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Ulcerative colitis is a disease that causes inflammation (painful swelling) and sores (ulcers) in the top layers of the lining of the large intestine. The inflammation usually occurs in the rectum and lower part of the colon (large intestine), though it may affect the entire organ. Ulcerative colitis may also be called colitis, ileitis or proctitis. This disease form is often difficult for doctors to diagnose because symptoms are very similar to irritable bowel syndrome (IBS) and Crohn's disease.
As with other inflammatory bowel disease conditions, ulcerative colitis has no known cause. There is some evidence that the body's immune (disease-fighting) system reacts to a virus or bacteria by causing ongoing inflammation in the intestinal wall. However, this has not been proven. Stress does not cause ulcerative colitis, nor do certain foods or food products, but these factors may set off symptoms in some people.
Affecting men and women equally, ulcerative colitis most often occurs in people 15 to 40 years of age. There is some evidence that the disease runs in families.
About half of all patients suffering from this disease have mild symptoms, including:
- Abdominal pain and bloody diarrhea (most common symptoms)
- Weight loss
- Loss of appetite
- Rectal bleeding
Other medical problems that crop up as a result of ulcerative colitis include arthritis, eye inflammation, liver disease, osteoporosis (loss of bone mass), skin rashes, anemia and kidney stones. These conditions are usually mild and go away when the colitis is treated.
In approaching a new case, IBD specialists first do a complete physical exam and then a number of tests to help determine whether ulcerative colitis is present.
Blood tests check for anemia and high white blood count - conditions that can indicate bleeding or inflammation somewhere in the body. A sample of the patient's stool can also provide clues of bleeding or infection in the colon or rectum.
To see inside the colon and rectum, the doctor may do a colonoscopy. An instrument called an endoscope is inserted into the anus. The long, flexible lighted tube connects to a computer screen and reveals any swelling, bleeding or ulcers on the colon wall. During this procedure, the doctor may also take a small sample of tissue to study under the microscope.
A barium enema X-ray of the colon can shed more light on the patient's condition. For this procedure, the colon is filled with barium, a chalky white solution. The barium shows up on X-ray film to allow the doctor a clear view of and any abnormalities on the colon.
Our team of IBD doctors design treatment plans for ulcerative colitis sufferers based on how severe the case is. Patients experience the condition differently, so treatment is adjusted for each individual. Emotional and psychological support is also an important part of any treatment plan.
Many patients have months or even years when the condition disappears. Unfortunately, most symptoms eventually come back. No one can predict when or for how long. A person with ulcerative colitis may need frequent checkups and regular medical care for some time. Among the strategies used by IBD specialists are:
- Drug therapy. At first, medicines that control inflammation are given. If the condition is not eased, a stronger category of drugs (steroids) is given to help reduce inflammation. Others may be given to relax the patient or relieve pain, diarrhea or infection. Some of the available drugs cause unpleasant or even severe side effects. Occasionally, the patient must go into the hospital (due to severe diarrhea or bleeding) and be fed a special diet through a vein.
- Surgery. Most people with ulcerative colitis never need surgery. If it does become necessary, many patients find comfort in knowing that after surgery, the disease can potentially be cured and they can resume their normal, active lives. Our IBD-trained surgeons will recommend removal of the colon when there is massive bleeding, severe illness, a rupture of the colon, risk of cancer or when drug treatments fail or cause side effects that threaten the patient's health.
Several types of surgeries may be done. The most common allows the surgeon to remove the colon and rectum. Waste then travels through the intestine and leaves the body through a small opening on the right side below the belt line. A pouch is worn over the opening to collect the waste, which the patient empties as needed.
A second type of surgery creates a pouch inside the lower abdomen. Waste empties into the pouch. The patient drains the pouch by means of a tube inserted into a small opening in the patient's side.
A third surgery, called a pull-through operation, allows the patient to have normal bowel movements because part of the rectum remains in the body.
Patients are encouraged to consider all factors (needs, personal lifestyle and expectations) before making the decision to go ahead with surgical options.