ULCERATIVE COLITIS

What is Ulcerative Colitis (UC)?

Ulcerative colitis (UC) is an ongoing health problem that causes inflammation and bleeding sores called ulcers in the top layers of the large intestine (colon) and rectum. It most often occurs in the lower part of the colon and rectum, but may affect the whole colon. When UC only occurs in the rectum, it is called proctitis. Most people find out they have UC between the ages of 15 and 40 years.

Ulcerative colitis is a form of inflammatory bowel disease. There are two main types of inflammatory bowel disease: ulcerative colitis (UC) and Crohn's disease (CD). The diseases are very similar. The main difference between UC and CD is the area of the digestive tract they affect -- CD can occur along the entire digestive tract and spread deep into the bowel wall. In contrast, UC usually only affects the top layer of the large intestine (colon) and rectum.

What are the symptoms of ulcerative colitis (UC)?

The two most common symptoms of UC are diarrhoea (often bloody) and crampy abdominal pain. Inflammation causes these symptoms. An inflamed bowel doesn't allow as much water to be absorbed into the blood. This makes the colon empty often in the form of diarrhoea. Inflammation also causes bleeding ulcers. The ulcers typical of UC also can make pus and mucus.

Other common signs of UC include:

• nausea
• loss of appetite
• weight loss
• frequent fever

For most people, the symptoms of UC come and go. When they feel well, the UC is said to have gone into remission. When they feel sick, they are having a relapse or flare-up.

About half of the people with UC have only mild symptoms. For others, the symptoms of UC may be very uncomfortable. In severe cases, people can become malnourished and may need a special diet or to be fed fluids through a vein.

Can ulcerative colitis (UC) cause health problems in parts of the body other than the colon?

Yes. UC can cause a number of problems outside of the colon including:

• joint pain or arthritis,
• inflammation in the eye,
• liver and bile duct disease,
• skin rashes,
• anemia, and
• kidney stones.

No one knows why these health problems are common in people with UC. The immune system may trigger inflammation in other parts of the body. These problems are usually mild and go away when the colitis is treated.

Osteoporosis is also more common among people with UC. This may be because their diets don't contain enough calcium and vitamin D. Plus, UC can prevent the body from absorbing enough calcium. Corticosteroids, medicines used to treat UC, can also boost a person's risk of osteoporosis.

How is ulcerative colitis (UC) diagnosed?

If you suspect you have UC, talk to your doctor. She will use your health history, a physical exam, and many different tests to figure out if you have UC.
Tests used to diagnose UC include:

• Blood tests: A sample of blood is studied in a lab to find signs of inflammation and anemia.
• Stool sample: A sample of a bowel movement is tested for blood or infection.
• Barium Enema: The doctor injects fluid containing a substance called barium into the rectum. The barium allows the doctor to see the colon on an x-ray. Using this x-ray, doctors can "see" if there are any ulcers or other signs of UC.
• Flexible Sigmoidoscopy: The doctor puts a thin tube with a light into the rectum. It allows the doctor to check the rectum and the lower part of the colon for signs of UC.
• Colonoscopy: The doctor puts a thin tube with a light through the rectum and into the colon. This allows her to "see" the lining of the whole colon and check for signs of UC.

Is inflammatory bowel disease (IBD) the same thing as Irritable Bowel Syndrome (IBS)?

No. Inflammatory bowel disease, including UC and CD, is different from irritable bowel syndrome (IBS). Unlike IBD, IBS does not cause inflammation, ulcers or other damage to the bowel. Instead, IBS is a much less serious problem called a functional disorder. This means that the digestive system looks normal but doesn't work as it should. Symptoms of IBS may include crampy pain, bloating, gas, mucus in the stool, diarrhoea and constipation. IBS has also been called spastic colon or spastic bowel.

How is inflammatory bowel disease (IBD) treated?

Doctors treat IBD in order to improve symptoms and decrease the amount of inflammation. Treatment for IBD may include:

• dietary changes
• lifestyle changes like stress reduction
• medicine
• surgery

The recommended treatment for IBD depends on:

• the type and severity of symptoms
• location of disease
• complications

People who have mild or no symptoms may not need treatment at all. But most people with IBD take medicine to control their symptoms. And many people with severe IBD need surgery to control the disease.

Surgery for Ulcerative Colitis

About 20 to 40 percent of people with UC need surgery at some point in their lives. Doctors may suggest surgery for people with UC in the following cases:

• ongoing, severe symptoms
• symptoms that do not get better with medicine
• precancerous changes in the colon
• high risk for colon cancer

Some people with UC need emergency surgery. Doctors often perform emergency surgery to fix the following problems:

• severe bleeding
• a hole (perforation) in the colon
• build up of gas and bacteria inside the colon called toxic megacolon

Surgery that removes the entire large intestine can completely cure UC. Even though surgery can be risky, studies show it greatly improves the lives of people with UC. Surgery used to be considered a last resort for people with UC. But now some doctors suggest surgery for people in the earlier stages of the disease.

Types of surgery for UC include:

Proctocolectomy: The doctor removes the entire large intestine including the colon, rectum and anus during this surgery. This is the most commonly recommended surgery for people with UC. It can be performed with an iIeostomy or ileoanal pouch anal anastomosis (IPAA). For more details on these procedures see the section above on surgery for CD.

Ileal pouch anal anastomosis (IPAA): In this procedure, the very end of the small intestine (ileum) is made into a pouch. It is then connected to the anus. In this way, waste can once again leave the body through the anus. People who have IPAA do not need to wear a pouch outside their bodies. But people who have IPAA have more complications than those who have an ileostomy. The most common problems with this surgery are blockages in the intestine and pouch inflammation or infection.