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Ulcerative colitis (UC) is a disease that involves the inner lining of the large bowel.
Ulcerative colitis (UC) is a disease that involves the inner lining of the large bowel. It causes abdominal pain and bleeds due to erosions and ulcers all over the large intestine and rectum. Inflammatory bowel disease (IBD) is a lifelong illness with no specific cause or cure. Patients have repeated cycles of flare-ups and remission with potential extraintestinal manifestations. Flare-ups may last days to a few weeks. Remission might last for months or even years.
UC is a lifelong disease with constant periods of flare-ups and remission. Several treatment options and lifestyle modifications reduce the symptoms and prevent flare-ups. Stool-related symptoms of UC include
- Diarrhea or loose stools more than four episodes a day
- Bloody stools, which may be bright red, pink or tarry
- Ribbon-like stools in case of narrowed intestines due to a long-standing disease
Diarrhea may be associated with cramps and abdominal pain. There may also be a constant feeling of the need to evacuate the bowels (tenesmus).
What are the signs and symptoms of ulcerative colitis?
Patients may present with the following signs and symptoms.
- Rectal bleeding
- Frequent stools
- Mucous discharge from the rectum
- Tenesmus (constant feeling of evacuation of the bowels)
- Lower abdominal pain and cramps
- Dehydration
- Severe diarrhea and cramps
- Fever
- Abdominal distention/bloating
- Increased heart rate
- Severe abdominal pain
- Weight loss
- Pus discharge through the anus
Ulcerative colitis (UC) is associated with various extracolonic manifestations such as inflammation of the eyes, joints, skin and lungs.
Grading of UC:
Severity of UC can be graded as follows.
- Mild: Bleeding per rectum and fewer than four bowel motions per day
- Moderate: Bleeding per rectum with more than four bowel motions per day; mild anemia seen
- Severe: Bleeding per rectum with more than four bowel motions per day and systemic illness with fever, weakness, shock and severe anemia
What is the treatment for ulcerative colitis?
Treatment involves medical and surgical treatment, depending on the severity of the disease. Patients would also require lifestyle changes and dietary modifications.
Medical treatment: Most patients require a combination of more than one medication. Medical treatment typically involves medications to suppress and/or modulate the immune system, painkillers, antibiotics, anti-diarrhea medications and nutritional supplements.
- Anti-inflammatory drugs: Anti-inflammatory drugs such as 5-aminosalicylates (sulfasalazines, balsalazides, etc.) and corticosteroids (prednisolone, budesonide, etc.) suppress the cells causing inflammation. These drugs are usually the first step in the treatment of ulcerative colitis (UC) and are well tolerated by most patients.
- Immune system suppressors: These medications reduce inflammation by suppressing the immune system response that stimulates the inflammation process. Immunosuppressants include Azasan and Imuran (Azathioprine); Purinethol and Purixan (Mercaptopurine); Gengraf, Neoral and Sandimmune (Cyclosporine) and Xeljanz (Tofacitinib).
- Biologics (monoclonal antibodies): These drugs target proteins produced by the immune system, neutralizing the protein. Types of biologics used to treat UC include Remicade (Infliximab), Humira (Adalimumab) and Simponi (Golimumab). Entyvio (Vedolizumab) is also a type of biologics that works by blocking the inflammatory cells from reaching the inflammation site. It is used in patients who are unable to tolerate other biologics.
- Anti-diarrheal medications: Doctors may advise Imodium A-D (Asloperamide) for severe diarrhea. Patients should avoid taking over the counter (OTC) anti-diarrheal medications without consulting their doctor because these can increase the risk of toxic megacolon (an enlarged colon).
- Painkillers: Doctors may advise Tylenol (Acetaminophen), which is safe to be used in UC. Patients should avoid taking other OTC painkillers without consulting their doctor.
- Antispasmodics: Doctors may prescribe antispasmodic medications to reduce cramps.
- Nutritional supplements: Doctors may advise iron supplements to patients with anemia (iron deficiency) caused by chronic intestinal bleeding. They may also prescribe vitamin D, folic acid and vitamin B complex.
Surgery: Surgery can eliminate UC. It involves removing the entire colon and rectum (proctocolectomy) followed by reconstruction.
Lifestyle and dietary modifications: Management of psychological stress and emotional support is important to prevent and reduce flare-ups. Moreover, regular exercise and a healthy diet are important. Doctors advise a diet with low fat, meat, vitamin B6, sulfur and milk.