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Patient Education

Ulcerative Colitis

What is Ulcerative Colitis?

Ulcerative colitis (UC) is a long-lasting inflammatory bowel disease (IBD) that causes inflammation and ulcers in the large intestine.  The large intestine includes the rectum and colon. In patients with UC, the immune system mistakingly targets the lining of the large intestine.  This can cause inflammation, ulceration, bleeding, and diarrhea in the colon and rectum.

Gastroenterology Consultants of San Antonio - Ulcerative Colitis

Ulcerative Colitis

There is no cure for ulcerative colitis, but treatment can usually control and reduce the symptoms.  Most people with ulcerative colitis live productive and active lives.

Ulcerative Colitis Symptoms

Symptoms of ulcerative colitis will vary based on where inflammation occurs and how severe it is. Symptoms can be mild to severe and include:

  • Diarrhea – may include blood or pus
  • Abdominal pain/cramping
  • Rectal pain/bleeding
  • Straining to defecate / constipation
  • Fever
  • Dehydration
  • Weight Loss

Ulcerative Colitis Causes

The exact cause of ulcerative colitis is unknown. However, research shows UC is influenced by genetics, environment, and an overactive immune system.

  • Genetics – Ulcerative Colitis often runs in families, which suggests a genetic role.
  • Environment – Infections can trigger an abnormal immune response in those susceptible to UC.
  • Immune System – If triggered, the immune system targets the large intestine and causes inflammation.

Ulcerative Colitis appears to be more common in those living in northern climates and developed countries (North America, Great Brittain) compared to those living in developing countries and southern climates. Doctors do not yet know the reasons for these correlations.

Ulcerative Colitis Definitions

The type of ulcerative colitis is determined by the location of the disease. Ulcerative colitis types include:

  • Ulcerative proctitis – UC when the disease is limited to the rectum
    Distal colitis/proctosigmoiditis – when the inflamed area extends into the mid-sigmoid colon.
  • Left-sided colitis – when inflammation extends to (but not beyond) the splenic flexure. The splenic flexure is the sharp turn in the intestines where the transverse colon meets the descending colon.
  • Extensive colitis – when UC extends beyond the splenic flexure, but not into the cecum (where the colon begins).
  • Pancolitis – When UC extends to the cecum

Ulcerative Colitis Risk Factors

Men and women are at equal risk for ulcerative colitis.  Risk factors for ulcerative colitis include:

  • Age: UC can occur at any age, but often begins before age 30.  Some may not develop UC until after age 60.
  • Race / Ethnicity: UC can occur in all races, but whites have the highest risk. The risk for those of Ashkenazi Jewish descent is even higher.
  • Family history: If close relatives have UC, you are at higher risk.  This includes parents, siblings, and children.

Ulcerative Colitis Complications

Ulcerative colitis can cause complications, some of them serious. Complications include:

  • Severe bleeding
  • Perforated colon (hole in colon)
  • Severe dehydration
  • Osteoporosis (bone loss)
  • Inflammation of the eyes, skin, and joints
  • Higher risk of colon cancer
  • Toxic megacolon (rapidly swelling colon)
  • Higher risk of blood clots

Ulcerative Colitis Diagnosis

The doctor will diagnose ulcerative colitis after ruling out other causes of signs and symptoms. To confirm the diagnosis of ulcerative colitis, your doctor may recommend the following tests and procedures:

  • Blood tests: Blood tests can check for anemia and signs of an infection.  Anemia is a condition when the blood doesn’t have enough healthy red blood cells.
  • Stool tests: Stool tests look for white blood cells that could indicate ulcerative colitis. These tests can also rule out other conditions like infections caused by parasites, viruses, or bacteria.
  • Colonoscopy:  This exam allows the doctor to view the inside of the colon using a thin, lighted tube with a camera.  A colonoscopy also allows the doctor to remove small tissue samples (biopsies) that can be tested to help confirm a diagnosis of UC.
  • Flexible sigmoidoscopy: If the colon is severely inflamed, the doctor may recommend a sigmoidoscopy instead of a colonoscopy.  A sigmoidoscopy exam allows the doctor to view the last portion of the colon, including the rectum and sigmoid.
  • X-ray: The doctor may recommend a traditional abdominal X-ray if you have severe symptoms.  This helps rule out more serious conditions like a perforated colon.
  • CT Scan – If complications from UC are suspected, the doctor may recommend an abdominal CT scan. This imaging scan may also determine the severity and location of the inflammation.

Ulcerative Colitis Treatment

Since ulcerative colitis is a chronic disease, it requires ongoing treatment. Treatment for UC usually involves medications or surgery.

The type of medication your doctor recommends will depend on the severity of the condition. Some drugs work better than others for certain people.

Your doctor will work with you to find a medication that works best for you. Some medications have side effects, which each patient will need to consider when deciding how to treat their ulcerative colitis.

Ulcerative Colitis Medications

Anti-inflammatory Drugs

The first step in treating ulcerative colitis is usually anti-inflammatory drugs.

  • 5-aminosalicylates – Metronidazole, ciprofloxacin, sulfasalazine (Azulfidine), mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal) and olsalazine (Dipentum), and other antibiotics may be used when an infection occurs.  Doctors may also prescribe them to treat complications of ulcerative colitis. Your doctor will help you determine the best drug based on your condition.
  • Corticosteroids (steroids) –  These drugs, including prednisone and hydrocortisone, reduce inflammation by suppressing the immune system.  They are usually recommended for moderate or severe ulcerative colitis that isn’t responding to other treatments. They are not usually given long-term due to potential side effects.
Immune system modifiers

Immunosuppressant drugs reduce inflammation by suppressing the immune system response that causes inflammation. A combination of these medications may be more effective for some people.

  • Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). These immunosuppressants are common in the treatment of inflammatory bowel disease. While taking them, it’s important to have your blood checked regularly to look for side effects (including pancreas and liver problems).
  • Cyclosporine (Gengraf, Sandimmune, and Neoral). This medication is usually reserved for patients who have already tried other medications. The potential side effects are serious and Cyclosporine is not intended for long-term use.
  • Infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi). These drugs are biologic therapies (biologics) suppress the immune system by targeting a specific pathway, reducing inflammation.  They are usually given to people with severe ulcerative colitis and those who don’t respond to or can’t tolerate conventional therapy.
  • Vedolizumab (Entyvio). This medication blocks inflammatory cells from the site of inflammation.  It’s reserved for those who don’t respond to or can’t tolerate conventional therapy.
Other medications

Other medications may be necessary to treat the symptoms of ulcerative colitis, including:

  • Antibiotics – Metronidazole, ciprofloxacin, or other antibiotics may be used during an infection, or to treat ulcerative colitis complications.
  • Anti-diarrheal medications –  Anti-diarrheal medications should only be used after talking with your doctor since they can increase the risk of toxic megacolon. Operamide (Imodium) may be effective for treating severe diarrhea.
  • Pain relievers. The doctor may recommend acetaminophen (Tylenol) for mild pain.  Doctors don’t recommend Ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), and diclofenac sodium (Voltaren).  These drugs can worsen symptoms and increase the severity of ulcerative colitis.
  • Iron supplements. Your doctor may recommend taking iron supplements if you have chronic intestinal bleeding that results in iron deficiency anemia.

Ulcerative Colitis Surgery

Surgery has the benefit of eliminating ulcerative colitis.  However, it’s only considered if other treatments like medications haven’t worked.  Ulcerative colitis surgery usually involves removing the colon and rectum (proctocolectomy).

Psychological Therapy

Because stress can make ulcerative colitis worse, counseling or psychotherapy may be recommended.  This can help people with UC who experience frustration, anxiety, or depression.

Cancer Screenings

Treatment for UC includes more-frequent screenings for colon cancer due to increased risk. The frequency will depend on how long you’ve had the condition and its severity.

Ulcerative Colitis Diet

There is no firm evidence that diet causes ulcerative colitis, but people may experience worsening symptoms when they eat certain foods.  Not everyone will react to different foods in the same way. Keeping a food diary can help you determine which foods aggravate your symptoms.

Some ulcerative colitis diet recommendations include:

  • Limit dairy products – Often, those with inflammatory bowel diseases find that limiting or eliminating certain dairy products can improve symptoms like diarrhea and abdominal pain.
  • Limit fiber – Some high-fiber foods, like whole grains and fresh fruit and vegetables, may make symptoms worse.  Other problem foods may include foods in the cabbage family, broccoli, cauliflower, nuts, seeds, corn, and popcorn. Talk with your doctor or a dietitian to make sure you’re getting enough fiber.
  • Avoid alcohol, caffeine, and spicy foods that may make symptoms worse.

Stress Reduction

Stress doesn’t cause ulcerative colitis, but stress can make symptoms worse.  Some ways to control stress include:

  • Exercise
  • Mindfulness
  • Meditation
  • Breathing Exercises
  • Yoga

Ulcerative Colitis Alternative Medicine / Treatments

  • Herbal supplements – Most alternative therapies and supplements are not regulated by the FDA, which means they may not be safe or effective. It’s important to discuss any alternative medicines you may be taking with your doctor, as some may negatively impact your body’s response to traditional therapies.
  • Probiotics – Research is limited and results have not been proved, but researchers suspect that adding more good bacteria (probiotics) to the digestive tract may have a positive effect in people with ulcerative colitis.


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