What is Ulcerative Colitis?

The disease is a type of inflammatory bowel disease (IBD) which causes ulcers and long-lasting inflammation in your digestive tract. The disease affects the innermost lining of your colon or large intestine and rectum. Rather than developing suddenly, ulcerative colitis symptoms usually develop slowly over time.

Ulcerative colitis develops when your body’s immune system behaves and responds abnormally. Normally, the proteins and cells which make up your immune system guard you from infection.

However, in ulcerative colitis, the immune system mistakes bacteria, food, and other materials in the large intestine for invading or foreign substances. Once this happens, your body sends white blood cells in response to the innermost lining of the large intestine, causing ulcerations and chronic inflammation¹.

The disease can be debilitating and can even result in life-threatening complications. Although there is no known cure for ulcerative colitis, the symptoms and signs of the disease can be significantly reduced with the right treatment and can even result in long-term remission.   

Causes of Ulcerative Colitis

A definite cause of the disease is still not known. Stress and diet were previously believed to be ulcerative colitis causes, but doctors now know that the factors can aggravate but cannot cause ulcerative colitis.

An immune system malfunction is one possible cause of ulcerative colitis. When your immune system sends white blood cells to fight off bacterium or an invading virus, an abnormal immune response results in the immune system attacking the cells in the digestive tract as well. White blood cells which usually protect you, attack the lining of your colon instead, causing ulcers and inflammation.

Heredity also seems to have a part in ulcerative colitis. The disease is more common with people who have a family history of the disease. However, most people suffering from ulcerative colitis don’t have any family members with ulcerative colitis.    

Types of Ulcerative Colitis

Ulcerative colitis is usually classified according to its location. Types of the disease include:

• Ulcerative proctitis

Inflammation only develops in the area closest to the anus (rectum). Ulcerative proctitis is the mildest form of the disease, and rectal bleeding might be the only symptom.

• Proctosigmoiditis

Inflammation affects the sigmoid colon (lower end of the colon) and the rectum. The symptoms and signs of the disease include abdominal pain and cramps, an inability to pass stools despite the urge to do so (tenesmus), and bloody diarrhea. 

• Left-sided colitis

Inflammation extends from the rectum, affecting the sigmoid and descending colon. The symptoms and signs of the disease include unintended weight loss, bloody diarrhea, and abdominal pain and cramping on the left side.

• Pancolitis

Pancolitis often involves the entire colon and causes severe bouts of bloody diarrhea, fatigue, significant weight loss, and abdominal cramps and pain. 

• Acute severe ulcerative colitis

Acute severe ulcerative colitis is a rare form of colitis which affects the entire colon. The disease causes profuse diarrhea, fever, severe pain, bleeding, and inability to eat. Potentially severe complications also include acute dilation of the colon (toxic megacolon) and massive bleeding, which might result in an opening in the bowel wall. These serious complications might also require surgery.

Signs and symptoms of Ulcerative Colitis

Ulcerative colitis symptoms vary and depend on the severity of the inflammation along with the area affected. The main symptom of the disease is bloody diarrhea and pus in your stools. Other ulcerative colitis symptoms include: 

• Weight loss
• Dehydration
• Skin sores
• Fever
• Crampy belly pain
• Not feeling hungry
• Feeling tired
• Sudden urges to empty your colon
• Soreness or joint pain
• Eye pain
• Canker sores
• Too few red blood cells (anemia)
• Waking up at night to empty your colon
• Unable to hold your stools on
• Feeling like you haven’t emptied your colon completely after using the bathroom

Most people suffering from ulcerative colitis experience mild to moderate symptoms. However, the course of the symptoms might differ, with some people experiencing long periods of remission. Make sure you consult your doctor or healthcare practitioner if you experience any of the above-mentioned symptoms.

Treatment for Ulcerative Colitis

Ulcerative colitis treatment focuses on two main goals. The first is to give your colon time to heal by easing your symptoms. The second is to prevent flare-ups and more severe symptoms. You might need a combination of medication, surgery, and diet changes to achieve these goals.

Diet

Food does not cause ulcerative colitis; however, certain types can aggravate the symptoms. When suffering from ulcerative colitis, it is better to eat soft, bland food rather than high-fiber or spicy dishes. If you're lactose intolerant and cannot digest the sugar in milk, your doctor might advise you to avoid dairy products. To ensure you get sufficient nutrients and vitamins from your snacks and meals, your doctor might recommend a high-calorie, high-protein eating plan which is low in fiber.

Medicine

Your doctor or healthcare practitioner might prescribe several different types of drugs, including:

• Antibiotics

Antibiotics allow your large intestine to heal by fighting infections.

• Anti-inflammatory drugs

Anti-inflammatory drugs are prescribed to ease your symptoms and lower the inflammation in your colon. Your doctor might start your treatment with aminosalicylates. However, if your symptoms continue to aggravate or become more severe, your doctor might prescribe corticosteroids, another type of anti-inflammatory drug. 

• Immune system suppressors

These drugs suppress the immune system response which begins the process of inflammation, thus reducing inflammation. For certain patients, a combination of anti-inflammatory drugs brings better results than a single drug.

• Biologics

Biologics² are medicinal drugs manufactured using proteins in living cells. They are usually prescribed for patients who are suffering from more severe ulcerative colitis.

• Other medications

You might need other medications to control and ease certain ulcerative colitis symptoms. Make sure you consult your doctor before taking any over-the-counter medications.

Surgery

If you have severe ulcerative colitis or other treatments don't ease your symptoms, you might need to undergo surgery to remove your colon.

Cancer Surveillance

Due to your increased risk, you will require a more frequent screening for colon cancer. The schedule and frequency of the screening will depend on the areas affected by the disease and how long you've had it.

References:

1. Medical News Today - Everything you need to know about inflammation
2. MedicineNet - Biologics (Biologic Drug Class)