Ulcerative Colitis: Symptoms, Diagnosis, and Treatment

What is ulcerative colitis?

Ulcerative colitis (UC) is an idiopathic inflammatory condition of the colon that results in diffuse friability and superficial erosions on the colonic wall and associated bleeding. It is the most common form of inflammatory bowel disease worldwide. Characteristically, it involves inflammation restricted to the mucosa and submucosa of the colon. Typically, the disease starts in the rectum and extends proximally in a continuous manner. In the United States, the disease accounts for a quarter-million provider visits annually. (https://www.ncbi.nlm.nih.gov/books/NBK279167/) 

What are the types of ulcerative colitis?

Based on the ulcer location, UC is classified as: 

• Ulcerative proctitis: Inflammation affects your rectum.
• Inflammation affects your rectum and sigmoid colon (the lower, S-shaped part of your colon).
• Left-sided colitis: Inflammation affects the left side of your colon.
• Pancolitis: Inflammation affects your entire colon. 

UC may be mild, moderate or severe, depending on your symptoms. The most severe form, fulminant ulcerative colitis, is rare. It can cause life-threatening complications that require urgent medical treatment. 

What are the symptoms of UC?

Symptoms of mild UC include:

• Diarrhea (with or without blood)
• Increased bowel movements or episodes of diarrhea (four or fewer episodes daily)
• Urgent bowel movements (sudden need to poop)
• Tenesmus (feeling like you have to poop but being unable to)
• Mild abdominal (belly) cramping or tenderness

      Symptoms of moderate to severe UC include: 

• Frequent bowel movement or episodes of diarrhea (four or more episodes daily)
• Blood, mucus or pus in stool
• Severe belly cramping
• Fatigue
• Sudden weight loss
• Nausea
• Fever 

 (https://my.clevelandclinic.org/health/diseases/10351-ulcerative-colitis) 

What are the causes and risk factors of UC?

Immune system malfunction or genetic predisposition are linked to UC. Ulcerative colitis affects about the same number of women and men. Risk factors may include:

• Age: UC is known to develop before the age of 30, however, some people may not develop the disease until after age 60.
• Ethnicity: Although UC is very common in Ashkenazi Jewish descent, it can happen in any race.
• Autoimmunity and having a family history of UC may also play an important role in the etiology of ulcerative colitis. People with UC have differences in their microbiomes when compared to people without. Researchers aren’t sure why. 

What are the complications of UC?

• Severe bleeding.
• A hole in the colon, known as a perforated colon.
• Severe dehydration.
• Loss of red blood cells, known as anemia.
• Bone loss, called osteoporosis.
• Inflammation of the skin, joints and eyes.
• An increased risk of colon cancer.
• A rapidly swelling colon, called toxic megacolon.
• Increased risk of blood clots in veins and arteries.
• Delayed growth and development in children. (https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-20353326) 

How is UC diagnosed?

• Blood tests can reflect anemia or show signs of infection. 
• Stool samples are collected to check inflammation and parasitic or other microbial infection.
• Imaging: X-rays can be done after injecting barium enema to reveal colon inflammation and complications like megacolon or perforation.
• A computed tomography (CT) scan or a magnetic resonance imaging (MRI) can be done to investigate moderate to severe inflammation in affected parts of colon. 
• Colonoscopy or Sigmoidoscopy are common endoscopic tests done to closely examine parts of the colon and also, for tissue biopsy if indicated. (https://my.clevelandclinic.org/health/diseases/10351-ulcerative-colitis) 

How is UC treated?

Other medicines may be used for symptomatic relief such as pain relievers, anti-spasmodics, anti-diarrheal and iron supplements. 

If medicines are not effective, proctocolectomy may be indicated. It involves removing your entire colon and rectum by connecting a pouch from the end of the small intestine directly to the anus, allowing for a relatively typical way to expel waste. 

In another type of procedure known as a continent ileostomy, also called a Koch pouch, the surgeon creates an ileal stoma opening in the belly, then places a one-way valve in the opening. A continent ileostomy does not collect stool in a bag. Instead, a tube is placed into the valve when stool needs to be emptied. This allows for control over the timing of bowel elimination. 

Cancer screening: People with UC are periodically under surveillance colonoscopy every 1 to 2 years, beginning as soon as eight years after diagnosis. The frequency depends on how much inflammation there is and how much of the colon is involved. (https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/diagnosis-treatment/drc-20353331)