Inflammatory bowel disease (IBD) is a type of disorder in which the digestive tract gets ulcers and inflammation. Ulcerative colitis is one such disease and is primarily long-lasting. This disease affects the inner lining of the rectum and large intestine. The symptoms might either occur suddenly or develop over time and could be debilitating and have life-threatening complications. However, there’s no cure for ulcerative colitis, but the correct treatment can certainly show a reduction in the signs and the symptoms. This also assures a long-lasting remission.

Symptoms

Depending on the intensity of the inflammation and the area of occurrence, the symptoms of ulcerative colitis might vary. Some of the common signs and symptoms include:

• Rectal bleeding or pain
• Diarrhea or loose stools with pus or blood
• Abdominal cramps or pain
• Fatigue
• Weight loss
• Fever
• Urgency to pass stools
• Not being able to defecate even when feeling it

In children, ulcerative colitis might restrict growth. Usually, people who have ulcerative colitis showcase moderate to mild symptoms. The treatment may vary from person to person. Few people might go without symptoms for a long period.

Types of ulcerative colitis

Depending on the location, there are different types of ulcerative colitis. These include:

• Left-sided colitis
  In this, the inflammation goes all the way from the rectum to the sigmoid and colon. Some common symptoms of this type of ulcerative colitis include cramps in the left side of the abdomen, diarrhea with blood-filled stools, and weight loss.
• Ulcerative proctitis
  In this form of ulcerative colitis, the inflammation is restricted to the area around the rectum. The key sign of this includes rectal bleeding. It is the mildest form of ulcerative colitis.
• Acute severe ulcerative colitis
  This rare type of ulcerative colitis affects the colon completely. This might lead to bleeding, fever, profuse diarrhea, severe pain, and the inability to eat anything.
• Proctosigmoiditis
  In this form of ulcerative colitis, the inflammation is seen in the sigmoid colon and the rectum. Some common signs include pain and cramps in the abdomen, loose stools with blood, and inability to pass stools despite the urgency.
• Pancolitis
  In this, the entire colon is affected and is followed by bloody diarrhea, which is highly severe. It can be followed by cramps and pain in the abdomen, weight loss, and fatigue.

When should you visit your doctor?

When you note a change in your bowel habits persistently, it is best to visit a doctor. You can also consider seeing a healthcare professional if:

• Abdominal pain is constant and unbearable
• Blood in the stool
• Over-the-counter medicines aren’t relieving diarrhea
• Sudden urgency to pass stool even in the middle of the sleep
• Fever that lasts for more than two days

Ulcerative colitis is not a fatal disease, but it might cause you certain complications, which are life-threatening.

Causes

There’s no information on the exact cause of ulcerative colitis. Initially, some theories stated that stress or diet could be the cause of ulcerative colitis. However, the doctors now believe that these factors might aggravate ulcerative colitis, but aren’t the cause of it. However, one primary cause of ulcerative colitis could be a malfunction of the immune system. In the process of fighting an invading bacterium or virus, the immune system might attack the digestive tract, leading to ulcerative colitis. Furthermore, heredity also could be a cause of ulcerative colitis. However, in most cases, the patients with ulcerative colitis didn’t have any family history of the disease.

Risk factors

Both men and women are equally prone to ulcerative colitis. The common risk factors of ulcerative colitis include:

• Age
  The onset of ulcerative colitis primarily starts before the age of 30. However, it is not age-specific and can occur in people, irrespective of their age.
• Family history
  You are automatically at a higher risk if someone in your family (parent or sibling) has had the disease.
• Ethnicity or race
  Though white people are most prone to the disease, this condition can occur in anyone. Moreover, the people of the Ashkenazi Jewish descent are at a much higher risk than the others.

Complications

Some common complications of the disease are:

• Excessive bleeding
• Inflammation in the eyes, skin, and joints
• Liver disease, which might happen in only rare cases
• Excessive dehydration
• Osteoporosis
• Perforated colon
• Higher risk of cancer of the colon
• Blood clots in arteries and veins
• Toxic megacolon

Diagnosis

The diagnosis of ulcerative colitis can be made only after ruling out the possibility of the other conditions. For a proper diagnosis, you’ll have to undergo one more screening or procedure. These may include:

• X-ray
  In case of extreme symptoms, you’ll have to undergo an X-ray of the abdominal area. It will help rule out more serious disorders, such as the perforated colon.
• CT scan
  CT scan is performed to know how far the inflammation has spread in the colon.
• Flexible sigmoidoscopy
  Under this method, a flexible, slim, and lighted tube is used to analyze the sigmoid and rectum. In case the colon is severely swollen, this test is preferred over a colonoscopy.
• Colonoscopy
  It is a prominent technique to examine the colon via a flexible and thin tube that has a camera annexed to it. In this, a few samples for biopsy might also be taken. Tissue samples are also effective for the proper diagnosis of the disease.
• Blood tests
  Initially, blood tests will be performed to examine anemia or other infections and inflammation.
• Stool sample
  The presence of white blood cells is a clear indication of ulcerative colitis. This test helps to rule out the possibility of other diseases or disorders, like an infection, which might be caused due to parasites, bacteria, or viruses.
• CT scans and MRI
  Either of the two tests might be recommended to understand how inflamed the bowel is.

Treatment

Ulcerative colitis can be treated through surgery or therapy. Different types of medicines may be used for the treatment of ulcerative colitis. The type of treatment method chosen for you would primarily depend on the location and the severity of the disease. However, not all types of medication work on everyone alike. So, the doctor will have to look for a treatment that works best patiently.

Corticosteroids
In this, budesonide and prednisone are used to treat severe or moderate cases of ulcerative colitis. This medication has severe side effects and is not ideal for long-term usage.

5-ASA
The 5-aminosalicylic acid drug is the foremost treatment measure towards ulcerative colitis. Some common examples of this medication include olsalazine and sulfasalazine. The medicine you opt for and how you consume them (orally or as a suppository or enema) depends on the degree and area of spread.

Immunomodulator drugs
The primary reason for the inflammation is the immune system. So, the medicine is used to suppress the immune system. These include:

• Mercaptopurine and Azathioprine
  When you opt for this course of treatment, you’ll have to work closely with the doctor. Further, you should regularly get your blood tested to examine side effects. It might hamper the liver, too.
• Tofacitinib
  It is a newer form of medication that is used for the treatment of psoriatic arthritis, rheumatoid arthritis, and ulcerative colitis.
• Cyclosporine
  If the affected person doesn’t respond to any other form of medication, this medication is used. It, however, cannot be continued for an extended period owing to its side effects.

Biologics
Some of the biologics that are involved in the treatment of ulcerative colitis are:

• Vedolizumab
  It is a medication for the gut. You can use this medication to block the inflammatory cells from reaching the inflammation site.
• Golimumab, Infliximab, and adalimumab
  It is a TNF inhibitor that helps neutralize the protein that’s being produced by the immune system.

Other medications

Sometimes, you might need other medications to cater to some specific symptoms of ulcerative colitis. For instance, if you have severe diarrhea, medication like loperamide should be taken.

Surgery

Surgery can also help get rid of ulcerative colitis. But surgery would mean the removal of the colon and rectum. Usually, this would require ileal pouch-anal anastomosis; the doctor aims to help the affected person get rid of a bag worn for stool collection. For this, a pouch is constructed from the terminal of the small intestine. This pouch is further annexed to the anus, which will ensure that the waste expulsion is done normally. However, in certain cases, it isn’t possible to create a pouch. In that case, the surgeon will make a permanent opening in the abdomen, where the stool passed is directly passed to the attached bag.

Cancer surveillance

People who have ulcerative colitis require regular colon cancer screenings. Ulcerative colitis increases the risk of colon cancer. The schedule and frequency of these screening will primarily depend on the duration and the location of the disease. If ulcerative colitis affects the rectum, then a colonoscopy screening every two years should help. If the majority of the colon is affected, then a colonoscopy surveillance every eight years post the disease diagnosis would help. On the other hand, if it is just the left side of the colon that is inflamed, then surveillance is required every fifteen years.

Lifestyle changes

Sometimes, ulcerative colitis can make you feel helpless. However, there are certain lifestyle and dietary changes that can be implemented to keep your symptoms under control. It will also increase the time between the two flare-ups. There is no real evidence to support the fact that an unhealthy healthy diet causes ulcerative colitis, but there are some foods and drinks that might aggravate the symptoms, especially if there is a flare-up. So, to ensure good health, it is best to maintain a food diary. It is also a good practice to write what is consumed. This will help analyze whether a particular food item is causing a symptom flare-up. The food item can then be eliminated from the diet.

Food that you should avoid

• Dairy
  A lot of people who have ulcerative colitis claim that dairy can aggravate abdominal pain, diarrhea, and gas issues. So, reducing the consumption of dairy can help keep these symptoms in check. Some people are lactose intolerant and should avoid dairy at all costs.
• Fiber
  Fibrous foods, such as whole grains, vegetables, and fruits, can aggravate the symptoms. So, it is best to avoid or reduce the consumption of such foods. Furthermore, steam, stew, or bake vegetables to minimize the symptoms and get the essential nutrients from them.
  Furthermore, foods from the cabbage family, like cauliflower and broccoli, popcorn, corn, nuts, and seeds might also aggravate the condition.
• Other problem foods
  There are certain other problem foods such as caffeine, spicy food, and alcohol that may trigger the symptoms, so it is best to avoid them.

Prevention

There’s no particular preventive measure, but a few routine changes can keep it at bay.

• Eat smaller portions
  A lot of people feel that consuming smaller meals five to six times a day is far more effective than eating three or two large meals.
• Consult a dietician
  If you are uncontrollably losing weight, consult a dietician immediately.
• Consume a lot of liquids
  Try to add abundant liquids, like water and juices, in your diet. Avoid beverages such as coffee or alcohol, as they might worsen diarrhea. Further, carbonated drinks, like cold drinks, can lead to gas production, so avoid them, too.
• Stress
  Though stress wouldn’t cause the disease, it can cause flare-ups.
• Avoid fatty food
  Do not eat a lot of fried or fatty food. Also, avoid sugar-rich or processed food items.