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What is ulcerative colitis?

Ulcerative colitis is an inflammatory bowel disease (IBD) of the lining of the rectum and colon.

Ulcerative colitis is classified based on disease location: ulcerative proctitis (inflammation in rectum alone), proctosigmoiditis (inflammation in rectum and sigmoid colon) or pancolitis (inflammation in the entire colon). Ulcerative colitis can become suddenly acute and severe, and can require hospitalization, close monitoring, appropriate medical therapy and potentially even surgery, as it can become life-threatening.

Ulcerative colitis symptoms

Ulcerative colitis usually starts between the ages of 15 to 30, and symptoms often develop gradually over time, rather than suddenly. The most common signs and symptoms are rectal bleeding and diarrhea.

Other symptoms may include:

  • Feeling that you need to pass stools, even though your bowels are already empty (tenesmus). This may involve straining, pain and cramping.
  • Fecal urgency
  • Rectal pain
  • Anemia
  • Severe tiredness/fatigue
  • Weight loss
  • Loss of appetite
  • Skin sores
  • Joint pain
  • Growth failure in children

Causes of ulcerative colitis

Experts aren’t yet sure what causes ulcerative colitis, but it could be triggered by an immune system overreaction to normal bacteria in the digestive tract. The abnormal immune response may cause the immune system to attack healthy cells in the digestive tract in addition to what it perceives is an invading virus or bacterium.

At one point, diet and stress were suspected causes, but doctors have since learned that those factors may aggravate ulcerative colitis without actually causing the condition.

One risk factor for ulcerative colitis is heredity; you are more likely to develop ulcerative colitis if other people in your family have the disease. However, most people with ulcerative colitis don’t have the disease in their family medical history.

Diagnosing ulcerative colitis

Doctors use blood tests, stool tests, colonoscopy or sigmoidoscopy, and imaging to diagnose UC.

Ulcerative colitis treatment

Treatment for UC depends on the severity and location of the disease and its symptoms.

Treatments include:

Ulcerative colitis medications: While no medications “cure” UC, many can reduce symptoms and improve inflammation. Medications can induce and maintain remission for months or possibly even years and improve quality of life. Many people with UC require medication therapy indefinitely, unless they have their colon and rectum surgically removed. The type of medication prescribed depends on the severity and location of the disease. 

Hospitalization: Sometimes UC symptoms are severe enough that the person must be hospitalized. This may include severe bleeding and/or diarrhea that cause dehydration, anemia and malnutrition. Intravenous fluids will help treat diarrhea and loss of blood, fluids and mineral salts. People with severe symptoms may need a special diet, tube feeding, medications or surgery.

Surgery: Some people may eventually need a proctocolectomy—surgery to remove the rectum and colon. Surgery is sometimes recommended if medical treatment fails or if the side effects of corticosteroids or other medications threaten their health. Other times surgery is performed because of massive bleeding, severe illness, colon rupture (perforation) or cancer risk. Surgery requires hospitalization and a full recovery of 4–6 weeks.

Dietary changes may help reduce symptoms. A recommended diet will depend on the person’s disease location, symptoms, medications and reactions to food.

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