Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterized by inflammation and ulcers in the lining of the colon and rectum. It is one of the two main forms of IBD, the other being Crohn’s disease. Symptoms usually develop over time and can include abdominal pain and cramping, diarrhea (often bloody), rectal bleeding, weight loss, fatigue, and fever. UC is a lifelong condition with periods of flare-ups and remission, and it requires ongoing management to control symptoms and prevent complications. The cause of UC is unknown but family history can play a role along with a previous irregular immune response.
There are four types of UC, based on its location.
- Ulcerative proctitis: Inflammation only to the rectum, where rectal pain and bleeding may be the only symptom.
- Proctosigmoiditis: Inflammation in the lower end of the colon- the rectum and sigmoid colon. Symptoms often include abdominal pain and cramps, and bloody diarrhea.
- Left-sided colitis: Inflammation from the rectum to the sigmoid and descending parts of the colon. Symptoms can include left sided abdominal pain and cramping, weight loss, bloody diarrhea and bowel movement urgency.
- Pancolitis: Inflammation of the entire colon. Symptoms include fatigue, loss of appetite, weight loss, abdominal pain and cramps, and bloody diarrhea.
How is it diagnosed?
Imaging tests such as CT scans or MRIs can be used to evaluate the extent and severity of inflammation and detect complications like strictures or perforation. Blood and stool tests help assess for inflammation, anemia, and infection. Endoscopic procedures such as colonoscopy and flexible sigmoidoscopy, which visualize the colon, help identify characteristic features of UC, like inflammation, ulcers, and pseudopolyps. Biopsy samples are taken to confirm the diagnosis and assess the severity of inflammation.
How is it treated?
Treatment for ulcerative colitis aims to induce and maintain remission, control symptoms, and improve quality of life. This may involve a combination of medications, lifestyle modifications, and, in some cases, surgery. Medications can include anti-inflammatory drugs like corticosteroids, immunosuppressant’s, biologic therapies and symptom-relief medications like antidiarrheals. Some medications can work for some people but not for others so it can take time to find what works for you. You will work with your physician to find the best solution. Lifestyle changes such as dietary modifications, stress management, quitting smoking, consistent exercise, and adequate hydration can help manage symptoms and improve your overall well-being. In severe cases or when medications fail to provide relief, surgery may be needed to remove the colon and rectum.
Resources
https://www.crohnscolitisfoundation.org
The Crohn’s and Colitis Foundation website is a great resource on treatment options, IBD medications guide, information on diet and nutrition, research information, financial and insurance material and community support options.
References
Mayo Clinic. 2022. Ulcerative Colitis. https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-20353326
Crohn’s and Colitis Foundation. n.d. What is Ulcerative Colitis? https://www.crohnscolitisfoundation.org/patientsandcaregivers/what-is-ulcerative-colitis
