What Is Ulcerative Colitis?

Ulcerative colitis is a disease that affects the large intestine. It causes ulcers and irritation in the inner lining of the colon and rectum. In a subgroup of individuals with ulcerative colitis involving the entire colon, the last 1 to 2 inches of the small intestine may also be involved.

The inflammation always starts in the rectum. In some individuals, the inflammation extends upward into the colon. Ulcers or sores develop in the lining of the colon.

Studies in large populations of patients with ulcerative colitis show the following conditions:

• 30% have limited proctitis (inflammation of the rectal lining), 30% have pancolitis (inflammation of the entire colon), and 40% have left-sided colitis (inflammation in the left side of the colon). 

Although there are several layers that make up the colon, the inflammation of ulcerative colitis involves only the innermost lining called the mucosa. Over time, some patients who are initially diagnosed with limited disease like proctitis may progress in a continuous fashion from the rectum to parts of the colon and develop inflammation in these areas of the colon.

Snippet Highlight: Ulcerative colitis goes through cycles of flare-ups and remission when the disease is active. It usually requires some form of treatment before going back into remission when flare-ups happen.

Although ulcerative colitis is most common in Northern Europe, the disease is now clearly seen with increasing frequency in Southern Europe and also developing countries in other continents. The prevalence of ulcerative colitis in areas of high risk, such as North Tees in England, Copenhagen County and Iceland has been approximately 100 patients per one lakh people.

IBD is said to result from the interaction between genetic, immune function, bacterial infection and environmental factors that influence the normal intestinal flora to trigger an inappropriate immune response.

• Genetic Factors - The prevalence of ulcerative colitis in first-degree relatives was found to be 15 times higher than in non relatives.
• Autoimmune Issues – Certain cases of ulcerative colitis result from attacks on the intestinal lining by the body’s own immune system.
• Environmental Factors – High meat and fat consumption, smoking, use of oral contraceptives and non-steroidal anti-inflammatory drugs are some of the environmental factors that can increase the risk for having ulcerative colitis.
• Bacteria – The presence of bacteria like Salmonella and Yersinia has been investigated as a possible case of ulcerative colitis, whereas Clostridium difficile toxin has been associated with disease exacerbation.

The following list includes the risk factors that may be involved in causing ulcerative colitis disease.

• In most studies ulcerative colitis has shown a bimodal age distribution in the white population.
• Jews have a higher incidence of the disease than the other races living in the same area.
• Environmental influences like migration play an important role in the development of ulcerative colitis.
• People living in dormitory suburbs were at significantly less risk than those in towns or the country due to different environmental factors.
• There is an increased risk of ulcerative colitis for the offspring, siblings, and parents who have a positive family history.

A combination of history, assessment of endoscopic and radiological appearances, histology, and microbiology is needed to diagnose ulcerative colitis.

The cardinal symptoms of ulcerative colitis are:

• Bloody diarrhea
• Urgency
• Straining at stool
• Abdominal Cramping
• Weight loss
• Joint Pain
• Rashes
• Dehydration
• Nausea and Vomiting
• Anorexia
• Fever
• Hyperactive bowel sounds
• Weakness

Snippet Highlight: The presence of bloody diarrhea for more than three weeks should alert the doctor to the possibility of the disease and endoscopy should be performed. The severity of symptoms and extent of the disease influence the treatment of ulcerative colitis.

The diagnosis of the disease using the following tests is fundamental to assess the extent and severity of the disease, monitoring the response to therapy, post-operative follow-up and the application of therapeutic interventions in case of surgical complications.

• Abdominal X-Ray
• Hematology (Blood Count, Liver Function Tests, electrolytes, urea and creatinine)
• Stool Analysis
• Urine Analysis
• Endoscopy
• Colonoscopy
• Sigmoidoscopy
• Barium enema
• Histology

Snippet Highlight: No one test can definitely diagnose something as having the disease with 100% certainty. The diagnosis is based upon a patient’s clinical history and physical examination in combination with radiologic, endoscopic, and laboratory testing.

And because each patient is an individual, not all patients undergo an identical evaluation; testing is tailored to each patient.

The treatment protocol for ulcerative colitis includes colectomy, diet modifications, transfusion therapy with packed RBCs and balancing of nutritional requirements.

It is important to try to differentiate ulcerative colitis from Crohn’s disease using the clinical presentation, X-ray, endoscopic and histological findings. This is because ulcerative colitis that does not respond to medical management can be cured by colectomy, which is not the case with Crohn’s Disease.

Indications for surgery include chronic ill-health and severe disease, complications e.g. perforation, massive bleeding and severe disease not responding to optical medical treatment in 7-10 days.

Ulcerative colitis is a chronic condition that has the tendency to relapse. About two thirds of patients have clear cut and often long lasting remissions, but the overall colectomy rate is still about 25%. The extent and severity of disease should be assessed to identify the best approach for treatment.

Conventional Treatments

The goals of therapy are threefold: induction and maintenance of remission, restoration of normal life function, and avoidance of surgery. Management should also include supportive therapy with fluids, nutritional supplementation and anti-diarrheal medicines when needed. Treatment regimens should be based on individual symptom response, tolerance of specific therapies, and quality of life.

• Drug therapy using antibiotics, probiotics, anti-diarrheal agents, antibiotics and laxatives are used to treat mild attacks, reduce relapse and risk of cancer, induce remission, modulate immune response and relief from symptoms like constipation.
• Topical therapy including use of liquid and foam enemas, suppositories and gels to deliver medications topically and relieve local symptoms.
• Surgical therapies like colectomy is indicated for patients with ulcerative colitis who have definite low-grade or high-grade cancer risk, who have colorectal cancer, or those who are steroid-dependent. 

Alternative Treatments

Several alternative therapies offer ways other than drugs or surgery to treat an inflamed colon. Alternate therapies include administration of probiotics, nicotine and fish oil. Ova of the non-pathogenic helminth (tapeworm) taken orally have shown success inducing remission in 43% of patients in a placebo-controlled trial. However, all of these therapies are to be followed under the guidance of a medical professional only.

Consuming foods containing parasitic tapeworms is extremely harmful to health.

Homeopathy Treatment

Homeopathy provides a better response in conditions like ulcerative colitis. Complaints of frequent passage of bloody stool and abdominal pain by a patient were reduced within 3-4 months of homeopathic treatment by administering hydrastis, a homeopathic medicine.

Ayurvedic Treatment

The use of complementary medicine among patients with ulcerative colitis, particularly in the form of herbal therapies, is widespread in the Western world as well as in many Asian countries including China and India.

The following are a few herbal remedies suggested by Ayurveda for treating ulcerative colitis.

• Aloe vera is used for its role in antimicrobial and anti-inflammatory responses.
• Boswellia or Indian frankincense, an ayurvedic herb is used to reduce chemically induced edema and inflammation in the intestine.
• Topical use of butyrate may help decrease the inflammation in the colon.
• Licorice can improve intestinal inflammation and inhibits carcinogenesis.
• Slippery elm, a supplement to treat diarrhea and other complaints of the GI tract.
• Tormentil extracts have anti-oxidative properties and are used as a complementary
• Wheat grass juice appears to be effective and safe as treatment for active distal ulcerative colitis.
• Curcumin in turmeric has anti-inflammatory activity and protects against injuries such as inflammation and ulcers.
• Bromelain found in fruits like pineapple, is an anti-inflammatory and has been used as a digestive aid.

Nutrition 

The chronic diarrhea and pain create a loss of appetite, which means that at a time when more calories are needed the individual is taking in fewer.

• Germinated barley consisting mainly of dietary fiber and protein that function as a probiotic help in the treatment and prolongation of remission in ulcerative colitis.
• Psyllium used in food can reduce symptoms such as bleeding and can maintain remission in patients with ulcerative colitis.
• Oral supplements containing omega-3 fatty acids, antioxidants and fermentable soluble fiber significantly reduced inflammation and corticosteroid requirements in patients with ulcerative colitis.
• Elimination diets restricting fiber, fat and lactose are prescribed for individuals with ulcerative colitis to reduce diarrhea. 

Movement 

Having to follow a restricted diet, particularly having to avoid most fruits and vegetables, poses particular difficulties for those who are challenged by being overweight. Especially if your diet is restricted because of ulcerative colitis, regular exercise is of paramount importance.

Although regular exercise is beneficial in the long term, at times, it can do more harm than good in the short term. So, exercise to stay fit, but only if you are fit enough to exercise. Those with ulcerative colitis also have to be extra careful not to become dehydrated. Finally, people who have undergone a surgery should avoid exercises that include lifting heavy objects or doing sit-ups.

Yoga

Yoga, meditation and relaxation skills like hypnosis may all help reduce the perception of pain, particularly in chronic disorders like ulcerative colitis.

Mindset

Positive thinking bolsters the immune system and encourages the body’s self-healing capacities.

Connecting with people who are suffering from the disease helps individual sufferers and their friends and families understand that they are not alone in coping with their circumstances. Try not to let any negative thoughts hinder your progress in fighting the symptoms and stress you.

Preventive measures in order to reduce the risk are an important part of management of people with IBD.

• Stress may exacerbate ulcerative colitis and hence, effective stress management can help in preventing incidence of the disease.
• Well balanced diet maintaining adequate caloric intake and avoidance of malnutrition can reduce symptoms.
• Prolonged stay in uncomfortable temperatures should be avoided.
• Lack of rest makes the digestive tract extra susceptible to disturbances; hence, ample rest is to be considered.
• Heavy exercise right after eating can induce flare-ups; hence, exercise timing should be scheduled accordingly.

*Medical Disclaimer - The following information is for educational purposes only. No information provided on this website, including text, graphic, and images, are intended as substitutes for professional medical advice. Please consult with your doctor about specific medical advice pertaining to your condition(s)