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Ulcerative Colitis: Types, Symptoms, Causes, Complications, Treatment & Prevention

Ulcerative colitis (UC) is an inflammatory bowel disease that affects your gastrointestinal tract. It occurs when the lining of your large intestine or your rectum becomes inflamed. UC causes long-lasting inflammation and ulcers in the digestive tract. The condition affects both men and women equally.

The symptoms of the condition develop over time and usually spreads from the rectum to other parts, often involving the entire colon. This inflammation causes your bowel to move its contents on a fast pace, which thereby empties your bowel frequently.

UC kills off the cells on the surface of the lining of your bowel, which in turn causes the ulcers to develop and hence lead to bleeding and pus discharge [1] [2] . UC is not contagious and as of now, there is no cure available for the condition.

The condition can affect individuals of any age and are commonly diagnosed in people aged between 15 and 35. In men, the condition can occur after the age of 50 as well [3] .

Types Of Ulcerative Colitis

The condition is characterised by its location. The different types of UC are as follows [3] [4] :

  • Ulcerative proctitis: This condition develops when the inflammation is near the rectum and is the mildest type of UC.
  • Left-sided colitis: The inflammation extends to the sigmoid and descending colon.
  • Proctosigmoiditis: Under this condition, the inflammation extends to the lower end of the colon (sigmoid).
  • Pancolitis: This type of UC affects the entire colon.
  • Acute severe ulcerative colitis: It is a rare form of UC and like pancolitis, affects the entire colon.

Symptoms Of Ulcerative Colitis

The signs of the condition vary depending on its location as well as the severity of the inflammation. The common symptoms of UC are as follows [5] :

  • Weight loss
  • Abdominal pain
  • Rectal pain
  • Fever
  • Cramps
  • Rectal bleeding
  • Inability to defecate despite urgency
  • Urgency to defecate
  • Diarrhoea, often with blood or pus
  • Fatigue
  • In children, stunted growth

Each type of UC has specific symptoms and they are as follows [6] :

  • Ulcerative proctitis: Rectal bleeding.
  • Left-sided colitis: Symptoms include abdominal pain and cramping on the left side, bloody diarrhoea and sudden weight loss.
  • Proctosigmoiditis: Symptoms include bloody diarrhoea, abdominal pain and cramps and tenesmus (an inability to move the bowels in spite of the urge to do so).
  • Pancolitis: Severe diarrhoea, abdominal cramp and pain, fatigue and weight loss.
  • Acute severe ulcerative colitis: Pain, severe diarrhoea, bleeding, loss of appetite and fever.

Causes Of Ulcerative Colitis

Doctors assume UC to be the result of an over-active immune system. The exact reason as to why the condition develops still lacks clarity as to why some immune systems attack the large intestines [7] .

Initially, it was assumed that diet and stress played the central role in the development of the condition but it has been found that, although these two aspects worsen UC, they do not cause the condition.

One of the possible causes would be immune system malfunction because when your immune system fights off a virus, an abnormal immune response can cause the immune system to attack the cells in the digestive tract [8] . Heredity also seems to play a role.

Risk Factors Of Ulcerative Colitis

  • Race: White people are at the highest risk of developing the condition. However, it affects people of other race and ethnicity as well.
  • Age: The condition usually begins before the age of 30.
  • Family history: Individuals who have a family history of the condition, such as a close relative, such as a parent, sibling or child, are at an increased risk of developing the condition [8] [9] .

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Complications Of Ulcerative Colitis

The condition can lead to the development of complications like the following [10] :

  • Increased risk of blood clots in veins and arteries
  • Severe bleeding
  • A hole in the colon (perforated colon)
  • An increased risk of colon cancer
  • A rapidly swelling colon
  • Liver disease
  • Bone loss (osteoporosis)
  • Inflammation of your skin, joints and eyes
  • Severe dehydration
  • Kidney stones
  • Blood infection

Diagnosis Of Ulcerative Colitis

The doctor will check your signs and symptoms first, to understand the type of UC. Then, the following tests will be carried out to diagnose the condition [11] :

  • Blood tests: A blood test will be prescribed to check for anaemia and any signs of infections.
  • Colonoscopy: This allows the doctor to examine your colon and take samples of tissue (biopsy) for laboratory analysis.
  • Stool sample: The presence of white blood cells can help indicate UC.
  • X-ray: If the symptoms are severe in nature, the doctor will take an x-ray of your abdominal area to rule out serious complications.
  • CT scan: If the doctor suspects a complication due to UC, a CT scan of your abdomen or pelvis may be performed.

Apart from these, the doctor may recommend a flexible sigmoidoscopy, computerized tomography (CT) enterography and magnetic resonance (MR) enterography [12] .

Treatment For Ulcerative Colitis

As it is a chronic condition, the treatment involves drug therapy or surgery, an aims to reduce the inflammation and limit the occurrence of flare-ups.

For medicines, the doctors will prescribe anti-inflammatory drugs and immune system suppressors. The other medicines prescribed are antibiotics, anti-diarrhoeal medicines, pain relievers and iron supplements [13] .

Surgery is regarded as the most effective form of treatment. Proctocolectomy is the surgery of removing your entire colon and rectum.

As the medicines for UC pose various side effects on the human body, some natural treatments help manage the condition.

Some of the natural remedies are [14] as follows:

  • Boswellia
  • Bromelain
  • Probiotics
  • Psyllium seed/husk
  • Turmeric

Note: Always talk your doctor before incorporating any of these natural remedies into your treatment procedure.

Prevention Of Ulcerative Colitis

Some of the measures adopted for the prevention of the condition are as follows [15] :

  • Drink water in small amounts, throughout the day.
  • Avoid fatty foods.
  • Eat smaller meals.
  • Limit your intake of foods rich in fibre.
  • Limit dairy products.
  • Avoid caffeine and alcohol.

Although stress does not cause the condition, it can worsen the symptoms. Therefore, take measures to reduce your stress levels by [16]

  • exercising regularly,
  • practising relaxation and breathing exercises, and
  • biofeedback (a stress-reduction technique).
View Article References
  1. [1] Timmer, A., Patton, P. H., Chande, N., McDonald, J. W., & MacDonald, J. K. (2016). Azathioprine and 6‐mercaptopurine for maintenance of remission in ulcerative colitis. Cochrane Database of Systematic Reviews, (5).
  2. [2] Sandborn, W. J., Su, C., Sands, B. E., D’Haens, G. R., Vermeire, S., Schreiber, S., ... & Friedman, G. (2017). Tofacitinib as induction and maintenance therapy for ulcerative colitis. New England Journal of Medicine, 376(18), 1723-1736.
  3. [3] Sandborn, W. J., Feagan, B. G., Wolf, D. C., D’Haens, G., Vermeire, S., Hanauer, S. B., ... & Aranda, R. (2016). Ozanimod induction and maintenance treatment for ulcerative colitis. New England Journal of Medicine, 374(18), 1754-1762.
  4. [4] Rosen, M. J., Karns, R., Vallance, J. E., Bezold, R., Waddell, A., Collins, M. H., ... & Baker, S. S. (2017). Mucosal expression of type 2 and type 17 immune response genes distinguishes ulcerative colitis from colon-only Crohn’s disease in treatment-naive pediatric patients. Gastroenterology, 152(6), 1345-1357.
  5. [5] Cleynen, I., Boucher, G., Jostins, L., Schumm, L. P., Zeissig, S., Ahmad, T., ... & Brant, S. R. (2016). Inherited determinants of Crohn's disease and ulcerative colitis phenotypes: a genetic association study. The Lancet, 387(10014), 156-167.
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  7. [7] Ramadass, S. K., Jabaris, S. L., Perumal, R. K., HairulIslam, V. I., Gopinath, A., & Madhan, B. (2016). Type I collagen and its daughter peptides for targeting mucosal healing in ulcerative colitis: A new treatment strategy. European Journal of Pharmaceutical Sciences, 91, 216-224.
  8. [8] Warren, S., & Sommers, S. C. (1949). Pathogenesis of ulcerative colitis. The American journal of pathology, 25(4), 657.
  9. [9] Rembacken, B. J., Snelling, A. M., Hawkey, P. M., Chalmers, D. M., & Axon, A. T. R. (1999). Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomised trial. The Lancet, 354(9179), 635-639.
  10. [10] Peyrin‐Biroulet, L., Germain, A., Patel, A. S., & Lindsay, J. O. (2016). Systematic review: outcomes and post‐operative complications following colectomy for ulcerative colitis. Alimentary pharmacology & therapeutics, 44(8), 807-816.
  11. [11] Negrón, M. E., Rezaie, A., Barkema, H. W., Rioux, K., De Buck, J., Checkley, S., ... & Panaccione, R. (2016). Ulcerative colitis patients with Clostridium difficile are at increased risk of death, colectomy, and postoperative complications: a population-based inception cohort study. The American journal of gastroenterology, 111(5), 691.
  12. [12] Chen, J. H., Andrews, J. M., Kariyawasam, V., Moran, N., Gounder, P., Collins, G., ... & Chang, J. (2016). acute severe ulcerative colitis–evidence‐based consensus statements. Alimentary pharmacology & therapeutics, 44(2), 127-144.
  13. [13] Worley, G. H. T., Segal, J. P., Warusavitarne, J., Clark, S. K., & Faiz, O. D. (2018). Management of early pouch‐related septic complications in ulcerative colitis: a systematic review. Colorectal Disease, 20(8), O181-O189.
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  15. [15] Singh, S., Stroud, A. M., Holubar, S. D., Sandborn, W. J., & Pardi, D. S. (2015). Treatment and prevention of pouchitis after ileal pouch‐anal anastomosis for chronic ulcerative colitis. Cochrane Database of Systematic Reviews, (11).
  16. [16] Pervin, M., Hasnat, M. A., Lim, J. H., Lee, Y. M., Kim, E. O., Um, B. H., & Lim, B. O. (2016). Preventive and therapeutic effects of blueberry (Vaccinium corymbosum) extract against DSS-induced ulcerative colitis by regulation of antioxidant and inflammatory mediators. The Journal of nutritional biochemistry, 28, 103-113.
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