Early symptoms of ulcerative colitis include recurrent abdominal pain, diarrhea, rectal bleeding, a periodic urge to empty the bowel, lack of appetite, fatigue.
What is Ulcerative Colitis?
Ulcerative colitis is an acute or chronic inflammatory disease that affects the large intestine (rectum and colon). This inflammation affects the mucosa (innermost lining) of the rectum and part of the colon, causing it to be inflamed, swollen and ulcerated. It rarely affects the small intestine except for the terminal ileum of the small intestine.
Though the precise cause of ulcerative colitis is unknown, researchers believe it is caused by an interplay of factors that involves genetics, the environment, and an overactive immune system.
- The Environment: Foreign substances (such as bacteria, virus) in the environment can trigger or stimulate the body’s defense system to react in an uncontrolled manner. Specific diets such as high intake of unsaturated fat and vitamin B6 may influence the development and/or relapse of ulcerative colitis.
- Genetics: A positive family history or inherited gene may predispose you to develop the disease. Disease concordance has been documented in identical twins
- Immune system: When triggered, the immune system loses its normal control, destroying the linings of the colon and rectum, thereby leading to the symptoms
Other factors that might be associated with ulcerative colitis include the following:
- Smoking: Surprisingly, smoking hurts ulcerative colitis. Nicotine in tobacco smoke may suppress the immune system and decrease the inflammatory process in ulcerative colitis
- Stress (psychological and psychosocial) do not cause ulcerative colitis but can aggravate or precipitate exacerbations.
- Consumption of milk may worsen the disease.
- Other studies suggest levels of sulfate-reducing bacteria tends to be higher in persons with ulcerative colitis, which could indicate higher levels of hydrogen sulfide in the intestine.
How Do You Feel When You Have Ulcerative Colitis?
People with ulcerative colitis can present with any of these symptoms. They usually have abdominal pain/discomfort, abdominal distention, blood or pus in the stool, reduced appetite, weight loss, fever, frequent and recurring diarrhea, dehydration, tenesmus (a feeling they haven’t completely emptied their colon after going to the toilet). Prolonged bleeding from the rectum can cause you to develop anemia which might cause you to feel tired easily, find it difficult to concentrate, feel dizzy, have shortness of breath and headache, particularly with exercise.
They may develop vitamins and mineral deficiencies, such as vitamin D deficiency leading to bone loss and easy fracture of the bones. Also, they may develop a rupture of the bowel which requires surgical intervention. Over time, people with ulcerative may develop an increased risk of developing colon cancer due to chronic inflammation of the colon. The risk of colon cancer is estimated to be 2% after 10 years, 8% after 20 years and 18% after 30 years. The risk tends to be greater for those whose entire colon tends to be affected as opposed to those who have only a small segment involved such as the rectum.
What does Ulcerative Colitis do to your Body?
Because of ulcerative colitis is believed to be autoimmune in origin, patients may present with comorbidities giving rise to symptoms outside of the colon. The frequencies of this extra-intestinal manifestation vary and include the following:
- May cause the eyes to be inflamed, a condition known as iritis or uveitis
- A small recurrent, painful, round or ovoid ulcer in the oral cavity
- Ankylosing spondylitis, arthritis with hardening of the spine
- Sacroiliitis, inflammation of the bone and ligaments of the lower spine
- Autoimmune hemolytic anemia.
- Pyoderma gangrenosum, a painful lesion affecting the skin.
- Due to the formation of immune complexes in the body, they might develop deep vein thrombosis and pulmonary embolism.
- Primary sclerosing cholangitis, inflammation, and fibrosis of the intrahepatic and extrahepatic bile ducts.
What is the Treatment of Ulcerative Colitis?
Ulcerative colitis is a lifelong disease. The goal of treatment is to limit disease progression, improve quality of life and prevent complications. Emotional and psychological support is also very crucial
Ulcerative colitis can be treated with so many categories of drugs. Anti-inflammatory drugs such as 5-aminosalicylates and corticosteroids are usually the first line of treatment. Corticosteroids such as prednisone and hydrocortisone are reserved for moderate to severe forms of ulcerative colitis. They are usually not given for a long time due to their side effects. 5-aminosalicylates includes drugs like mesalamine, sulfasalazine.
Another group of drugs used in the treatment of ulcerative colitis is the immunosuppressants. This category of drugs is reserved for people who do not respond well or tolerate other medication. Also because of their serious effects, they are given as last resorts. This class of drugs includes azathioprine, mercaptopurine, cyclosporine, infliximab, adalimumab, and golimumab.
Other medications are used to manage specific symptoms of ulcerative colitis.
- Antibiotics are used to prevent and treat bacteria infections associated with ulcerative colitis
- Pain relievers. For mild pain, acetaminophen is recommended. NSAID’s are not advised, as they can worsen symptoms and aggravate the disease.
- Iron supplements are prescribed for patients who develop iron deficiency due to chronic intestinal bleeding.
Other measures that can be taken to improve symptoms include activities that help to reduce stress such as regular relaxation and breathing exercises. Dietary measures include eating small meals at a time, drinking plenty of fluid preferably water. Alcohol and beverages that contain caffeine can stimulate the intense and worsen diarrhea, while carbonated drinks frequently cause bloating and also worsen your symptoms.
Can Ulcerative Colitis be cured?
Surgery is the only cure for ulcerative colitis, but it involves removing the entire colon and rectum, a procedure known as proctocolectomy. In most cases, this procedure involves creating a pouch, which is then attached directly to the anus for feces expulsion. In some cases, a pouch is not possible. Instead, a permanent opening is created in the abdomen through which stool is passed for collection in an attached bag that the patient carries around.
References
Benjamin Wedro, F. (2018). What is Ulcerative Colitis: Symptoms, Treatment & Causes. [online] eMedicineHealth. Available at: https://www.emedicinehealth.com/ulcerative_colitis/article_em.htm#what_is_ulcerative_colitis [Accessed 18 May 2018].
Emedicine.medscape.com. (2018). Ulcerative Colitis: Practice Essentials, Background, Anatomy. [online] Available at: https://emedicine.medscape.com/article/183084-overview#a5 [Accessed 18 May 2018].
Mayoclinic.org. (2018). Ulcerative colitis – Diagnosis and treatment – Mayo Clinic. [online] Available at: https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/diagnosis-treatment/drc-20353331 [Accessed 18 May 2018].