Nearly everybody has endured various gastrointestinal problems during their life, from a simple stomach flu as a child, to food poisoning, a trip out of the country, or over-indulgence of food or alcohol. GI problems are uncomfortable, and can be embarrassing. But for most people, they are a temporary problem that is easily cured by a few days of rest or some Pepto Bismol tablets. This is not the case for individuals who suffer from ulcerative colitis, which is a long-standing inflammatory bowel disease that leads to ulcers (open sores) and inflammation in the intestines.
Ulcerative colitis is a chronic disease of the colon, where the lining becomes inflamed and covered with small open ulcers or sores that can become infected, releasing pus and mucous. This often leads to diarrhea, cramping, and abdominal issues. Current research indicates that this condition is caused by an over-reaction of the immune system. As an auto-immune disease, the body reacts to food and bacteria in the digestive system as an ‘enemy’ and sends white blood cells to the area to combat the problem. The white blood cells end up creating ulcers that do not heal, which leads to chronic inflammation.
In the U.S for example, more than 1.6 million people last year was were diagnosed with Ulcerative colitis. In the U.K. more and more people are being affected with Ulcerative colitis at their teenage age, at the time when they are undertaking their education or when finding their first job. If you have recently been diagnosed with ulcerative colitis, know that there is help available, and that even though there is no known cure, ongoing treatment and dietary changes can help relieve your symptoms and allow you to live a normal life.
Signs and Symptoms
First, let’s take a look at ulcerative colitis, and the primary signs and symptoms. Most people develop symptoms gradually over time, so it may be years before you are actually diagnosed with ulcerative colitis. Here are some of the most common symptoms that people with ulcerative colitis experience:
* Bowel movements become looser or watery
* A sense of urgency before bowel movements
* Frequent diarrhea, for no apparent reason
* Blood in your stool
* Regular abdominal pain and cramps
It’s not surprising that individuals who begin to experience these types of symptoms often lose their appetites, and begin to lose weight. This is especially true for children, who may actually experience delayed growth or developmental problems due to inadequate nutrition. Other common symptoms of ulcerative colitis include low energy, sleepiness, and fatigue. These symptoms could also be caused by the fact that it can be difficult to get a good night sleep with abdominal pain and diarrhea.
In it’s early stages, ulcerative colitis may be difficult to diagnose because it comes and goes. Periods when your symptoms are active are known as flare-ups. Some people may have months or even years between their flare-ups, and end up thinking that the symptoms are caused by a virus or the flu. Other individuals may experience very mild symptoms, and never even think to mention their digestive problems to their physician. However, once your immune system begins to react to certain foods and bacteria in your colon, it is quite typical for the condition to gradually get worse.
The Difference Between Ulcerative Colitis and other Digestive Diseases
Ulcerative colitis only affects the colon. Other types of Inflammatory Bowel Diseases (IBD) include Crohn’s disease, which can affect the entire digestive tract, not just the colon. In addition, Crohn’s disease affects all layers and sections on the upper and lower intestines, while ulcerative colitis only includes the lining of the colon. Ulcerative colitis is not Irritable Bowel Syndrome (IBS), which is caused by abnormal muscle contractions in the GI tract that lead to symptoms that are similar.
Causes of Ulcerative Colitis
Unfortunately, even though many prominent research groups have spent decades trying to understand ulcerative colitis, a definitive reason has not been determined as to the causes of ulcerative colitis. The best current research indicates that ulcerative colitis is most likely a combination of many factors including inherited genes, a compromise immune system, and environmental or dietary factors that kick off the inflammation cycle. It us unknown what substances or antigens are introduced into a person’s body that leads to the inflammation in the colon. But unfortunately, once the inflammatory response has been activated, and the immune system begins to react to these substances, nothing can be done to reverse the process. If your body continues to come into contact with the antigens, you will continue to experience worsening symptoms.
Types of Ulcerative Colitis
There are many different types of ulcerative colitis. Here is a list of the most common types:
Thirty percent of all patients begin with ulcerative proctitis, where the disease is limited to the rectum (or the first six inches of the rectum). This is a milder type of ulcerative colitis, and typically has fewer episodes and fewer complications. This is also the easiest type of ulcerative colitis to treat.
When the inflammatory response include the rectum and sigmoid colon (which is the section of intestine directly above the rectum), this is known as proctosigmoiditis. One of the primary symptoms is a constant sense of needing to ‘go’, as well as cramps and diarrhea with blood. Many individuals also experience a constant sense of pain on the left side of their abdomen.
If the inflammation extends from the rectum through to the splenic flexure (which is the first bend in the colon, near the spleen) then it is referred to as left-sided colitis. Symptoms tend to be worse, and can include a loss of appetite, diarrhea, severe pain, regular bleeding, and weight loss.
This is also known as total colitis, and affects your entire colon. Symptoms tend to be very severe, and can include dilation of the colon which is extremely dangerous. The ulcers can lead to significant bleeding and this may lead to extensive blood loss, requiring surgery.
A small number of patients may have complications related to Ulcerative colitis in their eyes, skin or joints. The most feared complication, which rarely occurs, is the development of toxic megacolon. Patient with this condition is extremely ill with abdominal pain, fever, dehydration, and malnutrition. There are other few complications that result from Ulcerative colitis. Therefore, it is crucial to visit a doctor for a diagnosis.
There is active research going on to determine the ultimate cause of Ulcerative colitis. The mechanism of inflammation and optimal treatment are yet to be defined, but there is always something that we can do to by ourselves to ensure that we manage symptoms as much as we can and live a full life
Who Has Ulcerative Colitis?
According to the Crohn’s and Colitis Foundation of America, over 700,000 Americans suffer from ulcerative colitis. Most people receive their diagnosis in their mid to late thirties, after years of symptoms. The disease seems to affect men and women equally at this age. As people age, men are more likely to get this disease in their later years, than women. Research shows that this disease may be inherited, with about twenty percent of sufferers having a relative that also has the condition. But the remaining eighty percent have no know association or causes. Caucasions from European descent seem to be at a higher risk, as well as people of Jewish heritage.
Fortunately, significant strides have been made in the last ten years, to help those diagnosed with ulcerative colitis. Treatment can involve several different approaches, including medication, stress reduction, dietary changes, and even surgery. Here are the most common treatments:
These are usually the first step in treating ulcerative colitis, and include aminosalicylates like mesalamine (Asacol, Lialda, Rowasa, Canasa, others), balsalazide (Colazal) and olsalazine (Dipentum). These are available as enemas, suppositories, or as an oral medication. Another common type of anti-inflammatory medication are corticosteroids such as prednisone and hydrocortisone. These are typically used for more severe forms of the disease. Corticosteroids can cause several side effects including night sweats, swelling, high blood pressure, osteoporosis, cataracts and susceptibility to infections. Most physicians will prescribe steroids for only short periods of time, to get your symptoms under control. Then you will most likely be put back on one of the aminosalicylates.
The most common immunosuppressants for ulcerative colitis include azathioprine and mercaptopurine. These drugs work by suppressing your immune system’s over-reaction to food or bacteria in your colon. But side effects include liver and pancreas issues, more infections and the possibility of developing lymphoma or skin cancer.
Ulcerative colitis symptoms can also be treated with antibiotics, anit-diarrheal medications like Imodium, pain relievers, and iron supplements.
All medications listed here are for informational purposes only. Consult with your GI physician before taking any over-the-counter medications to treat your ulcerative colitis, and don’t ever take anyone else’s medications.
In some cases, surgery is a good option because it can potentially eliminate the disease. However, this involves removal of the colon and rectum and means that you will need to wear an external pouch that collects your stool , either directly from your anus, or from an opening that the surgeon creates in your abdomen.
It is well-known that certain foods will aggravate ulcerative colitis. Some well-known triggers include broccoli, sodas, dairy products, alcoholic beverages, popcorn, caffeine and raw fruits and vegetables.
Significant research also points to the fact that wheat-based or gluten products can bring on symptoms and make you feel worse. Gluten is found in wheat and many other grains such as rye and barley. Going on a gluten-free diet can be difficult, but many ulcerative colitis sufferers say that it is worth it to completely eliminate gluten from their diet. Common benefits after being gluten-free for a few weeks may include better concentration, less fatigue, better and firmer stools, less bleeding and less joint pain.
Gluten is found in many, many products. In order to have a gluten-free diet, you must begin to read labels. Obvious foods to avoid include bread, cake, muffins, cookies and cereals. But gluten can be found in many other food products such as soy sauce, licorice, veggie burgers, pasta, salad dressings, and ice cream. If you want to try a gluten-free diet, you must read the labels of every food you put in your mouth, to ensure it does not include gluten or gluten by-products.
Here is a list of gluten-free goods:
- Dairy products
- Tortilla chips
- and many other foods
Try eating only gluten-free foods for two weeks to see if this diet eases your ulcerative colitis.
Stress can definitely contribute to flare-ups of ulcerative colitis. Therefore, it makes sense to try some alternative therapies to ease your stress levels. Relaxation training using guided imagery or an audio disc can be very helpful in reducing stress. Consider taking a few sessions with a trained professional to help you learn how to do relaxation training. After a few sessions, you will be able to continue practicing at home, and gain the benefits, including less pain and fewer symptoms.
It’s no wonder, but many people with ulcerative colitis also struggle with depression. In this case, consider traditional therapy or cognitive behavioral therapy (CBT). CBT teaches one to listen to your thoughts and feelings, and then use them to change your behavior and reactions. This can lead to better coping strategies, which can improve your mood, attitude and resilience.
Some gastroenterologists recommend that all of their ulcerative colitis patients take probiotic supplements. Probiotics replace the
good bacteria in your digestive tract that may be lost to diarrhea and inflammation. Over twenty studies have been conducted, showing that remission rates are increased for patients that are regularly taking probiotic supplements.
Several other practices can help reduce your symptoms. These include: Drinking a small amount of water, and eating small meals at frequent intervals throughout the day, limiting fatty food intake and lowering your milk intake especially if you are lactose intolerant. It is also advisable to avoid acidic juices such as tomato juice or potatoes juice. These usually irritate your digestive track, so stick to clear fluids and avoid carbonated beverages.
Try using herbs in your cooking, to reduce your symptoms. Some suggestions include using turmeric or curcumin, as well as parsley, rosemary, sage, thyme, and ginger in your cooking. Other dieticians recommend daily doses of fish oil, which contains omega-3 fatty acids. Fish oil is a power anti-inflammatory that may improve the syptoms of ulcerative colitis.
Accupuncture is an another technique that can help reduce ulcerative colitis symptoms. Though it may not seem relaxing to have needles placed in various spots on your body, many people can attest to it’s success in reducing stress and the symptoms of ulcerative colitis.
If you have ulcerative colitis, it is important to take good care of yourself, both physically and mentally. Don’t let ulcerative colitis rule your life! Work closely with your physician to determine a good treatment regimen including appropriate medications and regular check-ups. Stick to a nutritious diet, and consider going gluten-free for a few weeks to see if your symptoms improve. Get regular exercise, and try adding some complementary treatments to your schedule to reduce stress and hopefully extend your symptom free periods. Attitude is everything, so make sure you can talk about your condition with a partner or good friend. If you find yourself feeling down or discouraged, talk about your feelings, or seek professional help. Ulcerative colitis is a difficult disease to live with, but with proper medical care and self-care, you can enjoy yourself and stay healthy!
- Langholz E, Munkholm P, Davidsen M, Binder V. Course of ulcerative colitis; analysis of changes in disease activity over years. Gastroenterology. 1994;107:3-11.
- Jess T, Gamborg M, Munkholm P, Sørensen TIA. Overall and cause-specific mortality in ulcerative colitis; meta-analysis of population-based inception cohort studies. 2007;102-609-617