What is ulcerative colitis?

Ulcerative colitis is inflammation of the colon, the lower part of the bowel (intestine) or digestive system.

By the time food has passed through the six and a half metres of your small intestine and reaches your colon, most of the food has been absorbed and only waste products are left. It is the job of the colon to absorb the excess water (as well as some fibre and potassium) from the waste and move the waste to the rectum. This becomes your bowel motion.

When the lower bowel becomes inflamed, swelling and ulcers develop in the colon. This is known as ulcerative colitis. It is a chronic condition.

People with ulcerative colitis have a higher chance of getting cancer of the colon - more so if the disease begins before the age of 15 or continues for longer than 10 years.

What causes ulcerative colitis?

The exact cause of ulcerative colitis is unknown. It is thought to be a type of autoimmune disease. This means the body's immune system malfunctions and attacks the tissues of the bowel. Ulcerative colitis seems to occur more in some families but it is not clear whether it is due to hereditary or environmental factors.

Ulcerative colitis may occur at any age, but it is most common in young adults in the 15-30 age group or later on, in the 50-70 age group. Women are affected more than men.

Some foods can make symptoms worse but this is on an individual basis with no specific foods being common to all people with the disease. Some believe that their symptoms are worse during periods of high stress, but flare-ups are just as likely to occur after a bout of the flu.

Most cases of ulcerative colitis are mild, but once symptoms are identified it is important to receive prompt medical attention because the condition can progress very quickly.

What are the symptoms?

The main symptoms are frequent attacks of bloody diarrhoea and pain in the lower abdomen (of varying intensity). This is interspersed with periods with no symptoms at all.

Most often an attack begins slowly and with mild symptoms such as an increased urgency to have a bowel motion, mild lower abdominal cramps, and blood and mucus appearing in the bowel motions. Pus may be present.

Ulcerative colitis may cause weight loss, fever, dry mouth, sunken eyes, a fast heart beat and pale skin. Loss of appetite, nausea and vomiting can occur. There may be some difficulty controlling bowel motions and it may feel that the bowel has not emptied properly.

When you are examined by a doctor the bowel near to your anus will most likely be inflamed.

To share your experiences of living with ulcerative colitis, or to ask others with the disease how they cope, visit the online everybody Communities Crohn's and Colitis Bulletin Board.

Diagnosis

Blood samples will be taken for testing and specimens of your bowel motions will be sent to the laboratory for examination to rule out an infectious cause of the colitis.

Your doctor will probably arrange a test on your lower bowel called a sigmoidoscopy. A narrow tube containing a camera and a light is passed through your anus into the lower bowel. This allows a specialist to look at the lining of your colon. Sometimes a small piece of tissue is removed (biopsy) so it can be examined more closely in a laboratory.

Another procedure called a colonoscopy may also be carried out. This allows a higher part of your colon to be examined. In addition, a barium enema is sometimes necessary to see how far the inflammation has spread. A barium enema is an x-ray procedure which involves feeding barium-containing paste-like dye into the bowel through the anus. A series of x-rays are then taken which show the inside walls of the bowel.

These tests may be a bit uncomfortable but they are not usually painful.

Treatment

Ulcerative colitis is usually treated with anti-inflammatory drugs (usually tablets) based on various preparations of the drug 5-ASA (Pentasa, Asacol and Dipentum). These drugs reduce the inflammation in the colon and are usually taken long term since they have been shown to reduce the likelihood of recurrence. Steroidal anti-inflammatory tablets or enemas (eg, prednisone) may be prescribed in severe cases. Follow-up sigmoidoscopy or colonoscopy is usually carried out to see if the colon has improved.

Your practice nurse or doctor will give you advice concerning nutrition and healthy eating habits. You may be asked to keep a diary of your daily food and drink intake to see which foods may be making your colitis symptoms worse.

Raw fruits and vegetables can be avoided to limit abrasion to the inflamed lining of the colon, and this may result in reduced symptoms. A milk-free diet may also decrease symptoms in some patients, but it need not be continued if no benefit is apparent. When you are well, there is no reason to avoid certain foods and it is important to eat a full and varied diet.

Mild to moderate ulcerative colitis does not usually require hospital treatment. Severe ulcerative colitis, or disease that does not respond to drug treatment, may mean that an operation to remove the colon is necessary. Nearly one-third of all patients with extensive ulcerative colitis ultimately require surgery. When performed in time, removal of the colon is curative. Normal life expectancy and quality of life are restored.

See also: Crohn's Disease

Original material provided by the Crohn's and Ulcerative Colitis Support Group. Edited by everybody.