Ulcerative Colitis

Ulcerative colitis is a chronic type of inflammatory bowel disease that causes inflammation and ulcers in part of the digestive tract.

Ulcerative colitis is usually in the colon and rectum. Symptoms can range from mild to severe and include bloody diarrhea and abdominal cramping.

Most people with ulcerative colitis experience symptoms during flare-ups, followed by periods with no symptoms.

Ulcerative colitis and Crohn’s disease are two of the most common types of inflammatory bowel disease (also called IBD). In the United States, over 2 million people have inflammatory bowel disease.

Understanding ulcerative colitis

Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that happens when the colon and rectum become inflamed. In ulcerative colitis, sores called ulcers form. The inflammation and ulcers cause symptoms that can get worse over time.

Types

Types of ulcerative colitis vary by the extent of inflammation:

• Ulcerative proctitis: Limited to the rectum
• Limited colitis: Involves the rectum and sigmoid colon
• Distal colitis: Extends from the rectum up to the left (descending) colon
• Pancolitis: Affects the entire colon

Symptoms

Ulcerative colitis symptoms usually get worse over time. Symptoms may include:

• Increased bowel movements
• Diarrhea
• Blood in stool
• Abdominal pain
• Feeling the need to have a bowel movement, but being unable to
• Fatigue
• Weight loss
• Nausea
• Fever
• Loss of appetite
• Joint pain
• Red or itchy eyes
• Sores, bumps, or rashes on skin

Early symptoms might not be noticeable. Over time, symptoms can become worse during flare-ups.

Causes

Ulcerative colitis may be caused by genetics and immune system problems. Certain factors put some people at higher risk than others of developing ulcerative colitis. Diet and stress may worsen symptoms, but are not causes of ulcerative colitis.

Genetics

Research has found that some genetic markers have been associated with ulcerative colitis. Ulcerative colitis is more common in people who have a family history of the conditions.

Immune system

The role of the immune system is to fight off viruses and bacteria. Sometimes, a problem with the immune system can cause it to attack the body. This can cause inflammation and tissue damage, including in the digestive tract.

Risk factors

Ulcerative colitis can affect anyone, but people can be at higher risk based on:

• Age: Most people are diagnosed between ages 15 and 30
• Race and ethnicity: White people are at highest risk, though ulcerative colitis can happen in any race. People of Ashkenazi Jewish descent have an even higher risk.
• Genetics: People with a parent, sibling, or child who has ulcerative colitis are at higher risk.

Ulcerative colitis complications

Having ulcerative colitis raises your risk of developing other conditions, including:

• Colon cancer: Inflammation in the colon from ulcerative colitis increases your risk of colon cancer.
• Anemia: Bleeding from the colon can cause anemia.
• Osteoporosis: Inflammation from ulcerative colitis can spread to the bones and joints.
• Issues in children: Ulcerative colitis can cause growth and developments problems in children.

Diagnosis

Health care providers use tests to help rule out other conditions and diagnose ulcerative colitis. Because some symptoms of ulcerative colitis can be similar to other conditions, it is important to get an accurate diagnosis.

Tests include:

• Physical exam and medical history
• Blood tests to check for anemia and rule out infection as a cause for symptoms
• Stool samples
• Colonoscopy to examine the entire colon
• Sigmoidoscopy, a minimally invasive test focusing on the sigmoid colon
• Imaging tests, including a barium enema x-ray, CT scan, or MRI to see images of the colon and rectum

Treatment

The goal of ulcerative colitis treatment is to put you into remission if you are experiencing a flare-up, or to eliminate ulcerative colitis through surgery.

Treatment for ulcerative colitis can include drug therapy or surgery.

There are several different categories of medicines that can be effective for treating ulcerative colitis. The type of drug that may be best for you depends on several factors. A health care provider can help determine which medicines might be most effective.

Surgery for ulcerative colitis

If medications are not effective, or if the complications from ulcerative colitis are serious, surgery may be an option.

The two main types of surgery for ulcerative colitis both involve removing part or all of the colon and rectum.

• Proctocolectomy and ileal pouch: This is the most common procedure for ulcerative colitis. In this procedure, the colon and rectum are removed. A section of the small intestine is connected to the anus. This section, called an ileal pouch, allows you to have normal bowel movements.
• Proctocolectomy and ileostomy: This procedure may be recommended if an ileal pouch is not an option. The colon, rectum, and anus are removed. The surgeon creates an opening in the abdomen that attaches to a pouch outside of the body (called an ileal stoma). This ileal stoma collects stool and must be regularly emptied.

Ulcerative colitis care at WashU Medicine

Our surgeons work as part of a team of specialists dedicated to caring for people with digestive and colorectal problems. This means you will receive comprehensive care focused on finding the best solution for you. We will work with you to determine what treatment options best fit your goals and needs. If surgery is necessary, our team has the expertise to help you achieve the best possible outcome to live a fulfilling life after treatment.