ulcerative colitis

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Overview

Ulcerative colitis (UC) causes irritation and ulcers (open sores) in the large intestine. It belongs to a group of conditions called inflammatory bowel disease (IBD). It often causes diarrhea with blood, cramping and urgency. Sometimes these symptoms can wake a person up at night to go to the bathroom as well.

The inflammation in ulcerative colitis usually starts in the rectum, which is close to the anus (where poop leaves your body). The inflammation can spread and affect a portion of, or the entire colon. When the inflammation occurs in the rectum and lower part of the colon it is called ulcerative proctitis. If the entire large intestine is affected it is called pancolitis. If only the left side of the colon is affected it is called limited or distal colitis.

The severity of UC depends on the amount of inflammation and the location. Everyone is a little different. You could have severe inflammation in the rectum (small area) or very mild inflammation in the entire colon (large area).

If you have ulcerative colitis, you may notice a pattern of flare-ups (active disease), when symptoms are worse. During times of remission, you might have little to no symptoms. The goal with therapy is to remain in remission as long as possible (years).

About half of the people diagnosed with ulcerative colitis have mild symptoms. Others suffer frequent fevers, bloody diarrhea, nausea and severe abdominal cramps. Ulcerative colitis may also cause problems such as arthritis, inflammation of the eye, liver disease and osteoporosis. It is not known why these problems occur outside the colon. Scientists think these complications may be the result of inflammation triggered by the immune system. Some of these problems go away when the colitis is treated.

Ulcerative colitis can occur in people of any age, but it usually starts between the ages of 15 and 30, and less frequently between 50 and 70 years of age. It affects men and women equally and appears to run in families, with reports of up to 20% of people with ulcerative colitis having a family member or relative with ulcerative colitis or Crohn’s disease. In addition, about 20% of patients are diagnosed before they are 20 years old and it can occur in children as young as two years of age.

Symptoms

Diarrhea, often with blood or pus.

Abdominal pain and cramping.

Rectal pain.

Rectal bleeding — passing small amount of blood with stool.

Urgency to defecate.

Inability to defecate despite urgency.

Weight loss.

Fatigue.

Causes

Researchers believe that UC may be the result of an overactive immune system. However, it’s unclear why some immune systems respond by attacking the large intestines, and others don’t.

Factors that may play a role in who develops UC include:

Genes. You may inherit a gene from a parent that increases your chance of having UC.

Other immune disorders. If you have one type of immune disorder, your chance of developing a second is higher.

Environmental factors. Bacteria, viruses, and antigens may trigger your immune system.

Types of ulcerative colitis

UC can be categorized according to the parts of the GI tract that it affects.

Ulcerative proctitis. In ulcerative proctitis, only the rectum is inflamed. It’s considered a mild form of UC.

Left-sided colitis. Left-sided colitis causes inflammation in the area between the splenic flexure (near the upper part of the colon, where it bends) and the last section of the colon. The last section of the colon, known as the distal colon, includes the descending colon and sigmoid colon. Left-sided colitis is also known as distal ulcerative colitis.

Proctosigmoiditis. Proctosigmoiditis is a form of left-sided colitis. It causes inflammation in the rectum and sigmoid colon.

Extensive colitis. Extensive colitis, also known as pancolitis, causes inflammation throughout the entire colon. It’s considered a severe form of UC.

Risk factors

Most people with UC don’t have a family history of the condition. However, about 12 percent of people with UC do have a family member with IBD, according to research from 2014.

UC can develop in a person of any race, but it’s more common in white people. If you’re of Ashkenazi Jewish descent, you have a greater chance of developing the condition than most other groups.

Young people with IBD may also be dealing with acne at the same time. Some older studies have suggested a possible link between the use of the cystic acne medication isotretinoin (Absorbica, Amnesteem, Claravis) and UC. However, newer research has yet to find a definitive causal relationship.

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Complications

Severe bleeding.

A hole in the colon (perforated colon)

Severe dehydration.

Bone loss (osteoporosis)

Inflammation of your skin, joints and eyes.

An increased risk of colon cancer.

A rapidly swelling colon (toxic megacolon)

Prevention

There’s no solid evidence indicating that your diet affects whether you develop UC. You may find that certain foods and drinks aggravate your symptoms when you have a flare-up, though.

Practices that may help include:

  • drinking small amounts of water throughout the day
  • eating smaller meals throughout the day
  • limiting your intake of high fiber foods
  • avoiding fatty foods
  • lowering your intake of milk if you’re lactose intolerant

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