Ulcerative Colitis

Ulcerative colitis is a chronic inflammation in which sores develop on the innermost lining of the colon and rectum. One of the inflammatory bowel diseases, ulcerative colitis often flares up during periods of physical and emotional stress. The disorder results in painful, often debilitating symptoms, and can eventually lead to colon cancer. It can, however, be managed with treatment.

Causes of Ulcerative Colitis

The precise cause of ulcerative colitis remains unknown. The condition may be an autoimmune disease that originates when the gastrointestinal tract tries to fight off an invading bacterium or virus. At one time, the disorder was blamed on diet and stress; it is now known that diet and stress simply exacerbate symptoms. Risk factors that may play a role in the genesis of ulcerative colitis are:

  • Age
  • Race and ethnicity
  • Family history
  • Certain acne medications, such as Accutane

Most patients develop ulcerative colitis before the age of 30, though some individuals do not have any symptoms of the disease until they are 60. White people, particularly Ashkenazi Jews, are at greater risk of developing the disease. Anyone with a close relative with ulcerative colitis is at increased risk of developing the disorder, though most patients diagnosed with ulcerative colitis have no relatives with the disease.

Symptoms of Ulcerative Colitis

Ulcerative colitis can develop gradually or present with a severe flare-up. While the disorder is associated with a wide range of symptoms, depending on the severity of the intestinal inflammation, the most common symptoms are abdominal pain and bloody diarrhea.

Other symptoms may include:

  • Low grade fever
  • Fatigue
  • Loss of appetite
  • Weight loss
  • Anemia
  • Rectal pain and/or bleeding

It is important that patients with the symptoms described be checked carefully by a gastroenterologist since these same symptoms may occur with a number of conditions.

Diagnosis of Ulcerative Colitis

One of the reasons ulcerative colitis may be difficult to diagnose is that patients with this disorder experience severe flare-ups and periods of remission. The latter may go on for months, or even years, during which the patient is completely asymptomatic. If the patient does, in fact, suffer from ulcerative colitis, the symptoms will eventually recur.

Tests administered to diagnose ulcerative colitis may include:

  • Blood test for anemia or infection
  • Stool sample to rule out bacterial or viral infection and parasites
  • Colonoscopy, usually with biopsy
  • Flexible sigmoidoscopy
  • X-rays
  • CT scan
  • Barium enema
  • Chromoendoscopy using spray dye

Not only do these tests help to confirm a diagnosis of ulcerative colitis, they help to rule out other similar disease conditions.

Treatments for Ulcerative Colitis

There are several treatment methods that may keep this challenging disease under control.

Anti-inflammatory Medications

Several types of medications may be prescribed to treat ulcerative colitis, including:

  • Corticosteroids
  • Immune system suppressors
  • Anti-diarrheals
  • Analgesics
  • Iron supplements

Frequently, these medications are administered in combination, both to treat symptoms and to prevent flare-ups. Because these drugs can have serious side effects, it is important that the risks and benefits be weighed in consultation with the physician, and that the administration of medications be carefully monitored.


In extreme cases, surgery can be performed to eliminate ulcerative colitis entirely. This is a drastic step, involving removal of the entire colon and rectum (proctocolectomy). Wherever possible, this surgery is performed in conjunction with a procedure called an ileoanal anastomosis that eliminates the need to wear a bag to collect stool. Instead, the surgeon constructs a pouch out of the end of the small intestine. The pouch is then attached directly to the anus, allowing waste to be expelled relatively normally.

In some cases, however, the latter procedure is not feasible and a colostomy must be performed, during which the surgeon creates a permanent opening in the abdomen (ileal stoma) through which stool is passed for collection into an attached bag.

Although ulcerative colitis can have serious complications, with careful treatment most patients can manage to live normal lives and some can go into years of complete remission.

Because patients with ulcerative colitis are at increased risk for colon cancer, they must be carefully monitored. The schedule of checkups and colonoscopies depends on the location of the disease, at what age the patient has been diagnosed, and whether the patient suffers from other medical conditions.

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