If you or someone you know has just been diagnosed with UC, you probably have many questions. What is ulcerative colitis? What are its causes and symptoms? How is it diagnosed, and what is the treatment for ulcerative colitis? Click below for answers to some of the most frequently asked questions.
Ulcerative colitis (UC) is a chronic condition. This means that it is a long-lasting disease of the large bowel (colon) and rectum where the lining of the gut becomes red and swollen (inflamed). In 2012, there were approximately 104,000 Canadians living with UC.
UC and Crohn’s disease affect the gut differently. UC usually affects only the innermost lining of the large intestine and rectum. Crohn’s disease can occur anywhere in the digestive tract and often spreads into the affected tissues.
Bloody stools, diarrhea and cramps are common signs. Symptoms of UC usually include frequent and bloody stools together with stomach pains.
Most people diagnosed with UC have mild to moderate symptoms; however, some are also diagnosed with severe UC. With proper management of UC, including medication and lifestyle changes, many people will get their symptoms controlled and achieve remission of their UC – periods when the symptoms go away for months or even years. In fact, about 50% of all patients are in remission at any time during follow-up.
The Mystery of Ulcerative Colitis ‒ Deep down in our bowels, UC remains a bit of a mystery.
What is the culprit to blame for UC? No one knows for sure, but like any good mystery, scientists have a few leads in mind:
Suspect 1: Viruses or bacteria. Some scientists think that viruses or bacteria may trigger the disease in some people.
Suspect 2: Your immune system. In some cases, your body’s immune system may be acting abnormally, thereby triggering inflammation for no apparent reason.
Suspect 3: Low vitamin D. It has been observed that people with UC have low levels of the sunshine vitamin. But the question is: does a lack of vitamin D cause UC? Or, are low vitamin D levels an effect of UC? Regardless, some doctors encourage patients to take supplements to make up for the lack of vitamin D.
Suspect 4: Genetics. Scientists suspect that UC may run in families. If one of your family members has UC, there may be an increased chance that you may have it as well. However, many people who have UC do not have a family history of it, therefore, genetics do not always play a role in UC.
Ulcerative colitis is a chronic (ongoing) condition. Most people diagnosed with UC have mild to moderate symptoms.
People with mild UC have less than four bowel movements (stools) daily, with no bleeding or a small amount of blood with stools.
Moderate disease is characterized by more than four bowel movements (stools) per day. However, people with moderate disease do not have severe symptoms of fever and anemia, which are signs of severe disease.
Symptoms of severe disease include more than six bloody bowel movements (stools) per day, often accompanied by fever, anemia and rapid heart rate.
Symptoms of UC may vary, depending on the severity of the inflammation and where it occurs. Because of this, doctors often classify UC according to its location and severity.
Ulcerative proctitis In this form of UC, which tends to be the mildest, inflammation is found only in the area closest to the anus (rectum). For some people, rectal bleeding is the only sign of the disease, while others may have rectal pain and a feeling of urgency.
Proctosigmoiditis This form of UC involves both the rectum and lower end of the colon (the sigmoid colon). Symptoms include bloody diarrhea, abdominal cramps and pain, and not being able to move the bowels in spite of a feeling of urgency.
Left-sided colitis With left-sided colitis, inflammation extends from the rectum up to the descending colon, which is located on the left side of the abdomen. Symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and weight loss.
Pancolitis Pancolitis often affects the entire colon and causes abdominal cramps and pain, bloody diarrhea that can be severe, fatigue and significant weight loss.
See your doctor if you experience a change in your bowel habits or if your signs or symptoms become persistent or severe.
You are unique and so is your UC
Not everyone has the same symptoms, and symptoms of UC can be similar to other bowel conditions. If your doctor suspects that you have UC, he or she will do a physical exam followed by a number of tests.
Based on the results, your doctor will discuss a number of possible treatment options. Together, you and your doctor will decide which treatment is best for you.
If your family physician suspects that you have UC, you may be referred to a gastroenterologist – a doctor who specializes in digestive diseases. A physical exam and medical history are usually the first steps in diagnosing UC, followed by one or more of the following tests:
Blood tests (to check for iron loss or infection)
Stool sample (to check for signs of inflammation, or to rule out other disorders)
Colonoscopy or sigmoidoscopy allows your doctor to see inside the colon and rectum with a camera. A small sample of tissue (biopsy) may be taken for laboratory analysis. In most cases, a light sedative will be prescribed to help you relax, as well as pain medication to help reduce any pain as a result of the procedure.
A CT (computed tomography) scan A CT scan uses a combination of x-rays and computer technology to create three-dimensional images. This procedure is performed in an outpatient centre and does not require anesthesia.
Barium enema x-ray A barium enema x-ray involves the injection into the rectum of a chalky solution to make parts of your digestive system more visible in x-rays. These x-rays can detect colon and rectum abnormalities. This procedure may be performed in a hospital or outpatient centre, and anesthesia is not needed.
Fecal calprotectin test This test is used to help doctors distinguish between IBD and non-inflammatory bowel diseases, such as irritable bowel syndrome. Fecal calprotectin is a substance that is released into the intestines when inflammation is present and can mean that a person has an IBD such as Crohn’s disease or UC.
TIP: Always bring a family member with you when you are having tests done.
There are many things to think about when starting a family, and if you have UC, there are a few additional factors to consider. Because everyone is different, the issues you need to think about are specific to your situation.
Yes, if your disease is in remission and you are healthy, you are just as likely to get pregnant as anyone else. However, if you are in the middle of a flare, you may have more trouble conceiving. Also, if you have surgery as a result of your UC, your fertility may be lower.
The best time for you to try to get pregnant is when your UC is in remission. If your disease is active when you conceive, there is a good chance it will remain active throughout your pregnancy. This could lead to complications during your pregnancy. That is why you should plan your pregnancy when your body is healthy.
During your pregnancy, it is essential you are as healthy as possible. However, there are risks associated with taking any drug during pregnancy. You should speak with your doctor who will help you weigh the benefits against the risk of taking your prescribed medication while pregnant.
Things to talk to your doctor about when you have UC and are pregnant include:
What is the treatment for
Use: These drugs help control inflammation. Unless the UC symptoms are severe, people are usually first treated with 5-ASAs.
Side effects: Side effects include nausea, vomiting, heartburn, diarrhea and headache.
Use: Corticosteroids reduce inflammation. Usually used for more severe UC or those who have not responded to 5-ASAs.
Administration: Can be given orally, through an enema, a rectal foam or a suppository, depending on which parts of the colon and rectum are affected.
Side effects: Side effects include weight gain, acne, facial hair, hypertension, diabetes, mood swings, loss of bone mass and an increased risk of infection.
Use: These medicines suppress the immune system and may be used in patients with UC who do not respond to 5-ASAs.
Administration: Given orally.
Side effects: Side effects include nausea, vomiting, fatigue, pancreatitis, hepatitis, a reduced white blood cell count and an increased risk of infection.
Use: Biologic drugs target and block molecules involved in inflammation and are used in moderate to severe UC. They are usually prescribed for people who do not respond to, or cannot tolerate other UC medications.
Administration: Given by intravenous infusion or subcutaneous injections
Side effects: Side effects may include toxicity and increased risk of infections, particularly tuberculosis.
If diet and lifestyle changes, medications or other treatments don’t relieve your symptoms, your doctor may recommend surgery (called “colectomy”). This may involve removing part or all of your colon. Surgery can often eliminate or “cure” UC. However, that often means removing your entire colon and rectum. In the past, people who had this surgery needed to wear a small bag to collect stool, called an ileostomy. An ostomy pouch is attached to this opening to collect stool. A specially trained nurse teaches the person how to clean, care for and change the pouch.
A new procedure called ileoanal anastomosis eliminates the need to wear a bag. An ileaoanal anastomosis or ileal pouch-anal anastomosis (IPAA) is an operation that attaches the ileum to the anus, creating a pouch. Waste is stored in this pouch and then passed through the anus in the usual manner. Ask your doctor if this is an option for you.