Ulcerative colitis is an inflammatory bowel disease that causes inflammation and ulcers (sores) in the digestive tract.
Ulcerative colitis affects the innermost lining of the large intestine (colon) and rectum. Symptoms usually develop over time, instead of suddenly.
Ulcerative colitis may be debilitating and can sometimes cause life-threatening complications.
Though it has no known cure, treatment can considerably reduce the signs and symptoms of this disease and cause long-term remission.
Ulcerative colitis symptoms may vary, based on the intensity of inflammation and where it happens.
Signs and symptoms may include:
- Diarrhea, often with blood or pus
- Abdominal cramping and pain
- Rectal pain
- Rectal bleeding — passing small Quantity of blood with feces
- Weight reduction
- In kids, failure to grow
Many people with ulcerative colitis have mild to moderate symptoms. The path of ulcerative colitis may vary, with some people having long periods of remission.
Doctors often classify ulcerative colitis based on its own location. Kinds of ulcerative colitis include:
Ulcerative proctitis. Inflammation is restricted to the region closest to the anus (rectum), and rectal bleeding might be the only sign of the disease.
Proctosigmoiditis. Infection involves the rectum and sigmoid colon the lower end of this colon.
Signs and symptoms include bloody diarrhea, abdominal cramps and pain, and an inability to move the bowels regardless of the urge to do this (tenesmus).
Left-sided colitis. The inflammation extends out of the rectum up through the sigmoid and descending colon. Signs and symptoms include bloody diarrhea, stomach cramping and pain on the flip side, and urgency to defecate.
Pancolitis. This kind frequently affects the entire colon and triggers bouts of diarrhea that might be acute, abdominal cramps and pain, fatigue, and significant weight loss.
When to Consult a Doctor:
See your Physician if you encounter a persistent change in your bowel habits or if you have symptoms and signs like:
- Blood in your stool
- Ongoing diarrhea that does not respond to over-the-counter medications
- Diarrhea that awakens you from sleep
- Fever lasting more than a day or two.
Although ulcerative colitis usually is not fatal, it’s a serious disease that, sometimes, might cause life-threatening complications.
The precise reason for ulcerative colitis remains unknown.
Previously, stress and diet have been suspected, but physicians know these variables may aggravate but don’t cause ulcerative colitis.
One possible cause is an immune system error. If your immune system attempts to fight off an invading bacterium or virus, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too.
Heredity also appears to play a role in that ulcerative colitis is more common in those who have family members with the disease. But most individuals with ulcerative colitis don’t have this family history.
Ulcerative colitis affects roughly precisely the same number of girls and men. Risk factors might include:
Age. Ulcerative colitis usually starts before age 30. However, it can occur at any age, and a few folks may not develop the illness until after age 60.
Race or ethnicity. Although whites have the maximum risk of the illness, it can happen in almost any race. If you’re of Ashkenazi Jewish descent, your risk is even higher.
Family history. You’re at higher risk if you have a close relative, including a parent, sibling, or child, together with the disease.
Possible complications of ulcerative colitis include:
- A hole at the colon (perforated colon)
- Acute dehydration
- Inflammation of your skin, joints, and eyes
- An increased risk of colon cancer
- A fast swelling colon (toxic megacolon)
- Increased risk of blood clots in arteries and veins
Endoscopic processes with tissue biopsy are the only way to definitively diagnose ulcerative colitis.
Other kinds of tests can help rule out issues or alternative types of inflammatory bowel disease, such as Crohn’s disease.
To help confirm a diagnosis of ulcerative colitis, you might have one or more of these tests and procedures:
Blood tests. Your physician may suggest blood tests to test for anemia a condition where there are not enough red blood cells to carry adequate oxygen to your tissues or to test for symptoms of infection.
Stool tests. White blood cells or certain proteins in your feces can signal ulcerative colitis. A stool sample can also help rule out other disorders, like infections caused by bacteria, parasites, and viruses.
Colonoscopy. This exam allows your doctor to look at your entire colon using a thin, flexible, lighted tube with a camera on the end.
During the process, your physician may also take tiny samples of tissue (biopsy) for laboratory evaluation. A tissue sample is vital to make the identification.
Flexible sigmoidoscopy. Your doctor uses a slim, flexible, lighted tube to examine the rectum and sigmoid colon at the lower end of your colon.
If your colon is badly inflamed, your physician may carry out this evaluation instead of a full colonoscopy.
X-ray. If you’ve got severe symptoms, your doctor may use a standard X-ray of your stomach region to rule out serious complications, including a perforated colon.
CT scan. A CT scan of your abdomen or pelvis may be carried out if your doctor suspects a complication from ulcerative colitis.
A CT scan can also reveal just how much of the colon is inflamed.
Computerized tomography (CT) enterography and magnetic resonance (MR) enterography. Your doctor may recommend one of these noninvasive tests if he or she would like to exclude any flaws in the gut.
These tests are more sensitive for finding inflammation in the bowel than are conventional imaging evaluations. MR enterography is a radiation-free alternate.
Ulcerative colitis treatment generally involves either drug therapy or surgery.
Several types of medication might be effective in treating ulcerative colitis. The type you take will depend on the seriousness of your situation.
The medications which work well for some folks might not work for others, so it could take time to discover a medication that helps you.
Additionally, because some drugs have severe side effects, you’ll want to weigh the benefits and risks of any treatment.
Anti-inflammatory drugs are frequently the initial step in treating ulcerative colitis and therefore are acceptable for the majority of individuals with this illness.
These drugs include:
5-aminosalicylates. Examples of this kind of medication include sulfasalazine (Azulfidine), mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal), and olsalazine (Dipentum).
That one you choose, and whether it’s taken orally or as an enema or suppository, is contingent on the area of your colon that is influenced.
Corticosteroids. These drugs, which include prednisone and budesonide, are usually reserved for moderate to severe ulcerative colitis that doesn’t respond to other treatments.
Due to the side effects, they are not usually provided long-term.
Immune system suppressors:
These medications also decrease inflammation, but they do so by suppressing the immune system reaction that starts the process of inflammation.
For some people, a mixture of those drugs works greater than 1 drug alone.
Immunosuppressant drugs include:
Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). These will be the most widely used immunosuppressants for the treatment of inflammatory bowel disease.
Taking them demands that you follow up closely with your physician and have your blood checked regularly to look for unwanted effects, such as effects on the liver and pancreas.
Cyclosporine (Gengraf, Neoral, Sandimmune). This medication is usually reserved for people who haven’t responded well to other drugs.
Cyclosporine has the potential for severe side effects and isn’t for long-term use.
Tofacitinib (Xeljanz). This can be called a”small molecule” which also works by stopping the process of inflammation.
Tofacitinib is effective when other therapies don’t work. The main side effects include the greater risk of shingles disease and blood clots.
The U.S. Food and Drug Administration (FDA) recently issued a warning regarding tofacitinib, saying that preliminary studies reveal an elevated risk of serious heart-related troubles and cancer from taking this medication.
If you’re taking tofacitinib for ulcerative colitis, do not stop taking the medication without first talking with your physician.
This category of therapies aims at proteins made from the immune system. Kinds of biologics used to treat ulcerative colitis include:
Infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi). These medications, known as tumor necrosis factor (TNF) inhibitors, or biologics, work by neutralizing a protein produced by your immune system.
They are for people with severe ulcerative colitis who don’t respond to or can’t tolerate other treatments.
Vedolizumab (Entyvio). This medicine is approved for the treatment of ulcerative colitis for those who do not respond to or can’t tolerate other treatments.
It works by blocking inflammatory cells by getting to the site of inflammation.
Ustekinumab (Stelara). This medicine is approved for the treatment of ulcerative colitis for people that don’t respond to or can’t tolerate other therapies.
It works by blocking another protein that causes inflammation.
You might need extra medications to manage certain symptoms of ulcerative colitis.
Always talk with your health care provider before using over-the-counter medications. They may recommend one or more of the following.
Anti-diarrheal medications. For acute diarrhea, loperamide (Imodium A-D) may be powerful. Use anti-diarrheal medications with great care and after speaking with your doctor, since they may raise the danger of an enlarged colon (toxic megacolon).
Pain Reliever. For mild pain, your physician might recommend acetaminophen (Tylenol, others) — but not ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), and diclofenac sodium, which may aggravate symptoms and increase the intensity of the disease.
Antispasmodics. Sometimes physicians will prescribe antispasmodic therapies to assist with migraines.
Iron nutritional supplements. In case you’ve got chronic intestinal bleeding, then you may develop iron deficiency anemia and also receive iron supplements.
Surgery can eliminate ulcerative colitis and entails removing your entire colon and rectum (proctocolectomy).
Typically, this involves a process called ileoanal anastomosis (J-pouch) surgery. This process removes the need to wear a bag to collect stool.
Your surgeon constructs a pouch by the end of your small intestine. The pouch is then attached directly to your anus, letting you expel waste comparatively normally.
In some cases, a pouch isn’t feasible. Instead, surgeons make a permanent opening in your stomach (ileal stoma) through which stool is passed for set within an attached bag.
You may need more frequent screening for colon cancer because of your increased risk.
The recommended schedule will depend on the location of your disease and the length of time you have had it. Individuals with proctitis are not at greater risk of colon cancer.
If your illness entails more than your anus, you will call for a surveillance colonoscopy every one to two decades, starting as soon as eight years after diagnosis if the vast majority of your colon is involved, or 15 years if just the left side of your colon is involved.
Sometimes you might feel helpless when facing ulcerative colitis. But changes in your lifestyle and diet may help control your symptoms and lengthen the time between flare-ups.
There’s no firm evidence that what you eat really causes inflammatory bowel disease. But specific foods and beverages can aggravate your signs and symptoms, particularly during a flare-up.
It can be handy to keep a food diary to keep track of everything you’re eating, as well as the way you feel. If you discover that a few foods are causing your symptoms to flare, you can try removing them.
Here are some general dietary suggestions that may help you manage your condition:
Limit dairy products. A lot of people with inflammatory bowel disease find that issues like diarrhea, abdominal pain, and gas improve by limiting or eliminating dairy products.
You might be flaxseed which is, your body can’t digest the milk sugar (lactose) in dairy foods. Using an enzyme product such as Lactaid may assist as well.
Eat modest meals. You may realize that you are feeling better eating five or six small meals daily instead of two or three larger ones.
Drink plenty of fluids. Try to drink plenty of liquids daily. Alcohol and drinks that contain caffeine stimulate your intestines and can make nausea worse, while carbonated drinks often produce gas.
Talk to a dietitian. If you start to shed weight or your diet has become very limited, speak with a registered dietitian.
Although stress doesn’t cause inflammatory bowel disease, it may make your signs and symptoms worse and may trigger flare-ups.
To help control anxiety, try:
Exercise. Even mild exercise can help reduce stress, relieve depression and normalize bowel function.
Talk with your doctor about an exercise plan that’s right for you.
Biofeedback. This stress-reduction technique makes it possible to reduce muscle tension and slow your heart rate with the help of a feedback system.
The goal is to help you enter a relaxed state so that you can deal more easily with anxiety.
Regular relaxation and breathing exercises. An effective approach to cope with anxiety is to do breathing and relaxation exercises.
You can take classes in yoga and meditation or practice at home using books, CDs, or DVDs.
Lots of people with digestive ailments have utilized some kind of complementary and alternative medicine (CAM).
However, there are few well-designed studies showing the effectiveness and safety of complementary and alternative medicine.
Although research is limited, there’s some evidence that adding probiotics together with other medications may be helpful, but this hasn’t yet been proved.
Preparing for your appointment:
Symptoms of ulcerative colitis may prompt you to visit your primary care physician. Your doctor may advise that you find a specialist who treats digestive ailments (gastroenterologist).
Because appointments could be short, and there’s often a great deal of information to discuss, it’s a fantastic idea to be well prepared.
Here’s some information that will help you get ready, and also what to expect from your doctor.
What you can do:
Be conscious of any pre-appointment restrictions. At the moment you create the appointment, be sure to ask if there is anything you need to do beforehand, for example, restrict your diet.
Write down any symptoms you are experiencing, including any that may seem unrelated to the reason that you scheduled the appointment.
Write down key personal information, including any major stresses or current life changes.
Make a list of all medications, vitamins, or supplements that you’re taking. Make sure you let your doctor know whether you’re taking any herbal preparations, too.
Ask a relative or friend to come with you. Sometimes it can be tricky to recall all the information offered to you during a scheduled appointment.
Someone who accompanies you may remember something which you missed or forgot.
Write down questions to ask your physician.
Your time with your doctor is limited, therefore preparing a list of questions ahead of time can help you make the most of your time.
List your questions from most significant to least important in case time runs out. For ulcerative colitis, some basic questions to ask your doctor include:
- What is the most probable reason for my symptoms?
- Are there any other possible causes for my symptoms?
- What kinds of tests do I need? Do these tests need any special preparation?
- Is this condition temporary or long-lasting?
- What treatments are available, and which do you recommend?
- What types of side effects can I expect from treatment?
- Are there any over-the-counter or prescription drugs I want to avoid?
- What sort of follow-up care do I want? How often do I need a colonoscopy?
- Are there any options for this primary approach that you are proposing?
- I have other health conditions. How do I best manage them collectively?
- Are there certain foods I can’t eat anymore?
- Will I manage to keep working?
- Can I have children?
- Can there be a generic alternative to the medication you are prescribing?
- Are there any exemptions or other printed material that I can take with me? What sites would you recommend?
Things to expect from your Physician:
Your doctor is likely to ask you a number of queries. Becoming ready to answer them may book a time to go over things you would like to spend more time on.
Your doctor may ask:
- When did you begin experiencing symptoms?
- Have your symptoms been continuous or intermittent?
- How severe are the symptoms?
- Have you had diarrhea? How frequently?
- Perhaps you have lost any weight unintentionally?
- Does anything appear to improve your symptoms?
- What, if anything, seems to worsen your symptoms?
- Have you ever experienced liver issues, hepatitis, or jaundice?
- Have you ever had any issues with your joints, eyes, skin rashes or sores, or had sores in your mouth?
- Can you awaken from sleep during the night due to nausea?
- Perhaps you have traveled? If so, where?
- Is anybody else in your home sick with nausea?
- Perhaps you have ever taken antibiotics recently?
- Do you regularly take nonsteroidal anti-inflammatory medications, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve)?
Ask your friends and loved ones for support.
If you’re feeling anxious or depressed, consider joining a support group or seeking counseling. Believe in your ability to take control of the pain…
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