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ULCERATIVE COLITIS
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Table of Contents
ULCERATIVE COLITIS
4
THE DIGESTIVE SYSTEM
5
SYMPTOMS
7
COMPLICATIONS
8
DIAGNOSIS
9
TREATMENT
10
Ulcerative colitis is an inflammatory
bowel disease. People with
ulcerative colitis develop inflammation in the lining of the large
intestine (colon). The inflammation
leads to the formation of ulcers.
This can cause bleeding, diarrhea,
weight loss, and fatigue.
Some people with ulcerative
colitis may have only occasional
symptoms. For others, the
symptoms can be constant.
Medications can usually control
the inflammation. But sometimes
surgery is required.
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Whether this is your first visit or a follow-up,
ask your doctor:
• What symptoms should I be on the lookout for?
• Which medications should I take even if I feel
fine and have no symptoms?
• Which medications should I take if my
symptoms get worse?
• Would eliminating certain foods from my diet
help my condition?
• Do I need to take any vitamins or supplements?
• What else can I do to help keep myself healthy?
• When and how often should I get checked for
colon cancer?
Tell your doctor:
• About any new symptoms you have had
• If your symptoms have improved or worsened
since your last visit
• If you think your medications are causing any
side effects
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WHAT IS ULCERATIVE COLITIS?
Ulcerative colitis is an autoimmune disease.
That means the immune system, which normally
helps fight off infections, mistakenly attacks the
lining of the colon (large intestine) and rectum.
Doctors aren’t sure what triggers ulcerative colitis.
And the trigger might not be the same for everyone.
Ulcerative colitis causes inflammation and ulcers in
the colon and usually the rectum. When only the
rectum is affected, the condition is called ulcerative
proctitis.
Inflammation causes the lining of the large intestine to:
A CLOSER LOOK AT THE DIGESTIVE TRACT
The digestive system breaks down food
and drink into nutrients the body uses for
energy and growth.
1 Food’s journey through
the digestive system
begins in the mouth.
3 Digestion
then begins in
the stomach.
2 It passes down
the esophagus.
• wear away in spots (leaving ulcers)
• bleed
• ooze cloudy material that contains mucus
Some people also have inflammation in other body
parts, including the eyes, skin, liver, back, and joints.
Ulcerative colitis is not contagious. You cannot get it
through contact with a person with the condition.
People with ulcerative colitis are far more likely to
develop colorectal cancer than people without it.
5 The remaining, watery,
food residue moves into
your colon (large intestine),
a muscular tube about
4 feet long and 3 inches
wide. As the undigested
contents pass through the
large intestine, bacteria
feed off the remnants. The
wall of the large intestine
soaks up most of the
remaining water.
4 The small
intestine further
breaks down
food. It absorbs
nutrients and
sends them into
the bloodstream.
6 Undigested food
settles in the rectum,
the final six inches
of the colon. Waste
accumulates until it is
released as a bowel
movement.
Ulcerative colitis can affect the colon, rectum, or both.
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ulcerative colitis
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SYMPTOMS OF ULCERATIVE COLITIS
Symptoms differ from person to person.
Most people with ulcerative colitis have mild to moderate symptoms. The most common symptoms are:
• diarrhea, often with blood and mucus
WHO DEVELOPS ULCERATIVE COLITIS?
• cramping abdominal pain, especially in the lower
abdomen
Other symptoms include:
Some people are at increased risk for
ulcerative colitis.
This includes people who:
• are between ages 15 and 30, or older than 60
• have a parent or sibling with ulcerative colitis
• have a parent or sibling with another
inflammatory bowel disease called Crohn’s
disease
• are of Jewish descent
• a frequent sensation
of needing to move
your bowels
• little warning before
you need to have a
bowel movement
• feeling tired
• dehydration
• the need to wake from
sleep to have bowel
movements
• loss of appetite
• weight loss
• fever
People with ulcerative colitis may also
develop a low red blood cell count
(anemia).
Doctors don’t know what causes ulcerative colitis.
The following factors may play a role:
Ulcerative colitis can also be associated
with pain or soreness in the joints, eye
irritation, and certain rashes.
Genes
Ulcerative colitis tends to run in families. Up to one
in four people with ulcerative colitis has a parent or
sibling with ulcerative colitis or Crohn’s disease.
Some people have “flares,” when symptoms
suddenly get worse, then they go into
“remission,” when they have no symptoms.
Overactive immune system
Normally, the immune system protects the body
from infection by identifying and destroying harmful
germs. In ulcerative colitis, the immune system
attacks the lining of the large intestine.
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Some people have symptoms all or most of the time.
Some have symptoms only rarely. The symptoms
a person experiences can vary depending on the
severity of the inflammation and where it occurs in
the large intestine.
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COMPLICATIONS OF ULCERATIVE COLITIS
Ulcerative colitis can cause problems
beyond pain and diarrhea.
Dehydration
Frequent loose bowel movements can lead to excessive
loss of body fluids. You may need fluids given by IV to
replace lost fluids and nutrients.
Nutritional deficiencies
You might be eating less to avoid diarrhea and not getting
enough vital nutrients. Inflammation in the intestine can
also lower vitamin and mineral levels. Your doctor may
recommend vitamins and nutritional supplements.
Rectal bleeding
This can occur when ulcers in the intestine bleed. Rectal
bleeding can cause anemia. Iron supplements and
changes in diet can help treat anemia.
Weakened bones
Calcium and vitamin D supplements, exercise, and
medications can help prevent or slow bone loss.
Inflammation in other areas
Inflammation may also affect large joints, like the hips and
knees, or occur in the eyes, skin, or liver. Medication may
be prescribed to treat this.
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DIAGNOSING ULCERATIVE COLITIS
Several steps are needed to diagnose
ulcerative colitis.
Diagnosis begins with:
• a personal and family health history
• a physical examination
• blood tests
• tests of the stool
The diagnosis is confirmed with a colonoscopy or a
flexible sigmoidoscopy.
Colonoscopy lets a doctor closely examine the
inside of the entire colon and rectum. The doctor
inserts a flexible tube with an attached camera
and light into the anus, and guides it through the
rectum and colon.
The camera sends images of the intestinal lining
to a monitor. The images can reveal irritated and
swollen tissue, ulcers, and abnormal growths. The
doctor will take a tissue sample (biopsy) to be
examined in a laboratory.
Flexible sigmoidoscopy is similar to colonoscopy.
But the doctor views and biopsies only the lower
part of the colon and the rectum.
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TREATMENT WITH MEDICATIONS
Medications cannot cure ulcerative colitis.
But they can stop or ease symptoms by controlling
inflammation. And they can help improve your
quality of life.
Which medication is right for you depends on
your symptoms and how severe they are. Most
medications prevent inflammation in the intestine.
Aminosalicylates
These anti-inflammatory drugs are related to
aspirin. Doctors usually prescribe them for people
with mild to moderate symptoms or to help them
stay symptom-free. Aminosalicylates suppress
inflammation in the digestive tract and in joints.
Corticosteroids
These drugs quiet down the immune system and
decrease inflammation. They can also help stop
or ease symptoms. Corticosteroids are usually
prescribed when people have more severe
symptoms that do not respond to aminosalicylates.
Because of potential side effects, they are not
usually recommended for long-term use.
When symptoms are severe or when diarrhea
causes dehydration, you may need to be
hospitalized. You will get fluids and
sometimes nutrition through a vein while
your colon recovers.
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Immunomodulators
These weaken the activity of the immune system.
This decreases inflammation and helps reduce
symptoms. Fast-acting immunomodulators
effectively stop symptoms in people with severe
disease. They are generally given until one of the
slower-acting immunomodulators begins to work.
Biologics
These drugs target a protein made by the immune
system. Blocking this protein decreases inflammation
in the large intestine. It can also quickly stop
symptoms. Biologics are often prescribed when
other medications are not effective. They are part of
a newer generation of drugs.
In addition to these medications, your
doctor may prescribe:
• acetaminophen, to relieve pain
• antibiotics, to prevent or treat bacterial
infections in the gastrointestinal tract
• medication to slow or stop diarrhea
• medication to decrease spasms of the colon
All medications carry the risk of side effects. Some
side effects of medications for ulcerative colitis may
be serious. Discuss your individual risks and benefits
of treatment with your doctor.
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SURGICAL TREATMENTS
Surgery to remove the colon and rectum is
sometimes the best option.
Surgery may be considered for people who have:
• severe symptoms not controlled by medicines
• unacceptable side effects from medicines
• a very high risk of colon cancer because of longlasting inflammation throughout the colon
TAKING YOUR MEDICATIONS
Surgery involves removing the colon and some or
all of the rectum and anus.
There are two types of surgery for ulcerative colitis:
Medications for ulcerative colitis may have
to be taken, or given, in different ways.
Colon
(removed)
Colon
(removed)
• By mouth: This is the traditional, familiar
method of taking medication.
• By enema or rectal foam: An enema involves
flushing a liquid form of medication into the
rectum, using a special type of bottle. When
using rectal foam, a foamy substance, rather
than a liquid, is placed into the rectum. These
therapies act directly on inflamed areas. They
are most effective for people with disease
confined to the rectum and the lower part of
the colon.
• By suppository: A solid medication is placed
into the rectum. It dissolves and is absorbed
into the lining of the rectum.
• Intravenous (IV): Medication is delivered
directly into a vein.
How you take your medicine may depend on the
location of disease in your colon.
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Stoma
Small
intestine
In one type, the surgeon
removes the entire colon,
then creates an opening
in the abdominal wall
(a stoma). After this
procedure, waste leaves the
body through the stoma,
rather than the anus. A bag
attached to the opening
collects the waste.
Anus
Small
intestine
In another type, the
surgeon removes the
colon, then connects
the small intestine to the
anus. After this procedure,
you can continue to
have bowel movements
through the anus.
Discuss the risks and benefits of surgery with your
doctor.
Surgery to remove the entire colon eliminates the
risk of colon cancer.
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HELPING YOURSELF FEEL BETTER
Avoiding certain foods and medications can
help improve symptoms.
The following items may worsen your symptoms:
• milk, yogurt, cheese,
and other dairy
• coffee, tea, soda, and
other beverages that
contain caffeine
• red meat
• condiments, like ketchup,
mustard, and mayonnaise
• salad dressing
• fruit and juice
• some vegetables,
including cabbage,
broccoli, and cauliflower
• fried, fatty, and spicy
foods
• beans and lentils
• spices and seasonings
• whole-grain and
multigrain breads
• artificial colors, flavors,
and sweeteners
• alcohol
To figure out if any of these foods causes
your symptoms to flare, keep a food diary.
Record exactly what you eat over several weeks, along
with how you feel afterwards. When you look back, you
may notice a pattern.
If one or more of these foods worsens
your symptoms, talk to your doctor about
eliminating them from your diet.
Your doctor may suggest a daily multivitamin supplement.
NSAIDs can make symptoms worse.
People with ulcerative colitis should take non-steroidal
anti-inflammatory drugs (NSAIDs), such as aspirin,
ibuprofen, and naproxen, only if prescribed by their doctor.
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ulcerative colitis
ULCERATIVE COLITIS AND COLORECTAL CANCER
Ulcerative colitis increases the risk of
colorectal cancer.
Colorectal cancer is the uncontrolled growth of
abnormal cells in the large intestine. Colorectal
tumors often begin as small growths (polyps) on the
inside of the large intestine.
The risk of colorectal cancer increases based on:
• the length of time a person has had
ulcerative colitis
• how much of the colon is affected by
ulcerative colitis
People with ulcerative colitis should have more
frequent screening tests for polyps and colorectal
cancer than people at average risk.
The gold standard screening test is a colonoscopy
(see “Diagnosing ulcerative colitis,” page 9). Polyps
can be removed during a colonoscopy. This reduces
the risk of colorectal cancer.
Your doctor can tell you how often you should be
checked for colorectal cancer.
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15
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ulcerative colitis:
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