Ulcerative Colitis Explained: What You Need to Know About This Condition

Ulcerative colitis is a lifelong condition and a type of inflammatory bowel disease in which the inflammation occurs in the colon. This condition can significantly affect daily life. Although there is no cure, it can be managed with treatment strategies. Whether you are newly diagnosed or seeking support for a loved one, this guide will provide valuable insights into its symptoms, causes, and treatment options to help navigate the journey with ulcerative colitis.

What happens in ulcerative colitis?

Ulcerative colitis is a chronic condition in which the colon and rectum become inflamed. Also, small ulcers can develop on the lining of the colon, which can bleed or produce pus. This is one of the most common types of inflammatory bowel disease. Symptoms worsen suddenly, with flare-ups followed by longer periods of remission, during which no symptoms are present.

What is the main cause of colitis?

Although anyone can get ulcerative colitis, some factors increase your risk. The risk factors of ulcerative colitis include:

Age: Common between 15-30 years or above 60 years of age.
Race and Ethnicity: Especially Ashkenazi Jewish descent and white people are at greater risk.
Family history: The risk is higher if a close relative (parent, sibling, or child) is suffering from this disease.

Other factors that can trigger its symptoms are stress, diet, lifestyle, certain medications like NSAIDs, birth control pills, etc., and environmental factors.

What are the symptoms of ulcerative colitis?

The ulcerative colitis (UC) symptoms can be mild, moderate, or severe, usually worsening with time. UC symptoms will also vary depending on the severity of the inflammation and the area where it occurs. Mild symptoms include:

Diarrhoea
Urgent need to poop
Increased bowel movements
Mild abdominal pain or cramping
Tenesmus (feeling to poop but unable to)

Moderate to severe UC symptoms include:

Frequent bowel movements
Fatigue
Fever
Sudden weight loss
Blood, pus or mucus in the stool
Nausea
Severe abdominal cramps

Most people experience mild to moderate symptoms during flare-ups, and some have longer periods of remission. Sometimes, the inflammation spreads to other parts of the body, exhibiting symptoms like red, burning, or itchy eyes, joint pain or swelling, or painful bumps, rashes, or ulcers in the skin.

What are the complications of ulcerative colitis?

If colitis treatment is not done early, it can cause many complications, increasing the risk of developing other diseases or conditions. Its complications include:

Severe dehydration
Severe bleeding
Bone loss (osteoporosis)
Perforated colon (hole in colon)
Toxic megacolon (severe inflammation in the colon that stops it from working)
Blood clots
Anaemia
Primary sclerosing cholangitis
Colon cancer
Growth and development issues in children

How can ulcerative colitis be diagnosed?

To diagnose UC, the doctor will first conduct a physical examination, assess your symptoms, and inquire about your medical history. To rule out conditions similar to ulcerative colitis, certain diagnostic tests or procedures may be performed. These include:

Blood tests to assess anaemia and rule out other causes of symptoms, such as infections.
Stool test to check the presence of white blood cells or C-reactive protein, which may indicate ulcerative colitis. Other infections can also be ruled out.
Colonoscopy to view the entire colon, where a tissue sample may be taken for further analysis.
Flexible sigmoidoscopy is performed when the colon is severely inflamed.
Imaging tests such as X-rays, CT scans, computerised tomography enterography or magnetic resonance enterography may be conducted.

How is ulcerative colitis treated?

The treatment for ulcerative colitis aims to provide relief in symptoms during a flare-up and maintain the remission phase. The treatment involves:

Medications: Several medications alone or in combination may be used, such as aminosalicylates, immunosuppressants, biologics, corticosteroids, and Janus kinase inhibitors.
Surgery: It may be needed if there is no relief from medications or in case of severe complications. These include proctocolectomy and ileal pouch (removing the colon and rectum and forming an ileal pouch) and proctocolectomy and ileostomy (colon, rectum, and anus are removed).

How can I prevent ulcerative colitis?

Although ulcerative colitis cannot be completely prevented, by identifying and avoiding triggers, flare-ups can be avoided. The common triggers you should be aware of are:

Lifestyle: Try to exercise regularly and look for ways to relieve stress through relaxation and breathing exercises.
NSAIDs: Some NSAIDs can worsen ulcerative colitis symptoms; try to avoid them.
Foods: Understand your food triggers to prevent flare-ups. Get a personalised meal plan from a healthcare provider.
Eat small meals
Drink more water or liquids

What foods trigger colitis?

There can be some foods that trigger the symptoms of ulcerative colitis. Your food triggers can be different from another person’s, so noting the triggers that cause flare-ups can be helpful. Work with your healthcare provider to understand the foods you should avoid. The common food triggers that should be avoided in ulcerative colitis include:

Alcohol
Dairy products
Some nuts
Coffee and other caffeinated beverages
Spicy foods
Sugary foods and drinks
High-fatty foods
Artificial sweeteners
Raw and gassy cruciferous vegetables
Raw fruits with skin or peel
Gluten
Processed meats

Does ulcerative colitis go away completely?

There is no permanent cure for ulcerative colitis. Its symptoms can only be managed with medications or surgery. Additionally, the doctor can help you understand common triggers for symptom flare-ups and provide guidance on achieving long-term remission.

Can I live a normal life with ulcerative colitis?

Living with ulcerative colitis can be stressful for some people, but you can live a happy and fulfilling life with proper treatment and lifestyle adjustments. Some people may experience only a single episode of symptoms with long periods of remission, while others may have worsening symptoms that require immediate treatment and possibly surgery. By working closely with your healthcare team, the symptoms can be effectively managed for an active and normal life.

References

Segal, J. P., LeBlanc, J. F., & Hart, A. L. (2021). Ulcerative colitis: An update. Clinical Medicine (London), 21(2), 135-139. https://doi.org/10.7861/clinmed.2021-0080

Ulcerative Colitis: An Annual Review. (n.d.). Annual Review of Medicine. https://doi.org/10.1146/annurev-med-052919-120048

Ulcerative colitis – NHS

Ulcerative colitis – Diagnosis and treatment – Mayo Clinic

Ulcerative Colitis: Symptoms, Causes, Diagnosis & Treatment

https://www.healthline.com/health/ulcerative-colitis-foods-avoid

Ulcerative Colitis Causes: Genes, Immune System, Environment