colon, but it avoids an ileostomy. By creating an internal pouch from the small bowel and attaching it to the anal sphincter muscle, the surgeon can preserve bowel integrity. This also eliminates the need for the patient to wear an external ostomy appliance which is far more desirable.
Where to Go From Here
If you’re confused about all the medications and therapies out there, you are not alone. IBD is extremely complex, and it is important to review the risks and benefits of all treatment options with your doctor. Learn more about available tools and resources that can help you make informed decisions about your care.
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