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Ulcerative colitis

Ulcerative colitis is an inflammatory bowel disease that affects about one in every 500 people in the UK.

Ulcerative colitis is a chronic (long-lasting) condition that causes inflammation and ulcers to develop in the lining of your large intestine (colon) and rectum. If you have ulcerative colitis you may have inflammation problems in other areas of your body, such as arthritis or red and painful skin or eyes.

Ulcerative colitis can occur at any age and affects men and women equally.

  • About ulcerative colitis
  • Symptoms
  • Complications
  • Causes
  • Diagnosis
  • Treatment
  • Living with ulcerative colitis
  • Further information
  • Sources
  • Related topics

About ulcerative colitis

No one knows exactly what causes ulcerative colitis. It may run in the family - about one in seven people with ulcerative colitis have a close relative who also has the condition. Most experts think that things in your environment, such as certain foods or an infection, are also needed to trigger it.

Will it clear up itself?

Ulcerative colitis is known as a "relapsing and remitting" condition. This means that your symptoms can disappear and then flare up again from time to time. You may have weeks or even months with few or no symptoms at all.

A recent survey of patient members of the National Association for Colitis and Crohn's Disease found that 55 percent of people with ulcerative colitis have flare-ups every few months, with some people having monthly or even weekly recurrences. Others have more flare-ups less often.

Symptoms

The main symptom of ulcerative colitis is frequent, watery diarrhoea that sometimes has blood and/or mucus in it. You may also have cramping abdominal during bowel movements.

Other symptoms include:

  • feeling like you haven't finished on the toilet
  • nausea
  • loss of appetite
  • weight loss
  • tiredness
  • inflammation (redness or pain) in the eyes, skin or joints.

These symptoms aren't always due to ulcerative colitis but if you have them you should visit your GP.

Complications

Having ulcerative colitis increases your risk of developing colon cancer. The risk depends on how long you have it for, and how extensive it is.

Because of this, if you have ulcerative colitis you should have regular colonoscopy's (See Tests) to check for any signs of cancer developing. If these are present you may need surgery to remove the affected area of colon. Talk to your GP or gastroenterologist (doctor who specialises in conditions that affects the digestive system) for more information about this.

Causes

Ulcerative colitis is caused by inflammation and ulcers in the lining of your large intestine and rectum. You get diarrhoea because water isn't easily absorbed by your inflamed colon. Sometimes ulcerative colitis only affects the rectum - this is called proctitis. Proctitis is less severe than ulcerative colitis. You may not have diarrhoea, but will still tend to have rectal bleeding.

Diagnosis

If you have some or all of the symptoms of ulcerative colitis, talk to your GP about it. You might feel embarrassed to talk about some of these problems. However, it's important to get a diagnosis so that other conditions can be ruled out, and treatment can be started.

You may be asked to give a sample of faeces to make sure you don't have any bacterial infections. Your doctor will probably also take some blood to check for anaemia and signs of inflammation. Depending on the results, he or she might refer you to a gastroenterologist for more tests.

Tests

Your gastroenterologist will do a test called a colonoscopy. He or she will look inside your large intestine using a narrow, flexible, tube-like telescope called a colonoscope. This is carefully passed through your anus (back passage) and rectum, and the image is relayed to a TV screen. To help you relax, you will be given a mild sedative before the examination.

The doctor will look for signs of inflammation, ulcers or bleeding. A small sample of the colon is also usually taken (a biopsy). This is where the doctor cuts away a tiny bit of tissue which is sent to a laboratory for testing.

Sometimes your doctor will want to carry out a special X-ray of the large intestine called a barium enema. For this, a liquid containing a small amount of barium is passed through a tube into your rectum where it enters the large intestine. The barium makes inflamed or ulcerated areas of the colon show up clearly on an X-ray image.

Treatment

At the moment there is no cure for ulcerative colitis. However, there are treatments that can help ease your symptoms and prevent complications.

Medicines

The most common treatments for ulcerative colitis are either steroids or a type of medicine called 5-aminosalicylate (5-ASA). You may also be given medicines to suppress your immune system (immunosuppressants) if these treatments don't work.

Steroids are very effective because they act quickly to dampen down the inflammation. However, in the long term they have serious side effects so your doctor will gradually reduce the dose to the minimum needed to control your symptoms.

5-ASA medicines work well for reducing moderate flare-ups or relapses. Some people need to switch to steroids if the 5-ASA treatment isn't working or if the flare-up is severe.

You take these medicines as tablets, suppositories or as enemas.

Surgery

In most people, the symptoms of ulcerative colitis can be controlled using medication. However, occasionally the colon needs to be surgically removed. This could be because the inflammation and ulceration continue despite treatment. Sometimes the bowel can become severely swollen - a condition known as megacolon. This is very serious and usually means that the colon needs to be removed.

Alternatively, you may choose to have surgery if your symptoms aren't controlled or you are getting severe side effects from your medication.

Surgery for ulcerative colitis can greatly improve your quality of life: removing the colon can effectively get rid of the disease.

Proctocolectomy

Proctocolectomy is now the surgery of choice for treating ulcerative colitis. In this procedure your colon is removed and the end of the small intestine is attached to the anus. A pouch or reservoir is then created from the small intestine to replace the colon, allowing you to have bowel movements as usual. Nevertheless, the pouch itself can eventually become inflamed. This is called pouchitis. Pouchitis can be treated with certain medicines.

Ileostomy

In the past, the colon was removed in an operation called an ileostomy. In this procedure, the surgeon removes your colon and attaches the small intestine to a small opening in the abdomen (called the stoma). You then use an external pouch placed over the opening to collect waste.

Even though living with an ileostomy is an inconvenience, much expert help and support is available. Your quality of life is still greatly improved.

Talk to your gastroenterologist for more information.

Living with ulcerative colitis

Having ulcerative colitis can be both physically and emotionally stressful. Frequent bouts of diarrhoea can get in the way of work and your normal social activities. Talk to your employer about any help that may be available to you.

You can also get in touch with other people who have ulcerative colitis through charities and patient groups. These can be an invaluable source of support and advice (please see Further Information).

Further information

National Association for Colitis and Crohn's Disease (NACC)

www.nacc.org.uk

Sources

  • Inflammatory Bowel Disease Basics. National Association for Colitis and Crohn's Disease. www.nacc.org.uk, accessed 21 February 2007
  • Ulcerative Colitis - the real impact. A survey of patient members of the National Association for Colitis and Crohn's Disease. www.nacc.org.uk, accessed 21 February 2007
  • Ghosh S, Shand A, Ferguson A. Ulcerative colitis. BMJ 2000; 320: 1119-1123
  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd Edition: Oxford University Press, 2005: 456

Related topics

Crohn's disease

Bowel cancer