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ULCERATIVE COLITIS

Whether this is your first visit or a follow-up, ask your doctor:

• What symptoms should I be on the lookout for?

• Which medications should I take even if I feel fine and have no symptoms?

• Which medications should I take if my symptoms get worse?

• Would eliminating certain foods from my diet help my condition?

• Do I need to take any vitamins or supplements?

• What else can I do to help keep myself healthy?

• When and how often should I get checked for colon cancer?

Tell your doctor:

• About any new symptoms you have had

• If your symptoms have improved or worsened since your last visit

• If you think your medications are causing any side effects

TALK WITH YOUR DOCTOR

Ulcerative colitis is an inflammatory bowel disease. People with ulcerative colitis develop inflam-mation in the lining of the large intestine (colon). The inflammation leads to the formation of ulcers. This can cause bleeding, diarrhea, weight loss, and fatigue.

Some people with ulcerative colitis may have only occasional symptoms. For others, the symptoms can be constant. Medications can usually control the inflammation. But sometimes surgery is required.

ULCERATIVE COLITIS 4

THE DIGESTIVE SYSTEM 5

SYMPTOMS 7

COMPLICATIONS 8

DIAGNOSIS 9

TREATMENT 10

Table of Contents

ulcerative colitis 32 ulcerative colitis

Ulcerative colitis can affect the colon, rectum, or both.

The digestive system breaks down food and drink into nutrients the body uses for energy and growth.

Food’s journey through the digestive system begins in the mouth.

1

It passes down the esophagus.2

Digestion then begins in the stomach.

3

The small intestine further breaks down food. It absorbs nutrients and sends them into the bloodstream.

4

The remaining, watery, food residue moves into your colon (large intestine), a muscular tube about 4 feet long and 3 inches wide. As the undigested contents pass through the large intestine, bacteria feed off the remnants. The wall of the large intestine soaks up most of the remaining water.

5

Undigested food settles in the rectum, the final six inches of the colon. Waste accumulates until it is released as a bowel movement.

6

A CLOSER LOOK AT THE DIGESTIVE TRACTWHAT IS ULCERATIVE COLITIS?

Ulcerative colitis is an autoimmune disease. That means the immune system, which normally helps fight off infections, mistakenly attacks the lining of the colon (large intestine) and rectum. Doctors aren’t sure what triggers ulcerative colitis. And the trigger might not be the same for everyone.

Ulcerative colitis causes inflammation and ulcers in the colon and usually the rectum. When only the rectum is affected, the condition is called ulcerative proctitis.Inflammation causes the lining of the large intestine to:

• wear away in spots (leaving ulcers)• bleed• ooze cloudy material that contains mucus

Some people also have inflammation in other body parts, including the eyes, skin, liver, back, and joints.

Ulcerative colitis is not contagious. You cannot get it through contact with a person with the condition.

People with ulcerative colitis are far more likely to develop colorectal cancer than people without it.

ulcerative colitis 54 ulcerative colitis

Symptoms differ from person to person. Most people with ulcerative colitis have mild to mod-erate symptoms. The most common symptoms are:

• diarrhea, often with blood and mucus

• cramping abdominal pain, especially in the lower abdomen

Other symptoms include:

People with ulcerative colitis may also develop a low red blood cell count (anemia).

Ulcerative colitis can also be associated with pain or soreness in the joints, eye irritation, and certain rashes.

Some people have “flares,” when symptoms suddenly get worse, then they go into “remission,” when they have no symptoms.

Some people have symptoms all or most of the time. Some have symptoms only rarely. The symptoms a person experiences can vary depending on the severity of the inflammation and where it occurs in the large intestine.

• a frequent sensation of needing to move your bowels

• little warning before you need to have a bowel movement

• feeling tired

• dehydration• the need to wake from

sleep to have bowel movements

• loss of appetite• weight loss• fever

SYMPTOMS OF ULCERATIVE COLITIS

WHO DEVELOPS ULCERATIVE COLITIS?

Some people are at increased risk for ulcerative colitis.This includes people who:

• are between ages 15 and 30, or older than 60• have a parent or sibling with ulcerative colitis• have a parent or sibling with another

inflammatory bowel disease called Crohn’s disease

• are of Jewish descent

Doctors don’t know what causes ulcerative colitis. The following factors may play a role:

Genes Ulcerative colitis tends to run in families. Up to one in four people with ulcerative colitis has a parent or sibling with ulcerative colitis or Crohn’s disease.

Overactive immune system Normally, the immune system protects the body from infection by identifying and destroying harmful germs. In ulcerative colitis, the immune system attacks the lining of the large intestine.

ulcerative colitis 76 ulcerative colitis

DIAGNOSING ULCERATIVE COLITIS

Several steps are needed to diagnose ulcerative colitis.Diagnosis begins with:

• a personal and family health history• a physical examination• blood tests• tests of the stool

The diagnosis is confirmed with a colonoscopy or a flexible sigmoidoscopy.

Colonoscopy lets a doctor closely examine the inside of the entire colon and rectum. The doctor inserts a flexible tube with an attached camera and light into the anus, and guides it through the rectum and colon.

The camera sends images of the intestinal lining to a monitor. The images can reveal irritated and swollen tissue, ulcers, and abnormal growths. The doctor will take a tissue sample (biopsy) to be examined in a laboratory.

Flexible sigmoidoscopy is similar to colonoscopy. But the doctor views and biopsies only the lower part of the colon and the rectum.

Ulcerative colitis can cause problems beyond pain and diarrhea.

Dehydration

Frequent loose bowel movements can lead to excessive loss of body fluids. You may need fluids given by IV to replace lost fluids and nutrients.

Nutritional deficiencies

You might be eating less to avoid diarrhea and not getting enough vital nutrients. Inflammation in the intestine can also lower vitamin and mineral levels. Your doctor may recommend vitamins and nutritional supplements.

Rectal bleeding

This can occur when ulcers in the intestine bleed. Rectal bleeding can cause anemia. Iron supplements and changes in diet can help treat anemia.

Weakened bones

Calcium and vitamin D supplements, exercise, and medications can help prevent or slow bone loss.

Inflammation in other areas

Inflammation may also affect large joints, like the hips and knees, or occur in the eyes, skin, or liver. Medication may be prescribed to treat this.

COMPLICATIONS OF ULCERATIVE COLITIS

ulcerative colitis 98 ulcerative colitis

When symptoms are severe or when diarrhea causes dehydration, you may need to be

hospitalized. You will get fluids and sometimes nutrition through a vein while

your colon recovers.

Immunomodulators

These weaken the activity of the immune system. This decreases inflammation and helps reduce symptoms. Fast-acting immunomodulators effectively stop symptoms in people with severe disease. They are generally given until one of the slower-acting immunomodulators begins to work.

Biologics

These drugs target a protein made by the immune system. Blocking this protein decreases inflammation in the large intestine. It can also quickly stop symptoms. Biologics are often prescribed when other medications are not effective. They are part of a newer generation of drugs.

In addition to these medications, your doctor may prescribe:

• acetaminophen, to relieve pain• antibiotics, to prevent or treat bacterial

infections in the gastrointestinal tract• medication to slow or stop diarrhea• medication to decrease spasms of the colon

All medications carry the risk of side effects. Some side effects of medications for ulcerative colitis may be serious. Discuss your individual risks and benefits of treatment with your doctor.

Medications cannot cure ulcerative colitis. But they can stop or ease symptoms by controlling inflammation. And they can help improve your quality of life.

Which medication is right for you depends on your symptoms and how severe they are. Most medications prevent inflammation in the intestine.

Aminosalicylates

These anti-inflammatory drugs are related to aspirin. Doctors usually prescribe them for people with mild to moderate symptoms or to help them stay symptom-free. Aminosalicylates suppress inflammation in the digestive tract and in joints.

Corticosteroids

These drugs quiet down the immune system and decrease inflammation. They can also help stop or ease symptoms. Corticosteroids are usually prescribed when people have more severe symptoms that do not respond to aminosalicylates. Because of potential side effects, they are not usually recommended for long-term use.

TREATMENT WITH MEDICATIONS

ulcerative colitis 1110 ulcerative colitis

Discuss the risks and benefits of surgery with your doctor.

Surgery to remove the entire colon eliminates the risk of colon cancer.

In one type, the surgeon removes the entire colon, then creates an opening in the abdominal wall (a stoma). After this procedure, waste leaves the body through the stoma, rather than the anus. A bag attached to the opening collects the waste.

In another type, the surgeon removes the colon, then connects the small intestine to the anus. After this procedure, you can continue to have bowel movements through the anus.

Surgery to remove the colon and rectum is sometimes the best option.Surgery may be considered for people who have:

• severe symptoms not controlled by medicines• unacceptable side effects from medicines• a very high risk of colon cancer because of long-

lasting inflammation throughout the colon

Surgery involves removing the colon and some or all of the rectum and anus.

There are two types of surgery for ulcerative colitis:Colon

(removed)

Stoma Small intestine

Colon(removed)

Small intestine

Anus

SURGICAL TREATMENTS

TAKING YOUR MEDICATIONS

Medications for ulcerative colitis may have to be taken, or given, in different ways.

• By mouth: This is the traditional, familiar method of taking medication.

• By enema or rectal foam: An enema involves flushing a liquid form of medication into the rectum, using a special type of bottle. When using rectal foam, a foamy substance, rather than a liquid, is placed into the rectum. These therapies act directly on inflamed areas. They are most effective for people with disease confined to the rectum and the lower part of the colon.

• By suppository: A solid medication is placed into the rectum. It dissolves and is absorbed into the lining of the rectum.

• Intravenous (IV): Medication is delivered directly into a vein.

How you take your medicine may depend on the location of disease in your colon.

ulcerative colitis 1312 ulcerative colitis

ULCERATIVE COLITIS AND COLORECTAL CANCER

Ulcerative colitis increases the risk of colorectal cancer.Colorectal cancer is the uncontrolled growth of abnormal cells in the large intestine. Colorectal tumors often begin as small growths (polyps) on the inside of the large intestine.

The risk of colorectal cancer increases based on:

• the length of time a person has had ulcerative colitis

• how much of the colon is affected by ulcerative colitis

People with ulcerative colitis should have more frequent screening tests for polyps and colorectal cancer than people at average risk.

The gold standard screening test is a colonoscopy (see “Diagnosing ulcerative colitis,” page 9). Polyps can be removed during a colonoscopy. This reduces the risk of colorectal cancer.

Your doctor can tell you how often you should be checked for colorectal cancer.

Avoiding certain foods and medications can help improve symptoms.The following items may worsen your symptoms:

To figure out if any of these foods causes your symptoms to flare, keep a food diary.

Record exactly what you eat over several weeks, along with how you feel afterwards. When you look back, you may notice a pattern.

If one or more of these foods worsens your symptoms, talk to your doctor about eliminating them from your diet.

Your doctor may suggest a daily multivitamin supplement.

NSAIDs can make symptoms worse.

People with ulcerative colitis should take non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen, only if prescribed by their doctor.

• milk, yogurt, cheese, and other dairy

• coffee, tea, soda, and other beverages that contain caffeine

• alcohol• fruit and juice• fried, fatty, and spicy

foods• whole-grain and

multigrain breads

• red meat• condiments, like ketchup,

mustard, and mayonnaise• salad dressing• some vegetables,

including cabbage, broccoli, and cauliflower

• beans and lentils• spices and seasonings• artificial colors, flavors,

and sweeteners

HELPING YOURSELF FEEL BETTER

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Harvard Health Publications content should not be used for diagnosis or treatment, or as a substitute for visits to your medical provider. Always seek the advice of your health care provider if you have questions regarding your health or any medical condition.

©2014 Harvard University. All Rights Reserved. HHP/HMS content licensing by Belvoir Media Group.

Harvard Health Publications does not endorse drug products.

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