Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) often characterized by severe inflammation of the rectum and colon. This inflammation can lead to the formation of ulcers and sores on the inner lining of the large intestine.
Common symptoms of ulcerative colitis include severe diarrhea (sometimes with blood or pus), abdominal pain, weight loss, stomach cramping and a frequent urge to empty the bowels. However, for reasons that aren’t well understood, some patients may experience symptoms that extend beyond the GI tract, including liver disease, osteoporosis, joint pain, arthritis and inflammation of the eyes.
There are three types of ulcerative colitis, categorized by where they occur:
Ulcerative proctitis, which involves inflammation only in the rectum
Extensive colitis (AKA “pancolitis”), in which the entire large intestine is inflamed
Left-sided colitis (AKA “distal colitis” or “limited colitis”) in which inflammation begins at the rectum, but extends only as high as the bend in the large intestine in the upper abdomen on only the left side of the body.
Hoag’s Margolis Family Inflammatory Bowel Disease (IBD) Program provides comprehensive, patient-first diagnosis and care for those living with chronic conditions of the bowel, including inflammatory bowel disease, ulcerative colitis, Crohn’s disease, lymphocytic colitis, collagenous colitis and pouchitis.
Through a team-based, multidisciplinary approach that strives for whole-patient care, we work to help those with or at increased risk for developing these conditions find the accurate diagnosis, advanced treatment options and personalized recommendations and dietary advice that can help them return to an active lifestyle with less worry about their digestive health. Meet the Hoag Margolis Family IBD Program Team.
Treating ulcerative colitis can be challenging. Symptoms often range in both type and severity from patient to patient. Sufferers may have mild symptoms at first, but issues often get worse over time. Early symptoms of ulcerative colitis can include:
Chronic, persistent diarrhea
A recurring, urgent need to have a bowel movement
Unexplained nausea
Abdominal pain and cramping
Weight loss without trying
Fatigue
Anemia
Other symptoms of more advanced or severe ulcerative colitis may include:
Seeing pus in bowel movements
Bloody diarrhea
Developing fistulas
Severe abdominal cramping
Unexplained fever
Skin rashes and sores in the mouth
Unexplained pain in the joints
Inflammation of the eyes
Liver disease
Toxic megacolon, a rare but life-threatening condition in which inflammation causes the colon to swell many times its usual size
The exact cause of ulcerative colitis is unknown. However, researchers believe it might be caused by a variety of factors working alone or in combination, including genetics, an overactive immune system response and environmental factors.
Environmental factors can potentially include infections, smoking and taking certain drugs, including nonsteroidal anti-inflammatory medications for pain like aspirin, ibuprofen and naproxen.
The first step in diagnosing ulcerative colitis involves ruling out other conditions that might produce similar symptoms, including intestinal infections, immune system disorders, Crohn’s and other issues.
Your doctor will usually begin by asking you about your symptoms, any medicines you might take, and any family history of ulcerative colitis, Crohn’s or other bowel diseases.
This will be followed by a thorough physical exam. During the exam, the physician may check your abdomen for bloating, use a stethoscope to listen for sounds in the abdomen, and tap or press on your abdomen to check for tenderness or pain. The exam may also include a digital rectal exam to check for any blood in your GI tract.
Depending on the outcome of the physical exam, you may be asked to submit to diagnostic and imaging tests, including:
Blood teststo check for issues associated with ulcerative colitis, including anemia or an elevated white blood cell count
Fecal tests, which may require you to provide stool samples
Endoscopy, in which a long, flexible tube with a camera at the tip is used to directly view the lining of the rectum and colon to check for signs of ulcerative colitis. The two types of endoscopy that may be employed include:
Flexible Sigmoidoscopy, in which a device called a sigmoidoscope is used to view the lining of the rectum and the lower colon
Colonoscopy, in which an endoscope is used to view the lining of the rectum and entire colon
At Hoag, we know it’s not enough to just give a diagnosis. We need to find the right diagnosis for each patient based on their condition, symptoms and the best path to healing. That’s why we’re committed to utilizing the latest tools and techniques, including the most advanced imaging options available.
Among the imaging options available at Hoag for people with ulcerative colitis and other chronic conditions of the bowel:
Abdominal ultrasound with elastography
Computed tomography (CT)
MRI
Magnetic Resonance Enterography (MRE)
Small Bowel Follow-Through (SBFT) using Omega Fluoroscopy System
There’s no known cure for UC, so treatment options for people with ulcerative colitis symptoms are usually focused on treating the most serious complications, reducing inflammation in the large intestine, managing pain and maintaining remission. Doctors can sometimes successfully treat ulcerative colitis through diet changes, helping patients avoid known triggers, etc. In severe cases that don’t respond to treatment, surgery may be required.
Non-surgical treatments for ulcerative colitis usually involve medication. These may include:
Aminosalicylates, which are drugs that work to help limit inflammation in the intestine
Corticosteroids, which are steroids that help the body respond better to infection
Immunosuppressants, which “tone down” the body’s immune response
Biologics, which are drugs produced by microorganisms, plants or animals
Keeping a food diary, in which you carefully note exactly what you eat and when for a set period of time. This can help your doctor determine which foods and eating schedules affect your symptoms and might be causing a flare up.
If a patient has symptoms that don’t improve with medication or only respond to corticosteroids (which can’t be taken long term, due to serious side effects), surgery to remove the colon and rectum may be considered, followed by procedures to restore the body’s ability to eliminate waste. The most common types of surgery following the removal of the colon and rectum are:
Ileoanal reservoir surgery, in which surgeons use the end of the small intestine (AKA the ileum) to create a pouch, which is then connected to the anus. Stool collects in this pouch, then passes through the anus during bowel movements.
Ileostomy, in which surgeons attach the end of the ileum to an opening called a stoma that’s created in the wall of the abdomen. After an ileostomy, stool passes through the stoma into an ostomy pouch, which is a bag attached to the stoma that collects stool.
The exact cause of ulcerative colitis is unknown, so there’s no known way to definitely prevent yourself from developing the disease.
However, good general preventive measures might include getting regular exercise and maintaining a healthy weight, eating a balanced diet that’s high in vegetables and low in fat, not smoking and taking steps to improve your overall gut health.
Next-Generation Treatment, Surveillance and Management Options for IBD at Hoag
Hoag is committed to offering the latest and most promising treatment and management options for those facing chronic issues involving the GI tract. Among the advanced techniques available at Hoag:
Colonoscopy
Infusion Services
Those with ulcerative colitis can have periods of time in which symptoms are active (called “flare ups”) followed by periods of remission in which symptoms lessen in severity or disappear. These periods of remission can last for months or years. In some cases, ulcerative colitis flare ups can be triggered by stress, hormonal changes, illness or certain foods, but these triggers don’t directly cause the condition.
Ulcerative colitis can occur at any age, but is most commonly diagnosed in patients between the ages of 15 and 30, affecting both genders equally. The exact cause of UC is unknown, but it appears to have a genetic component in at least some cases, as up to 20% of people with ulcerative colitis have a close relative with UC or Crohn’s disease.
One important concern in terms of complications of ulcerative colitis is that it can increase a person’s risk of developing colon cancer , with the risk increasing the longer a person has the disease.
According information published by the National Institutes of Health, between 0.06% and 0.16% of patients in the U.S. with ulcerative colitis develop colorectal cancer every year.
There is currently no cure for ulcerative colitis, but there are treatment and management options available that can potentially reduce inflammation in the colon, manage symptoms, reduce flare up recurrence and improve quality of life for those living with the condition.
While both Ulcerative Colitis and Crohn’s are forms of Inflammatory Bowel Disease (IBD), they impact different parts of the GI tract. Ulcerative colitis is usually limited to the colon, while Crohn’s can affect any part of the digestive tract from the mouth to the anus.
Another difference between ulcerative colitis and Crohn’s is the way each condition affects the tissues of the GI tract. With ulcerative colitis, inflammation is limited to the innermost lining of the colon, while Crohn’s can affect the entire thickness of the bowel wall.