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Ulcerative colitis

Ulcerative colitis is a condtion in which the lining of the large intestine (colon) and rectum become inflamed.

Ulcerative colitis is a form of inflammatory bowel disease (IBD). Crohn's disease is a related condition.

Alternative Names

Inflammatory bowel disease - ulcerative colitis; IBD - ulcerative colitis

Causes

The cause of ulcerative colitis is unknown. People with this condition have problems with the immune system. However, it is not clear if immune problems cause this illness. Stress and certain foods can trigger symptoms, but they do not cause ulcerative colitis.

Ulcerative colitis may affect any age group. There are peaks at ages 15 - 30 and then again at ages 50 - 70.

The disease can begin the rectal area. It may involve the entire large intestine over time. It may also start in the rectum and other parts of the large intestine at the same time.

Risk factors include a family history of ulcerative colitis, or Jewish ancestry.

Symptoms

The symptoms can be more or less severe. They may start slowly or suddenly. About half of people only have mild symptoms. Others have more severe attacks that occur more often. Many factors can lead to attacks.

Symptoms include:

  • Pain in the abdomen (belly area) and cramping
  • A gurgling or splashing sound heard over the intestine
  • Blood and pus in the stools
  • Diarrhea, from only a few episodes to very often
  • Fever
  • Feeling that you need to pass stools, even though your bowels are already empty. It may involve straining, pain, and cramping (tenesmus).
  • Weight loss

Children's growth may slow.

Other symptoms that may occur with ulcerative colitis include the following:

  • Joint pain and swelling
  • Mouth sores (ulcers)
  • Nausea and vomiting
  • Skin lumps or ulcers

Exams and Tests

Colonoscopy with biopsy is most often used to diagnose ulcerative colitis. Colonoscopy is also used to screen people with ulcerative colitis for colon cancer.

Colonoscopy

Other tests that may be done to help diagnose this condition include:

  • Barium enema
  • Complete blood count (CBC)
  • C-reactive protein (CRP)
  • Sed rate (ESR)

Treatment

The goals of treatment are to:

  • Control the acute attacks
  • Prevent repeated attacks
  • Help the colon heal

You may need to be treated in the hospital for severe attacks. Your doctor may prescribe corticosteroids. You may be given nutrients through a vein (IV line).

DIET AND NUTRITION

Certain types of foods may worsen diarrhea and gas symptoms. This problem may be more severe during times of active disease. Diet suggestions include:

  • Eat small amounts of food throughout the day.
  • Drink plenty of water (drink small amounts throughout the day).
  • Avoid high-fiber foods (bran, beans, nuts, seeds, and popcorn).
  • Avoid fatty, greasy or fried foods and sauces (butter, margarine, and heavy cream).
  • Limit milk products if you are lactose intolerant. Dairy products are a good source of protein and calcium.

STRESS

You may feel worried, embarrassed, or even sad or depressed about having a bowel accident. Other stressful events in your life, such as moving, or losing a job or a loved one can cause digestive problems.

Ask your doctor or nurse for tips on your to manage your stress.

MEDICINES

Medicines that may be used to decrease the number of attacks include:

  • 5-aminosalicylates such as mesalamine or sulfazine, which can help control moderate symptoms. Some forms of the drug are taken by mouth; others must be inserted into the rectum.
  • Medicines to quiet the immune system.
  • Corticosteroids such as prednisone. They may be taken by mouth during a flare-up or inserted into the rectum.
  • Biologic therapy, if you do not respond to other drugs.
  • Acetaminophen (Tylenol) may help relieve mild pain. Avoid drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). These can make your symptoms worse.

SURGERY

Surgery to remove the colon will cure ulcerative colitis and removes the threat of colon cancer. You may need surgery if you have:

  • Colitis that does not respond to complete medical therapy
  • Changes in the lining of the colon that can lead to cancer
  • Severe problems, such as rupture of the colon, severe bleeding, or toxic megacolon

Most of the time, the entire colon, including the rectum, is removed. After surgery, you may have:

  • An opening in your belly called the stoma (ileostomy). Stool will drain out through this opening.
  • A procedure that connects the small intestine to the anus to gain more normal bowel function.

Support Groups

Social support can often help with the stress of dealing with illness, and support group members may also have useful tips for finding the best treatment and coping with the condition.

The Crohn's and Colitis Foundation of America (CCFA) has information and links to support groups.

Outlook (Prognosis)

Symptoms are mild in about half of people with ulcerative colitis. More severe symptoms are less likely to respond well to medicines.

Cure is only possible through complete removal of the large intestine.

The risk of colon cancer increases in each decade after ulcerative colitis is diagnosed.

Possible Complications

You have a higher risk for small bowel and colon cancer if you have ulcerative colitis. At some point, your doctor will recommend tests to screen for colon cancer.

More severe episodes that recur may cause the walls of the intestines to become thickened, leading to:

  • Colon narrowing or blockage
  • Episodes of severe bleeding
  • Severe infections
  • Sudden widening (dilation) of the large intestine within 1 to a few days
  • Tears or holes (perforation) in the colon

Problems absorbing nutrients may lead to:

  • Thinning of the bones (osteoporosis)
  • Problems maintaining a healthy weight
  • Slow growth and development in children

Less common problems that may occur include:

  • Type of arthritis that affects the bones and joints at the base of the spine, where it connects with the pelvis (ankylosing spondylitis )
  • Liver disease
  • Tender, red bumps (nodules) under the skin, which may turn into skin ulcers
  • Sores or swelling in the eye

When to Contact a Medical Professional

Call your health care provider if:

  • You develop ongoing abdominal pain, new or increased bleeding, fever that doesn’t go away, or other symptoms of ulcerative colitis
  • You have ulcerative colitis and your symptoms worsen or do not improve with treatment
  • You develop new symptoms

Prevention

There is no known prevention for this condition.

References

Sands BE, Siegel CA. Crohn's disease. In: Feldman M, Friedman LS, Brandt, LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 111.

Burger D, Travis S. Conventional medical management of inflammatory bowel disease. Gastroenterology. 2011 May;140(6):1827-1837.e2.

Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011 May;60(5):571-607.

Kornbluth A, Sachar DB, et al. Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 2010; 105:501-523.

Updated: 10/13/2013

George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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