UC is a chronic inflammatory condition of the colon (large intestine) that often occurs in teenagers and young adults, but also can occur in older individuals. The symptoms can include abdominal pain, bowel urgency, diarrhea, and blood in the stool. The inflammation begins in the rectum and extends up the colon in a continuous manner. While there is currently no known cure, there are many effective therapies to keep the inflammation under control.
Ulcerative Colitis is a chronic condition. This means that it is ongoing and life-long, although you may have periods of good health (remission), as well as times when symptoms are more active (relapses or flare-ups). UC is a chronic inflammatory disease of the gastrointestinal (GI) tract, called inflammatory bowel disease (IBD). Crohn’s disease and microscopic colitis are the other common IBDs. Read more in Crohn’s Disease and Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis.
Understanding the Large Intestine
The large intestine is part of the GI tract, a series of hollow organs joined in a long, twisting tube from the mouth to the anus—an opening through which stool leaves the body. The last part of the GI tract, called the lower GI tract, consists of the large intestine—which includes the appendix, cecum, colon, and rectum—and anus. The intestines are sometimes called the bowel.
The large intestine is about 5 feet long in adults and absorbs water and any remaining nutrients from partially digested food passed from the small intestine. The large intestine changes waste from liquid to a solid matter called stool. Stool passes from the colon to the rectum. The rectum is located between the lower, or sigmoid, colon and the anus. The rectum stores stool prior to a bowel movement, when stool moves from the rectum to the anus and out of a person’s body.
Ulcerative colitis (UC) is an idiopathic inflammatory bowel disease that occurs more often in industrialized countries. This disease affects both men and women similarly. The disease may be acute and chronic with unpredictable relapses and remissions. Major advances have been made in many aspects of inflammatory bowel disease, including new information on the molecular basis of the disease, epidemiological considerations, immunology and genetics. The clinical and scientific understanding of ulcerative colitis has been greatly expanded far beyond our earlier knowledge.
Types of Ulcerative Colitis
There are several subtypes of ulcerative colitis that are named according to the part of the large intestine affected –
- Ulcerative proctitis, which affects only the rectum
- Proctosigmoiditis, which affects the rectum and lower segment of the colon, or the sigmoid colon
- Left-sided colitis, which affects the rectum, sigmoid colon, and descending colon up to where there is a sharp bend in the colon near the spleen
- Pan-ulcerative or total colitis, which affects the entire large intestine
Who is at risk?
Ulcerative colitis can occur in people of any age. However, it is more likely to develop in people –
- Between the ages of 15 and 304
- Older than 601
- Who have a family member with IBD
- Of Jewish descent
- Males and females appear to be affected equally.
- Men are more likely than women to be diagnosed with ulcerative colitis in their 50s and 60s
Causes
- Overactive intestinal immune system – Scientists believe one cause of ulcerative colitis may be an abnormal immune reaction in the intestine. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. Researchers believe bacteria or viruses can mistakenly trigger the immune system to attack the inner lining of the large intestine. This immune system response causes the inflammation, leading to symptoms.
- Genetic Factor – Ulcerative colitis sometimes runs in families. Research studies have shown that certain abnormal genes may appear in people with ulcerative colitis. However, researchers have not been able to show a clear link between the abnormal genes and ulcerative colitis.
- Environmental Factor – Some studies suggest that certain things in the environment may increase the chance of a person getting ulcerative colitis, although the overall chance is low. Nonsteroidal anti-inflammatory drugs,1 antibiotics,1 and oral contraceptives may slightly increase the chance of developing ulcerative colitis. A high-fat diet may also slightly increase the chance of getting ulcerative colitis.
Some people believe eating certain foods, stress, or emotional distress can cause ulcerative colitis. Emotional distress does not seem to cause ulcerative colitis. A few studies suggest that stress may increase a person’s chance of having a flare-up of ulcerative colitis. Also, some people may find that certain foods can trigger or worsen symptoms.
Symptoms
The most common symptoms of ulcerative colitis are episodes of bloody diarrhoea and pain in the lower abdomen. There may also be a sensation of urgent need to pass a bowel motion. The bowel motions may be explosive and may contain mucous or pus.
Other symptoms that may be experienced include –
- Fatigue
- Weakness
- A general feeling of ill health
- Weight loss
- Loss of appetite
- Bloating of the abdomen
Symptoms vary in frequency and severity. Approximately half of all sufferers will experience only mild symptoms. However for others, symptoms will be more severe. The severity of the symptoms tends to be related to how much of the colon is affected.
Ulcerative colitis is characterised by episodes where symptoms are problematic (“flare-ups”) and episodes where symptoms are absent (remissions).
Ulcerative colitis patients may experience signs or symptoms outside the colon, such as ulcers in the mouth, inflammation of the iris (eye), arthritis, skin lesions, blood clots and anaemia.
There is an increased risk of bowel / colorectal cancer in patients who have had extensive ulcerative colitis for a number of years.
Complications
There are some complications related to ulcerative colitis. Possible complications include –
- Severe bleeding
- Dehydration
- Perforated colon (a hole in the colon)
- Kidney stones
- Osteoporosis (loss of bone strength)
- Toxic megacolon (severe abdominal swelling accompanied by a fever, rare)
- Liver disease (rare)
Treatment
Treatment for ulcerative colitis aims to prevent complications of the condition by reducing inflammation and maintaining periods of remission.
The type of treatment recommended will depend on the extent and severity of the condition. A person’s age, general health, lifestyle and personal choice will also be taken into account.
Stress reduction – While stress does not cause ulcerative colitis, it can worsen symptoms in some people. Developing techniques to reduce stress can be helpful in managing the condition.
Medication
- Corticosteroids (such as prednisone and budesonide) also reduce inflammation by controlling the body’s immune system response. Steroid medications are effective for short-term control of a flare-up, however they are not recommended for long-term use because of their significant side-effects.
- Immunosuppressants (such as 6-MP and azathioprine) may be recommended if your condition does not respond to other treatments. These medications suppress (reduce) the activity of the body’s immune system to control inflammation, however, they also weaken the body’s ability to fight infection.
- Biologics (such as infliximab, adalimumab and Golimumab) are powerful medications used for people with moderate-to-severe ulcerative colitis when other treatments have been unsuccessful.
Surgery – About 10 to 15% of people with ulcerative colitis may eventually need surgery to treat their condition, if medical therapy is not successful or complications arise. Ulcerative colitis surgery usually involves removing the entire colon and rectum (proctocolectomy).
Alternative Treatment
Vitamins
Vitamin B-12 is absorbed in the lower section of the small intestine (ileum). People who have ileitis or those who have undergone small bowel surgery may have vitamin B-12 deficiency. If diet and oral vitamin supplements don’t correct this deficiency, a monthly intramuscular injection of vitamin B-12 or once weekly nasal spray may be required. Folic acid (another B vitamin) deficiency may occur in IBD patients who take the drug sulfasalazine or methotrexate.
Vitamin D deficiency is common in people with UC. Vitamin D is essential for good bone formation and for the metabolism of calcium. A vitamin D supplement of 800 IU per day is recommended, particularly for those with active bowel symptoms. A vitamin D deficiency can lead to a calcium deficiency, which can also occur in people with UC in the small intestine or who have had a section of the intestine surgically removed.
Iron deficiency (anemia), which results from blood loss following inflammation and ulceration of the intestines, can occur in people in people with ulcerative colitis and Crohn’s (granulomatous) colitis. Anemia is treated with oral iron tablets or liquid, usually taken one to three times a day or intravenous infusions of iron taken weekly for eight weeks.
Calcium is also needed for strong bones. Calcium at certain doses may interfere with some medications.
Probiotics – Several studies indicate that taking probiotics, or “good” bacteria, can help reduce symptoms. One study found that giving Lactobaccillus, Bifidobacteria, and a nondisease causing type of Streptococcus to people with chronic pouchitis helped prevent the condition. Sacchromyces boulardi may also help improve the overall health of the intestine.
Folic acid – Many people who have ulcerative colitis have low levels of folic acid in their blood. In addition, some medications, such as sulfasalzine, may cause levels of folic acid in the body to drop. People with ulcerative colitis also have a higher risk of developing colon cancer, but some studies have found that taking folic acid can reduce that risk. Folic acid can mask a vitamin B12 deficiency.
Omega-3 fatty acids found in fish oil – At least one study has found that, compared to placebo, fish oil supplements containing omega-3 fatty acids may reduce symptoms and prevent recurrence of ulcerative colitis.
N-acetyl glucosamine – Studies suggests that N-acetyl glucosamine supplements or enemas may improve symptoms of inflammatory bowel disease. More studies are needed to know whether glucosamine would have any effect on ulcerative colitis.
Aloe vera is widely used topically for wound healing and pain relief. It is also thought to have anti-inflammatory properties.
Psyllium seeds – Psyllium is a type of insoluble fiber, and may be irritating to some people, especially during flares.
Boswellia – Boswellia has anti-inflammatory properties. One small study suggests that people who took boswellia had similar improvement as people who took the prescription drug sulfasalazine.
Curcumin or turmeric – Turmeric shows anti-inflammatory properties in test tubes. One small study found that people with inflammatory bowel disease who took curcumin reduce their symptoms and their need for medication.
Licorice root is a demulcent (it coats mucous membranes to relieve irritation) and an expectorant (it helps bring up mucus) that has been used for thousands of years to treat many conditions.
Butyrate is a fatty acid that is actually produced as a byproduct in our intestines. Butyrate enemas have been studied as a treatment for left-sided (or distal) ulcerative colitis.
Biofield therapies affect energy fields that allegedly surround and penetrate the body. These energy fields have not yet been scientifically measured. Biofield therapies involve the application of pressure or the placement of hands in or through these energy fields. Examples include Reiki, qi gong, and therapeutic touch.
Bioelectromagnetic-based therapies utilize electromagnetic fields for the purposes of healing. Examples include magnetic therapy, sound energy therapy, and light therapy.
Manipulative and body-based practices involve manipulation or movement of one or more parts of the body as a means of achieving health and healing. Examples include chiropractic and osteopathic manipulation, massage, reflexology, Rolfing, Alexander technique, craniosacral therapy, and Trager bodywork.
Reference –
http://www.healingwell.com/community/?f=38
http://www.ccfa.org/assets/pdfs/living_with_uc_brochure_final.pdf
http://www.aafp.org/afp/2007/1101/p1323.pdf
http://www.ulcerativecolitiscure.com/
http://www.everydayhealth.com/ulcerative-colitis/
http://patient.info/health/ulcerative-colitis-leaflet
http://www.crohnsandcolitis.org.uk/about-inflammatory-bowel-disease/ulcerative-colitis