Ulcerative Colitis

What is ulcerative colitis?

Ulcerative colitis is an inflammation in the lining of the large intestine (colon) and rectum.

How does it occur?

The cause of ulcerative colitis is not known. It appears to be a problem with the immune system. The disease is not caused by emotional distress or sensitivity to certain foods, but these things may trigger symptoms in some people who have colitis. The stress of living with ulcerative colitis may also contribute to a worsening of symptoms.

What are the symptoms?

The symptoms usually come and go. Flare-ups of symptoms alternate with times when you have no symptoms (remissions).

Symptoms include:

• diarrhea, usually with blood or mucus
• crampy pain in your lower abdomen
• dehydration
• fever
• weight loss
• fatigue.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. You may have blood tests to check for anemia and inflammation.

You may have the following tests:

• barium enema X-ray
• sigmoidoscopy or colonoscopy (procedures for looking inside your large intestine with a flexible lighted tube).

If you have a sigmoidoscopy or colonoscopy, your provider may do a biopsy during the procedure. For the biopsy, your provider will take a sample of tissue from the lining of the colon to examine with a microscope.

How is it treated?

Your healthcare provider may advise a special diet high in protein and calories. Depending on your condition, you may need to have a high-fiber or low-fiber diet.

Three medicines are commonly used to treat ulcerative colitis:

• mesalamine
• sulfasalazine
• steroids (hydrocortisone or methylprednisolone).

For severe colitis, drugs that suppress the immune system may be prescribed. Azathioprine is an example of this type of drug.

In some cases you may need to stay in the hospital. Your treatment may include:

• IV (intravenous) feeding to replace lost nutrients and fluids
• blood transfusions to restore lost blood
• antibiotics to treat any possible infection
• nasogastric suction to remove stomach juices through a tube passed through your nose (this allows the stomach and intestines to rest).

In severe cases, when medicines fail to control the symptoms, surgery may be required. This may mean complete removal of the large intestine, followed by an operation called a permanent ileostomy. When this operation is done, the ileum (the lower part of the small intestine) is brought through a cut in the abdominal wall and formed into an opening to allow bowel movements to collect in a small bag attached to the skin.

How long will the effects last?

Some people have an attack of colitis and then may not have any symptoms for months or even years. However, in most cases the symptoms eventually return. Ulcerative colitis can usually be controlled with medicines and diet, but you may need surgery if your symptoms are severe.

How can I take care of myself?

• Follow the treatment plan your healthcare provider prescribes. You and your healthcare provider will need to be partners in controlling your symptoms. Ask how you can take care of yourself at home. Also ask when you should see your provider for new or worsening symptoms as well as how often you should have regular checkups.
• Follow the diet recommended by your provider. Avoid milk products if they make your symptoms worse.
• When you have diarrhea, rest your bowel by drinking only clear liquids such as water, juice, tea, and bouillon for a few hours. It is important to drink small amounts often so you don't get dehydrated. Suck on ice chips if you feel too nauseated to drink anything. Do not eat solid foods if they cause cramps.
• Learn to use deep breathing exercises and other relaxation techniques when you feel stress.
• Make sure you get enough rest and sleep.
• Learn to recognize the signs of recurrence early so you can get early treatment.

Because chronic ulcerative colitis may be associated with cancer of the intestine, make sure you have regular checkups. Follow your healthcare provider's recommendations for colon cancer screening exams.

For more information, contact:

Crohn's and Colitis Foundation of America
Phone: 800-932-2423
Web site: http://www.ccfa.org.