What is Ulcerative Colitis?

Ulcerative colitis is a chronic inflammatory condition of your digestive tract. It is one of the two types of inflammatory bowel disease (IBD), the other being Crohn’s disease.

1. Symptoms of Ulcerative Colitis

Ulcerative colitis is a chronic condition, meaning symptoms persist (in an on-and-off manner) for a longer duration. The most common symptoms of clcerative colitis are:

Frequent loose bloody stools (may be 10 or more per day in severe cases).
Diarrhea with or without increased mucous discharge.
Crampy abdominal pain.
Fever
Unexplained weight loss.
Fatigue.
Low blood count (anemia).

In persons suffering from ulcerative colitis, the symptoms wax and wane during the course of illness. Sometimes, they are very severe (called a “flare-up.”). At other times, you may be completely symptom-free (“clinical remission”).

2. Causes of Ulcerative Colitis

Ulcerative colitis is an autoimmune disease, in which your body’s immune system recognizes the lining of your digestive tract as a foreign body and attacks it, causing inflammation. This inflammation results in bleeding, loose stools, and abdominal cramps. The exact cause that triggers our immune system to attack our own cells is mostly unknown.

3. Risk Factors of Ulcerative Colitis

The common risk factors for ulcerative colitis are:

Age: Most people are younger, between 15 and 25 years of age but it can occur at any age. It affects men and women equally.
Ulcerative colitis is more common in urban areas and developed countries.
Ethnicity: Ulcerative colitis is also more common in white Europeans and those of Ashkenazi Jewish descent.
Family history of Crohn’s disease.
Ulcerative colitis is less common in chronic cigarette smokers (unlike Crohn’s disease, which is more common in cigarette smokers) but health professionals strongly advise against smoking as a way of treating or preventing ulcerative colitis.

4. Complications of Ulcerative Colitis

The common complications seen in persons suffering from ulcerative colitis are:

Mouth ulcers, blisters and skin ulcers
Colon Cancer
Malnutrition
Bowel obstruction
Painful red leg swellings
Inflammation of the eyes
Thinner and weaker bones
Liver inflammation
Blood clots (including deep vein thrombosis)
Anemia.
Medication side effects

5. Diagnosis of Ulcerative Colitis

Your doctor will first take a detailed history and will perform the relevant physical examination. Since multiple other conditions can produce the same symptoms as ulcerative colitis, your doctor will suggest various medical tests to confirm the diagnosis. Tests may include:

Stool tests: Used to exclude infection or to detect inflammation (fecal calprotectin).
Blood tests: May detect the presence of inflammation, abnormal antibodies, anemia, or nutritional and vitamin deficiencies.
Colonoscopy: Used to look at the lining of your digestive tract with a scope or a tube with a camera and a light at the end. A sample of tissue can be obtained through these scopes (biopsy) for microscopic examination.
Computerized tomography (CT) scanning or magnetic resonance imaging (MRI) to evaluate the intestinal tract and surrounding structures.

6. Treatment of Ulcerative Colitis

Ulcerative colitis is a chronic condition and medicine cannot cure it — but the symptoms are better controlled with regular use of medicines. The goal is to improve the quality of life and place the disease in remission. Your doctor will prescribe medications that are best for controlling the disease. Multiple classes of medications are available, such as:

Aminosalicylates
Corticosteroids
Immunomodulators
Anti-TNF therapies
Other newer medications (e.g. Vedolizumab, ustekinumab)
Almost all of these medicines work by reducing inflammation and the body’s immune response. Every person has a different response to there medicines. Your doctor will prescribe medicine depending upon your general health and symptom severity. Your doctor may also sometimes prescribe antibiotics during flare ups. You might have to try a few different medicines before you find the one that works best for you.
Surgical Management of Ulcerative Colitis
Surgery is not the first-line treatment for the patients with ulcerative colitis. Surgery is only helpful if medicines are not effective enough to control your symptoms or if the medicines are causing a lot of side effects. Surgery can help you to feel better and control symptoms. In ulcerative colitis, surgery is performed if there is:
Massive bleeding
No improvement in symptoms with medicines
Severe side effects from medications

Theoretically, removal of the entire colon, including the rectum, “cures” ulcerative colitis but it immensely affects quality of life and is only done when other options have failed.

7. Diet and Exercise

Although there is no clear evidence that foods actually cause inflammatory bowel disease, certain foods may aggravate your symptoms of ulcerative colitis. Your doctor may recommend a special diet given via a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat the symptoms of your ulcerative colitis. This not only improves your overall nutrition but also allows your bowel to rest. Bowel rest can reduce inflammation in the short term. Your doctor may also recommend:

Limiting dairy products.
Trying low-fat foods.
Limiting fiber.
Avoiding spicy foods, alcohol, and caffeine.
Eating small meals.
Drinking plenty of liquids.
Using multivitamins.
Managing stress and anxiety.
Increasing physical activity.
Yoga.

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