Ulcerative colitis is a chronic disease in which the lining of the large intestine becomes inflamed.
The large intestine will then develop ulcers (open sores) that produce blood, pus, and mucus.
The small intestine is rarely affected.
The combination of inflammation and ulcers causes abdominal discomfort, frequent bowel movements, and bloody stools.
There are several subtypes of ulcerative colitis that are named according to the part of the large intestine affected:
Ulcerative colitis is a type of inflammatory bowel disease (IBD), but its not the same as irritable bowel syndrome (IBS).
Although the disorders share some of the same symptoms, such as abdominal pain and diarrhea, inflammation or ulcers do not occur with IBS.
Ulcerative colitis affects as many as 700,000 Americans, according to the Crohns & Colitis Foundation of America.
Caucasians have a higher risk of developing ulcerative colitis than African-Americans or Hispanics.
The incidence of ulcerative colitis is highest in the Western and Northern hemispheres and is lowest in Asia.
People of Ashkenazi Jewish descent have an especially high risk.
Ulcerative colitis tends to run in families, affecting men and women equally.
Experts believe this type of IBD is the result of a combination of environmental factors, a malfunctioning immune system, and a genetic predisposition.
While a specific cause is unknown, diet and stress may aggravate the condition.
For example, research shows that a high intake of trans fat, the type of fat in many processed foods, raises the risk of ulcerative colitis.
A high intake of omega-3 fatty acids may lower the risk of the condition.
Fatty, cold-water fish, such as mackerel, tuna, salmon, sardines, and herring, are rich sources of omega-3 fatty acids.
Symptoms of ulcerative colitis most often start either between age 15 and 40, or between 50 and 80.
The discomfort and diarrhea tend to come and go in cycles of active disease and remission.
In general, the more of the colon thats affected, the more serious the disease and the worse the symptoms.
The disease may progress over time, affecting greater areas of the colon.
Possible complications of ulcerative colitis include:
One of the most serious and potentially life-threatening complications of ulcerative colitis is toxic or fulminant colitis.
It occurs when a section of the colon becomes dilated and immobile, raising the risk of heavy bleeding, perforation, and peritonitis, an infection of the abdominal lining.
A dilated colon is also called acute, severe colitis or toxic megacolon. Common symptoms are pain, abdominal distention, fever, and rapid heart rate.
In many cases, toxic colitis requires surgery to remove all or a portion of the colon and rectum.
Ulcerative colitis is also associated with:
People with ulcerative colitis have a higher risk of colorectal cancer than the general population, and those with severe ulcerative colitis have the highest risk.
However, studies have shown that adhering to maintenance medications to prevent recurrences of active disease may lower your colon cancer risk.
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The most common symptoms of ulcerative colitis are abdominal pain and diarrhea that often contains blood or pus or both.
The disease and these symptoms typically come on gradually.
As the disease progresses, other symptoms may include:
Ulcerative colitis symptoms tend to come and go, with periods of remission between flare-ups.
A remission can last for months or years, which makes it difficult to determine whether a treatment helped or a spontaneous remission occurred.
Consult a doctor if you have some combination of the following symptoms:
Tests that may be used to help diagnose ulcerative colitis and rule out other conditions include:
A definitive diagnosis is generally made via endoscopy, that is, a colonoscopy or sigmoidoscopy.
Your doctor inserts an endoscope, a flexible tube with a light and camera attached, through your rectum into your colon.
The endoscope lets the doctor view the lining of your colon and withdraw tissue samples.
Acute, severe colitis is also called toxic or fulminant colitis. Its a complication of ulcerative colitis and is a life-threatening emergency.
Toxic colitis may occur rapidly and spontaneously for no apparent reason or as a result of overusing certain medications, such as antidiarrheal drugs and some pain relievers.
Symptoms of acute, severe colitis may include:
Rebound tenderness is a sign of peritonitis, an infection of the lining of the abdomen.
If you have acute, severe colitis, your doctor will probably hospitalize you for treatment.
In some cases, your doctor may prescribe high-dose, intravenous corticosteroid drugs to control your symptoms.
If this approach fails, your doctor may try other drugs.
In some cases, you will need surgery to remove the diseased portion of your colon.
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The goals of treatment for ulcerative colitis are:
Initially, your doctor prescribes medication to treat your colitis.
If drug therapy fails or an emergency develops, your doctor is likely to recommend surgery to remove a portion of your colon or all of it.
Sometimes it's necessary to remove the rectum as well.
Drugs that suppress the inflammation in your colon allow the tissues to heal, reducing the severity of your symptoms, such as diarrhea and abdominal pain.
Typically, your doctor will prescribe one or more of the following:
Other types of drugs your doctor may prescribe include:
Surgery may be necessary in the following situations:
Surgery for ulcerative colitis removes some or all of the colon and possibly the rectum.
When your rectum is removed, the surgeon must create an alternative way of moving waste from your body.
For example, a proctocolectomy, or removal of your entire colon and rectum, requires an ileostomy.
The surgeon creates a small opening in the abdominal wall and attaches the tip of the lower small intestine, the ileum, to the opening.
Waste exits the body through this opening.
A surgeon may leave the rectum intact, and attach the ilium to it in a procedure called an ileorectal anastomosis. This allows you to pass stool fairly normally.
However, ongoing medical treatment of ulcerative proctitis may be necessary.
In a third type of surgery, an ileoanal anastomosis, the surgeon preserves the outer muscles of the rectum and attaches the end of the lower small intestine to the inside of the rectum, forming a pouch to hold fecal material.
This surgery allows you to pass stool through the anus fairly normally.
A number of lifestyle measures help control ulcerative colitis symptoms and reduces the stress of living with this chronic condition.
Check with your doctor before trying any of the following approaches to managing your colitis:
Given the lack of a cure for ulcerative colitis and the difficulty of living with the disease, researchers continue to look for more and better treatments.
Among those that have been studied:
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The initial treatment for mild or moderate ulcerative colitis includes anti-inflammatory and antidiarrheal medications, corticosteroids, and fluids for rehydration.
Acute, severe ulcerative colitis (called toxic or fulminant colitis) requires hospitalization and intensive, intravenous fluid-replacement or corticosteroid therapy.
One of the first medications prescribed for mild to moderate ulcerative colitis is the drug mesalamine (Liaida, Apriso, Canasa, Pentasa, Asacol).
It belongs to a class of anti-inflammatories called aminosalicylates.
Mesalamine is used both to treat active symptoms of ulcerative colitis and as a maintenance drug to prevent symptom recurrence.
Mesalamine may be taken orally as a tablet or capsule or rectally as a suppository or in an enema. Depending on the formulation, it may be necessary to take three or four doses of mesalamine daily.
For ulcerative proctitis that is, when the disease confined to your rectum your doctor may prescribe the suppository formulation alone.
For disease that extends beyond the rectum, your doctor may prescribe a suppository, an enema, and an oral formulation.
Another first-line treatment for ulcerative colitis is the corticosteroid drug budesonide (Entocort, Uceris).
Budesonide can be taken orally as a tablet or capsule or rectally as in a foam or enema.
If you take systemic corticosteroids orally or by injection, you may have significant side effects.
However, because of the way the body processes budesonide, the oral form causes fewer side effects than other corticosteroids.
Nonetheless, local steroids, which are applied just to the place needing treatment, are the preferred option, when possible.
In 2014, the Federal Drug Administration (FDA) approved a rectal budesonide foam for inducing remission of active, mild-to-moderate ulcerative proctitis or proctosigmoiditis (disease extending from the rectum to the lower segment of the colon).
Another form of budesonide, called budesonide multi-matrix system (MMX), is in development.
Budesonide MMX tablets deliver budesonide to the colon, theoretically minimizing the systemic side effects of other corticosteroids.
For severe ulcerative colitis flare-ups, hospitalization and high-dose intravenous corticosteroids are often required.
Once remission is achieved, the dose of steroids is tapered gradually and ultimately stopped.
Steroids are ineffective as maintenance therapy to keep ulcerative colitis in remission.
Possible side effects of steroid use include:
If youre suffering from acute ulcerative colitis, and intravenous corticosteroids arent effective, your doctor may prescribe intravenous cyclosporine (Sandimmune) or infliximab (Remicade).
Cyclosporine is an immunosuppressant, meaning it works by suppressing the activity of your immune system.
Infliximab is a tumor necrosis factor-alpha (TNF-alpha) inhibitor. It works by blocking the action of TNF-alpha, a substance in the body that causes inflammation.
The immunosuppressant drug azathioprine (Imuran) may also be used to treat ulcerative colitis, alone or in combination with infliximab.
Like corticosteroids, immunosuppressant drugs such as cyclosporine and TNF-alpha inhibitors, raise the risk of infection.
These drugs are also associated with a higher risk of certain cancers.
However, if one of these drugs is controlling your ulcerative colitis symptoms without bothersome side effects, the benefits of continuing the drug may outweigh these risks.
Other medications doctors prescribe to treat ulcerative colitis include:
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Ulcerative colitis, a chronic inflammatory disease of the large intestine, isnt caused by any particular food or diet.
Nor is there evidence that specific foods contribute to the inflammation or ulceration that characterize the condition.
Nevertheless, during a disease flare, some foods may aggravate your symptoms more than others.
In addition, because ulcerative colitis tends to cause diarrhea, its important to replace lost fluids and stay hydrated when the disease flares.
When the disease is in remission or not causing symptoms experts suggest a balanced diet that provides the basic nutrients for good health.
During a disease flare, it's helpful to stick to bland foods that are easy to digest.
Such foods include:
Keeping a food journal can help you learn and remember which foods bother you and which do not.
While no foods have been found to worsen the inflammation or ulceration of ulcerative colitis, some foods may make symptoms, such as cramping and diarrhea, worse.
During a flare, avoid high-fiber foods, which are harder to digest than low-fiber foods.
High-fiber foods include:
Greasy, fried, or high-fat foods, such as butter and margarine, may also cause diarrhea.
Other foods and beverages to approach cautiously include:
Some people will have more trouble with certain foods and beverages than others.
Whats important is finding which foods cause digestive discomfort for you and avoiding them.
The job of the large intestine is to reabsorb water from digested food and move solid waste out of the body.
When the colon is inflamed during an active bout of ulcerative colitis, it does not reabsorb water properly, which leads to diarrhea and subsequently dehydration.
That's why it is so important to drink an adequate amount of fluid when your ulcerative colitis is active.
According to the Crohns & Colitis Foundation of America, a good rule of thumb is to consume half an ounce of fluid per pound of body weight per day.
If you weigh 140 pounds, for example, you need at least 70 ounces of fluid a day, or nearly 9 cups.
Since drinking ice-cold liquids or consuming too much fluid at once can worsen diarrhea, takes sips of warm or cool beverages throughout the day.
Avoid gulping fluids, since this can aggravate diarrhea and cause you to swallow air along with the fluid.
Eating during a disease flare may cause abdominal cramping. One way to minimize the discomfort is by eating frequent, small meals of bland foods.
If youre having trouble finding foods that don't worsen symptoms or youre losing weight because of that difficulty, consult a registered dietitian who is knowledgeable about inflammatory bowel disease.
Your dietitian may recommend using liquid supplements if you cant tolerate solid foods.
You may need to take vitamin or mineral supplements or both to make up for nutrient deficiencies caused by your diet, the disease, or the medications you take to treat the disease.
Speak to your doctor or nutritionist about which, if any, supplements you may need.
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