Ulcerative colitis can prove to be a both physically and mentally challenging disease. Difficult, sometimes embarrassing symptoms can add stress to an already painful condition.
However, medical treatment options and lifestyle choices can help control the disease and lead to long periods of remission.
Similar to Crohn’s disease, ulcerative colitis involves the inflammation of the rectum and innermost areas of the large intestine. This long-term condition can vary in severity and symptoms.
Understanding the different symptoms and types of the disorder is of great importance to both patients and loved ones. Treatment options for ulcerative colitis are being explored and will likely expand as more is learned.
There are several different forms of ulcerative colitis, with varying symptoms, complications and areas of inflammation.
In ulcerative proctitis, one type of the disorder, the inflammation occurs only in the rectum and usually in only a fairly small area.
This is typically a fairly mild form of the disease and has fewer complications. The Crohn’s and Colitis Foundation of America (CCFA) reports that approximately 30 percent of all ulcerative colitis patients experience ulcerative proctitis.
The only symptom may be bleeding from the rectum. The urgent need to visit the bathroom and rectal pain can also occur with ulcerative procitis.
Proctosigmoiditis affects only the rectum and the lowest segment of the colon (the sigmoid colon). It is characterized by a sensation of needing to go the bathroom without being able to actually defecate. Cramps, moderate abdominal pain and bloody diarrhea are also common.
In left-sided colitis, the inflammation ranges from the rectum to the splenic flexure, a bend in the colon near the spleen, located on the left side of the abdomen. Patients with left-sided colitis often display weight loss, reduced appetite, more severe abdominal pain and diarrhea.
Pan-ulcerative colitis (or total colitis) occurs when the entire colon is affected. Severe bouts of diarrhea can occur, along with intense cramps and high rates of weight loss.
According to CCFA, “potentially serious complications include massive bleeding and acute dilation of the colon (toxic megacolon), which may lead to an opening in the bowel wall.”
Fulminant colitis is an additional form of the disease, though it is rare. In this life-threatening form, the severity of diarrhea can cause shock and dehydration. Along with toxic megacolon, the rupture of the colon is another possible complication.
The Mayo Clinic reports that while people with ulcerative colitis often experience bouts of heavy symptoms alternating with periods of remission, the intensity and severity of the disease over time usually remains constant. The means that more mild forms of the disease are unlikely to progress into more severe types of ulcerative colitis.
The treatment of ulcerative colitis is focused on calming the inflammation present in the digestive tract, hopefully reducing symptoms and leading to longer periods of remission.
Along with lifestyle changes like diet and stress reduction techniques, the two main medical methods of treatment are medication or surgery..
CCFA reports that over time, with the use of medication, “periods of remission can be extended and periods of symptom flare ups can be reduced.”
According to The Mayo Clinic, anti-inflammatory drugs are usually the first method to be tried, as they work to calm the inflammation present in the digestive tract. These anti-inflammatories include medications like Sulfasalazine or corticosteroids and can be oral medications or topical drugs.
Side effects vary depending on the type of anti-inflammatory, but can range from headaches and weight gain to mood swings and glaucoma.
Immune system suppressors are another type of medication that may be prescribed. These tackle the inflammation problem by focusing on the immune system, as according to The Mayo Clinic, “scientists theorize that damage to digestive tissues is caused by your body's immune response to an invading virus or bacterium or even to your own tissue.”
For this type of drug, side effects related to the suppression of the immune system, like allergic reactions and infections can occur, along with inflammation of the liver.
Medications like pain relievers, anti-diarrheals, antibiotics and iron supplements may also be used in the treatment of ulcerative colitis. Doctors will work with individual patients to find the right mix for each unique case.
The Mayo Clinic reports that these drugs may be prescribed in combinations, “for example, corticosteroids may be used with an immune system suppressor — the corticosteroids can induce remission, while the immune system suppressors can help maintain remission.”
Surgery is usually only undertaken after other treatments, like medications and lifestyle changes, have been tried.
According to the CCFA, this “medical therapy” in unsuccessful in about one-quarter to one-third of ulcerative colitis, leading to the treatment option of surgery.
The colon and rectum may be removed, and an external bag used to collect waste matter, or a pouch created from the small intestine to allow for a more normal method of defecating. The latter option has become available more recently, due to technological advances.
Surgery can put a final end to the colitis through this removal of the colon, but it is a major procedure and only undertaken in severe cases.
Though ulcerative colitis can be a difficult disease to cope with, understanding the different forms of the disorder, symptoms that characterize them and treatment methods available can aid patients as they cope with the disorder.
Though surgery is a possible treatment method, thankfully most patients are able to live comfortable lives through medication and lifestyle changes.