Ulcerative Colitis

Ulcerative colitis is a chronic condition which affects the colon. The colon is also known as the large intestine and is responsible for absorbing nutrients from undigested food and passing waste products through to the rectum and anus.

Ulcerative colitis is sometimes referred to as inflammatory bowel disease, along with Crohn’s disease. The condition causes the colon to become inflamed and ulcers to form on the lining of the colon. In severe cases, it can be very painful and result in bleeding, pus or mucus. Ulcerative colitis is an unpredictable condition, as it can flare up and cause severe symptoms and then disappear for long periods of time.

What causes ulcerative colitis?

The exact cause of ulcerative colitis is unknown, though research has established a number of factors can play a role. These include genetic factors, the environment and the role of the body’s immune system. There is also evidence to suggest that the genes you inherit increase your risk of developing ulcerative colitis, with around 16% of those affected having a close relative with the condition. Rates can also be higher in certain ethnic groups. Environmental factors believed to play a part include pollution and diet, although these factors are not concrete and research is ongoing.

How much of the colon is affected?

The rectum is always affected by ulcerative colitis, but the amount of the colon actually affected can vary. In some cases, a small part can be affected and symptoms will be mild, but, in severe cases, the whole colon can become inflamed and this is known as Pancolitis.

Who is affected by ulcerative colitis?

Ulcerative colitis is not a common condition. It usually develops between the ages of 15 and 30, affecting 10 in 100,000 people in the UK. It is more common among white people and is rare among people of Asian heritage; the reason for this is not completely understood.

Symptoms of ulcerative colitis

Symptoms tend to vary according to how much of the colon is affected. The most common symptoms include abdominal pain and diarrhoea, which will contain blood and mucus. Other symptoms include:

• Weight loss.
• Loss of appetite.
• Anaemia.
• Dehydration.
• A high temperature (fever).
• Tiredness.
• Wanting to empty the bowel constantly.

Symptoms can often be general, especially in mild cases, so an individual can be lead to think they don’t need to see their doctor. In severe cases, the symptoms can be much more serious and may put a real strain on day-to-day living.

Diagnosing ulcerative colitis

If you notice any of the relevant symptoms it is advisable to visit your GP. They will ask you about your symptoms, medical history and, if they suspect you have ulcerative colitis, they will order specific tests, which include a blood test, stool test and a physical examination. The physical examination will include checking if you are pale (this is linked to anaemia) and feeling your abdomen to check for signs of inflammation. Your blood sample will be analysed to check for changes in the blood that indicate inflammation. Two specific tests called the erythrocyte sediment rate (ESR) test and C-reactive protein test will be conducted. The stool sample will be analysed for signs of infection and an X-ray may also be ordered to assess the severity of the condition. Additional tests will be required to reach a firm diagnosis, which includes tests to examine the bowel. The first test to be carried out is usually a sigmoidoscopy, which involves using a thin, flexible tube known as a sigmoidoscope to look at the rectum and the lower portion of the colon. A camera is attached to the tube, making it possible for doctors to see the structures in detail. A colonoscopy may also be carried out, which involves examining the entire colon using a longer tube, called a colonoscope. The procedure is not painful but it may cause initial discomfort.

Treatment for ulcerative colitis

As the exact cause of ulcerative colitis is unknown, this can make treatment difficult. However, there are effective treatments to ease symptoms and put the disease into remission (this means that no symptoms are present). The aim of treatment is to treat symptoms and manage the condition, so that the individual can live a normal life. If you are diagnosed with ulcerative colitis you will be referred to a specialist gastroenterologist, who will assess the severity of your condition and draw up a suitable plan. Treatment for ulcerative colitis usually involves medication, with the aim of reducing inflammation. There are three main types of medication:

• Aminosalicylates.
• Immunosuppressants.
• Steroids: these are usually reserved for more severe cases.

Managing ulcerative colitis with medication

There is no exact cure for ulcerative colitis, but there are treatments that can manage the condition and help to prevent the development of further unpleasant symptoms. The main treatment for easing symptoms and facilitating remission is medication, of which there are three main types used (as mentioned above).

Aminosalicylates: this is usually the first treatment given to patients with mild to moderate ulcerative colitis, because these drugs help to reduce inflammation. Aminosalicylates can be taken orally, by enema or as a suppository. Aminosalicylates are usually effective but they can cause side-effects, including nausea, headaches and diarrhoea.

Steroids: in severe cases, steroids may be used. Steroids help to reduce inflammation and are much stronger than Aminosalicylates. Long-term use of steroids can produce harmful side-effects, so once the symptoms have eased your doctor will normally advise you to stop taking them.

Immunosuppressants: these may be given if the individual is not responding to other forms of medication. They work by suppressing the action of the immune system, which will prevent the inflammatory response. The disadvantage of immunosuppressants is that they affect the whole body, leaving you more susceptible to illnesses and infections.