Ulcerative Colitis

What is Ulcerative Colitis?

Ulcerative colitis (UC) is a long-term condition that results in inflammation and ulceration of the lining of the large intestine, medically called as colon.

The digestive system is responsible for digesting the food we eat so that nutrients in the food are available to provide energy to the body.

The digestive system is a system of organs and consists of long tubes which connects mouth to the anus. When the food leaves the mouth it enter the esophagus (the part of GI tract) and then the stomach. Food pauses for sometime in the stomach and mixed up with the acids and juices present in the stomach.

It then passes into the small intestine, which measures about 20 feet in length. The small intestine has three parts; the part nearest the stomach is the duodenum, the next part is the jejunum and the third part that connects to the large intestine is the ileum. Small intestine is the site where most of the food is digested with the assistance of secretions from the liver, gall bladder, and pancreas. The nutrients from this digested food are then absorbed through small intestine.

Followed by the small intestine is the large intestine, which is more frequently referred to as the colon. The large intestine (colon) is 6-7 feet in length. The first part of the colon is called the caecum and the appendix is found there. The caecum and appendix are situated in right lower portion of the abdomen. Large intestine then extends upward (this portion being called as ascending colon), then takes a turn and passes across (portion called as transverse colon) and then goes down wards (descending colon). At the end of descending colon, portion of large intestine which look like alphabet S is called as sigmoid colon which opens into rectum. The main function of the colon is to absorb water from the processed food residue that arrives after the nutrients have been absorbed in the small intestine. The last part of the colon is the rectum, which is a reservoir for feces. Faeces are stored here until a bowel movement occurs.

The patients of ulcerative colitis have swelling along with ulcers located in their colon and rectum.

Broadly speaking ulcerative colitis is included under an umbrella term called as inflammatory bowel disease (IBD). IBD is a term referring to the diseases that cause chronic inflammatory condition of digestive tract. Another condition included under this category is Crohn’s disease. Crohn’s disease can cause inflammation similar to ulcerative colitis anywhere in the digestive tract from the mouth to the rectum, but more commonly it attacks the small intestine in contrast to ulcerative colitis, which attacks mainly the large intestine.

Types of Ulcerative Colitis:

The inflammation related to ulcerative colitis usually occurs in the rectum and lower part of the colon, but it may affect the entire colon. Ulcerative colitis rarely affects the small intestine except for the lower section, called the ileum. Depending upon which portion of intestine is most affected by UC, it is put under various types as follows.

Inflammation of
Entire colon =Pan-colitis (pan =entire, colitis=inflammation of colon)
Rectum= Proctitis
Sigmoid colon (S shaped portion of colon located just above the rectum) = Sigmoiditis
Beyond sigmoid colon= Left-sided colitis

Pathology:

Inside the large intestine, the inflammation of the inner lining (mucosa) causes death of the colon lining cells and this results in sores or ulcers. Also the inflammation makes the colon to empty frequently resulting in diarrhea. As the lining of the colon is destroyed, ulcers form releasing mucus, pus and blood.

Nature of the disease:

Ulcerative colitis is a chronic disease and is notorious for its waxing and waning nature.

Usually the patients of ulcerative colitis have alternating periods of relative health where the patient is symptom-free or experiences very mild symptoms (remissions) alternating with periods of active disease (relapse or flare).

Fortunately, as treatment has improved, the proportion of people with continued symptoms appears to have diminished significantly.

How common is the condition:

Ulcerative colitis is a global condition affecting people world over. It is estimated that in Unites states alone there are about one million people who suffer from some form of IBD. About half of the people with IBD have ulcerative colitis; about half have Crohn’s disease.

Ulcerative colitis affects people of all ages, but at large it is the disease of young adults. Most cases of UC are diagnosed in people between the ages 15 to 40 years. However, children as small as few months old and older people sometimes develop the disease.

The incidence of Ulcerative colitis has risen with the tide of civilization. Moreover this is a disease of young people having grievous impact on their education and career.

Ulcerative colitis does not show any gender preference and affect males and females equally. It appears to run in families. Studies also consistently conclude that ulcerative colitis occurs more often within the Jewish population.
causes of TN are explained in detail on a separate page. In short, it has been increasingly proved and understood that most cases of TN have demyelination of the sensory nerve fibers of the Trigeminal Nerve, either in the nerve root or (rarely) the brain stem. Demyelination means an erosion of the nerve sheath, which leads to the exposure of the nerve fibers. The exposed nerve fibers often get compressed or irritated by blood vessels (pulsating arteries or veins), which lead to painful episodes of Trigeminal Neuralgia due to misfiring of the nerve..

The precise cause of this terrible affliction is still unknown. Theories about what causes ulcerative colitis abound, but none have been proven. The current studies suggest that there are more than one factors responsible for the development, maintenance and relapse of Ulcerative colitis. The causes may involve, but are not limited to, heredity, genetic factors, environmental factors, or disturbances of the immune system.
One of the major underlying causes suggest abnormal activation of the immune system, leading the ulcerations in the intestines. For easy understanding we will divide these factors in two groups i.e. extrinsic and intrinsic factors.

Extrinsic factors:

01 Diet

Intake of junk food and low-residue high-refined sugar has been correlated in many studies with susceptibility to have ulcerative colitis. In fact many sufferers of ulcerative colitis notice flare-up of the problem following specific food.

02 Infections

Some researchers feel that ulcerative colitis may be related to certain infections digestive caused by microorganism E. Coli. One theory holds that modern measles virus, improperly cleared from the body, results in low grade, chronic inflammation of the intestinal lining.

03 Drugs

The studies have also shown links between intake of oral contraceptive pills and Ulcerative colitis. May patients experience flare-up of condition following modern medicine drugs like antibiotics and NSAIDs. Isotretinoin, a commonly used drug for severe acne is found to trigger UC and Crohn’s disease in some patients.
The important point is although many of us are eating the most-blamed diet or having infection with E. Coli, every one of us is not having ulcerative colitis. This brings us to the conclusion that there must be some roots within an individual, which makes him more susceptible to these environmental factors.

Intrinsic factors:

01 Disturbance of immune system

Some experts believe that there may be a defect in one’s immune system responsible for ongoing inflammation in the intestinal wall. The disturbance is thought to be either of two.
Allergy: Some studies suggest that Ulcerative colitis is a form of exaggerated allergic response to certain food or to the presence of some microorganisms present in the intestine.
Autoimmunity: Autoimmunity simply means allergy to oneself. Most recent research indicate that ulcerative colitis can be a form of autoimmune disease in which body’s defense system starts attacking body’s own organs and tissues. One amongst them being large intestine.

02 Genetics

Current research suggests that certain genetic factors may increase the likelihood of person having Ulcerative colitis.

03 Hereditary factors

If any of your immediate family members is having ulcerative colitis, then your chances of having the disease increases.

04 Psychosomatic

Mind plays a vital role in maintaining a healthy or diseased condition of the body. Medical community has accepted the fact that any kind of emotional stress has definite detrimental effect on the immune system and hence can be the root cause of chronic disease like ulcerative colitis. In fact, it is a very common experience of physicians that many patients mention that their problem of Ulcerative colitis started after some stressful situations in life or their problem gets worse following stressful events.

Ulcerative Colitis Symptoms

Ulcerative colitis affects each individual uniquely. Some suffer only mild symptoms, but others have severe and disabling symptoms with frequent flare-ups. Usually the symptoms tend to come and go, and there may be long periods without any symptoms at all. Usually, however, the symptoms reappear after an interval, which varies from days to months or even years. Although, all the sufferers of ulcerative colitis may not have all the symptoms of the disease, the common and consistent ones are as follows:

01 Diarrhea (Diarrhoea):

The most common symptom of UC is diarrhea. When severe, it may require frequent visits to a toilet (in some cases up to 20 or more times a day). The disorder typically begins gradually, with crampy abdominal pain and diarrhea that is usually bloody.

02 Blood in the stools:

UC is characterized by presence of blood in the stools. Blood is admixed with the stools and not in the form of blood clots. Passage of blood clots usually suggests some other diagnosis or condition. In addition to blood, stools may also contain mucus and pus.

03 Tenesmus:

Inflammation of the gut can affect the nerves in such a way as to make the patient feel that there is stool present ready to be evacuated when there actually is not. That results in the symptom known as tenesmus where there is a painful urge to defecate but nothing comes out.

04 Nausea, vomiting and abdominal pain or cramps:

Flare-ups of ulcerative colitis may be associated with nausea, vomiting, abdominal cramps and diarrhea. Abdominal pain may not be a consistent feature of UC. When pain is present it may indicate the presence of severe inflammation or the development of a complication such as an abscess or a perforation of the intestinal wall.

05 Fever, fatigue, loss of appetite are usual accompaniments with consequent weight loss. The patient may become weak and very sick.

06 Constipation:

At times, some UC patients experience constipation during periods of active disease.

07 Loss of water and nutrients:

With increased diarrhea the person may lose invaluable water and nutrients from the body and may present with dry mouth, sunken eyes, a fast heartbeat, and pale skin.
A flare-up is a stage when the rectum and/or colon become inflamed. During a flare-up, people experience periods of increased symptoms of ulcerative colitis, such as bloody diarrhea, rectal bleeding, abdominal pain or cramping, and an urgent need to go to the bathroom. Flare-ups can vary in duration and intensity.
Remission is the time between flare-ups of ulcerative colitis when people experience few, mild, or no symptoms of ulcerative colitis. Periods of remission vary in duration, anywhere from a matter of days to a number of years.

Extra-intestinal complications:

In some patients with Ulcerative colitis, disease may spread its wing to encompass other organs of the body like joints, skin, eyes, etc. Hence patients may experience a wide variety of extra-intestinal (outside digestive system) manifestations of the disease. However, it may be noted that not all who suffer from UC develop complications. No one knows for sure why problems occur outside the colon. Scientists think these complications may occur when the immune system triggers inflammation in other parts of the body. The common once are as follows:

01 Arthritis (joint swelling):

The most common amongst extra-intestinal complications is joint pain due to inflammation of the joints. Most suffer from either peripheral or spinal arthritis. Peripheral arthritis causes pain, swelling, and stiffness in one or more joints of the arms and legs, such as wrists, knees, and ankles. It may be migratory. If untreated, the pain lasts several days to weeks.

02 Skin complications:

People with ulcerative colitis may experience several types of skin lesions including skin rash. However the two common ones are pyoderma gangrenosum and erythema nodosum.
* Pyoderma gangrenosum are small ulcers that begin as painful, pus-filled sores that unite into a non-bacterial sore within days. These are usually found on the exterior surfaces of the legs or the face.
* Erythema nodosum commonly appears as painful red nodules on the front of the legs below the knees, or on the arms. Women are more commonly affected than men.

03 Eye complications:

About 10% of people with ulcerative colitis develop eye problems. These include various types of eye inflammations (iritis, conjunctivitis and episcleritis). Patient complains of sensitivity to light, blurred vision, pain, and redness of the eye. Symptoms may come on suddenly or slowly.

04 Liver diseases:

These include fatty liver, hepatitis, cirrhosis, and primary sclerosing cholangitis.
Symptoms of advanced liver disease include: Jaundice, itching, a full feeling in the upper abdomen, puffiness or swelling, excessive sleepiness, etc.
a Fatty Liver is the result of a disturbance in liver metabolism that causes fat accumulation inside the liver.
b Primary Sclerosing Cholangitis The most common liver complication of IBD is Primary Sclerosing Cholangitis (PSC). PSC is characterized by inflammation and scarring of the bile ducts. The bile ducts are the tubes which carry digestive juice called bile.
c Cholangiocarcinoma: Very rarely some patients of ulcerative colitis may develop cancer of the ducts carrying bile, an important digestive juice.
d Cirrhosis: Only 1-2% of patients develop cirrhosis of liver.
e Chronic active hepatitis: Patients of ulcerative colitis may have concurrent hepatitis C infection.

Ulcerative Colitis Diagnosis

Ulcerative colitis is not always simple to diagnose. A thorough physical examination and a series of tests may be required to diagnose ulcerative colitis.

Steps for Diagnosing Ulcerative Colitis

01 Your doctor will ask you to narrate the complaints in detail and will inquire about any of your family member having the similar complaints and other relevant information to rule out other disorders that may mimic the symptoms of ulcerative colitis. A through history will provide the doctor some clues to arrive at the correct diagnosis.
02 The next step is thorough physical examination to detect signs and symptoms of ulcerative colitis (e.g., abdominal tenderness, weight loss).
03 Next, your doctor may order tests helpful to diagnose ulcerative colitis, such as stool tests or blood tests. By testing a stool sample, the doctor can tell if there is bleeding or infection in the colon or rectum. Blood tests may be done to check for anemia, which could indicate bleeding in the colon or rectum. Blood tests may also reveal a high white blood cell count, which is a sign of inflammation somewhere in the body.
04 As doctor cannot see inside of colon or rectum, he may perform a procedure called endoscopy. Endoscopy is a procedure, which enables the physician to view (=scopy) inside (=endo) of an organ. The procedure involves putting a flexible tube with light and camera into the anus to see the inside of the colon and rectum. When doctor views the sigmoid colon the procedure is called as sigmoidoscopy. Colonoscopy is an examination of the entire colon using a lighted, flexible tube. The doctor will be able to see any inflammation, bleeding, or ulcers on the colon wall. During the procedure, the doctor may do a biopsy, which involves taking a sample of tissue from the lining of the colon to view with a microscope.
For the procedure, you will lie on your left side on the examining table. You will probably be given pain medication and a mild sedative to keep you comfortable and to help you relax during the procedure. The physician will insert a long, flexible, lighted tube into your rectum and slowly guide it into your colon. The tube is called a colonoscope (koh-LON-oh-skope). The scope transmits an image of the inside of the colon, so the physician can carefully examine the lining of the colon. The scope bends, so the physician can move it along the curves of your colon. You may be asked to change position occasionally to help the physician move the scope.
Colonoscopy is usually completed within half an hour to an hour. You will need to remain at the endoscopy facility for 1 to 2 hours until the sedative wears off.
05 An X-ray provides your doctor with a picture of your intestines. The x-ray procedure done for diagnosing ulcerative colitis is called as barium enema, x-ray of the colon. As colon is soft tissue meaning it is not hard like bone it does not create a shadow on the x-ray plate. Hence first the colon is filled with barium, a chalky white solution. The barium shows up white on x-ray film, allowing the doctor a clear view of the colon, including any ulcers or other abnormalities that might be there. In addition, a barium enema is sometimes necessary to see how far the inflammation has spread.

Monitoring ulcerative colitis

Having your condition monitored by medical professionals is an important part of living better with ulcerative colitis. The reasons for monitoring include:
01 Keeping your condition under control
02 Checking for changes, even if you are in remission
03 Evaluating the effects of medications

How ulcerative colitis is monitored

Ulcerative colitis is monitored using many of the same techniques used to diagnose ulcerative colitis, including colonoscopies and biopsies. Your doctor may also conduct blood tests to monitor your condition and medications.

Concerns about Cancer

Many patients are concerned about their risk of developing colon cancer. People with long-standing ulcerative colitis (i.e., about 10 years) do have a somewhat higher risk of developing colon cancer than the general population. While not every person with ulcerative colitis will develop colon cancer, early intervention may help prevent its progression. Hence it is advisable to undergo colonoscopy every yearly or biyearly to detect the cancer in very initial stage.

Ulcerative Colitis Related Conditions

Crohn’s disease

The disease resembling most as per the symptoms, pathology, and nature to Ulcerative colitis is Crohn’s disease. Both these conditions are together called as inflammatory bowel disorders. In spite of their close resemblance, they do share some important differentiating points.

Crohn’s disease (CD) is an inflammatory process of digestive system that can affect any portion of the digestive tract from mouth to anus. However, it is most commonly seen (roughly half of all cases) in the last part of the small intestine called the terminal ileum and cecum.

Crohn’s disease causes inflammation, deep ulcers and scarring in the wall of the intestine and often occurs in patches.

The main symptoms of Crohn’s disease are pain in the abdomen, urgent diarrhea, general tiredness and loss of weight. Rarely is there obvious bloody diarrhea. Nausea and vomiting may be associated with this condition. Crohn’s is sometimes associated with other inflammatory conditions affecting the joints, skin and eyes. The pain of CD is often in the lower right area of the abdomen. This is where the terminal ileum is located. CD frequently results in the development of fistulas, which are abnormal connections between loops of intestine. These may even involve other organs such as the urinary bladder or open onto the skin. If the fistulous tract appears between the intestine and the bladder, stool is allowed to pass into the urine.

CD inflammation also frequently results in the formation of scar tissue with narrowed segments known as strictures. These strictures frequently cause acute crisis with bowel obstructions the symptoms of which will depend on the severity. Hemorrhoid-like skin tags and anal fissures may also develop.

Crohn’s disease is a chronic condition and the severity of the symptoms fluctuates unpredictably over time. Patients are likely to experience flare-ups in between intervals of remission or reduced symptoms.

Ulcerative colitis Vs Crohn’s disease:

Ulcerative colitis Crohn’s Diseases
Onset Onset of ulcerative colitis may be sudden or insidious. Onset of Crohn’s disease is usually insidious.
Location(1) Ulcerative colitis affects large intestine only. Crohn’s disease can affect small intestine as well as large intestine.
Location (2) Ulcerative colitis usually does affect rectum. Crohn’s disease usually doesn’t affect rectum, but frequently affects anus instead.
Pathology Ulcerative colitis causes inflammation or swelling of top layer of inner lining of colon. Crohn’s disease causes inflammation of entire thickness of lining of intestine or it is much more deeper than ulcerative colitis.
Incidence Ulcerative colitis is more common in non-smokers. Crohn’s diseases is more common in smokers
Symptoms Ulcerative colitis is almost always associated with bloody diarrhea. Though diarrhea is main feature of Crohn’s disease, it is usually not bloody.
Complications The common complication of ulcerative colitis is toxic megacolon. The common complications of Crohn’s disease include fistulas and strictures with incidental bowel obstruction.

Irritable bowel syndrome (IBS)

IBS, sometimes known as spastic colon, is a disorder characterized by dysfunction of motility and sensation in the bowel.

Muscles in the bowel normally contract a few times a day, moving feces along and ultimately resulting in a bowel movement. It is believed that in a person with IBS, these muscles are exceptionally sensitive to stimuli, or triggers such as stress, dietary changes, and activity). While these triggers would not normally affect others, they can provoke a strong response in a person with IBS. A person who does not have IBS may have no trouble eating a salad, or drinking coffee, but a person with IBS may exhibit symptoms such as pain, bloating, and diarrhea.
Studies indicate IBS is much more common than Ulcerative colitis or Crohn’s diseases.

Symptoms

Typically, people with IBS will have crampy abdominal pain along with gradual changes in their bowel pattern, often alternating between diarrhea and constipation. A hard stool followed by one or more loose stools per day or a series of hurried soft bowel movements following breakfast is common. Stool is often hard and is passed in small pellets with straining, or can be very loose and passed with a sense of urgency. Evacuation often feels incomplete. Abdominal pain is usually on the lower left side of the abdomen but it can be present in any area. Passing gas or visiting the bathroom may temporarily relieve this cramp-like discomfort. Mucus may be present in the stool. There may be a sensation of bloating or even visible swelling of the abdomen. Some may even experience nausea and vomiting.

Diagnosing irritable bowel syndrome

The diagnosis of IBS is made on the basis of symptoms and by ruling out other disorders through a thorough health history, physical examination, and some laboratory tests. An endoscopy or an x-ray may be performed. The typical symptoms of irritable bowel syndrome include abdominal pain is relieved by a bowel movement, abdominal pain associated with a change in the frequency of bowel movements, abdominal pain is associated with a change in the consistency of the stool.

Irritable bowel syndrome Vs ulcerative colitis:

01 The most crucial point is that no significant abnormalities like inflammation or ulceration are seen upon examination of the colon in patients with irritable bowel syndrome. But those with ulcerative colitis have inflammation in the colon lining that can be seen by a doctor when the colon is examined.
02 In patients with ulcerative colitis this inflammation may lead to symptoms of diarrhea, but not usually constipation, and not always with abdominal pain. While alternating diarrhea and constipation is hallmark of irritable bowel syndrome.
Another way that ulcerative colitis can be distinguished from IBS is that people with ulcerative colitis may have rectal bleeding, a symptom missing from IBS.

Long term complications

Ulcerative Colitis Future & Long Term Complications

Ulcerative colitis is very stubborn affliction of digestive system, which once acquired can garrote the person for his or her entire life. However with rightly chosen medical management it is possible to extend the periods of remission dramatically.

Ulcerative colitis and colon cancer…

While not every person with ulcerative colitis will develop colon cancer, as compared to general population patients with ulcerative colitis bear more chances of having colon cancer (around 10-20%).

The risk of cancer increases with the duration and the extent of involvement of the colon. Colon cancer generally does not appear before someone has had the disease for at least 8-10 years. In addition, if only the lower colon and rectum are involved, the risk of cancer is not higher. Only, if the entire colon is involved, the risk of cancer may be more.

Fortunately, good disease control of ulcerative colitis itself is beneficial with regard to risk for colorectal cancer. This goal can be safely and surely achieved with Homoeopathy.

Other complication of ulcerative colitis, which can pose a medical emergency, is toxic megacolon. Toxic megacolon is a severe dilatation of the colon, which occurs when inflammation spreads from the mucosa through the remaining layers of the colon. The colon becomes paralyzed which can lead to it eventually bursting; this is known as a “perforation”. Such perforation is a dire medical emergency. Warning signs of this condition are abdominal pain/tenderness, abdominal distention, fever, large numbers of stools with obvious blood and a rapid (more than 100/minute) pulse rate. Fortunately, this grave complication appears to be decreasing in frequency, which probably reflects more effective treatment.
There are many other complications of Ulcerative colitis which are common but not life threatening:
01 Growth failure: Growth failure is more common in the pediatric patients. Puberty delay may be greater than 1 year.
02 Kidney stones: Perhaps the most frequent renal problem associated with Ulcerative colitis is kidney stones.
03 Osteoporosis: Osteoporosis, which means “porous bones”, refers to the wasting or deterioration of bone. Bone mass is reduced to a level below that required for adequate support. As a result, the bones become soft and weak and fracture easily.
04 Anemia: The term “anemia” is used by physicians to indicate a low red blood cell count. The main manifestations produced by anemia are weakness and fatigue. Shortness of breath, especially with physical activity, is also common. Patients often find that they just can’t do things with as much energy as they used to.
05 Decreased male fertility: There is some evidence to suggest that fertility in male may go down. This may be related more to ‘sulfa drugs’ prescribed during conventional treatment for the condition rather than disease itself.