What Is Ulcerative Colitis?

Ulcerative colitis (UC) is part of a group of diseases that negatively affect the gastrointestinal tract, known as inflammatory bowel disease (IBD). If you have a diagnosis of inflammatory bowel disease, you may be diagnosed with UC or a related disorder called Crohn’s disease. The roots of ulcerative colitis begin when the lining of your colon (also known as the large intestine) suffers from inflammation. The inflammation grows into tiny ulcers, which primarily affect the rectum and spread contiguously to another part of the colon. Unlike Crohn’s disease, ulcerative colitis only presents in the large intestine. 

What Is the Difference Between Crohn’s Disease and Ulcerative Colitis?

It may be confusing that both Crohn’s disease and ulcerative colitis are referred to as inflammatory bowel disease. While some of their symptoms are similar, they are two very distinct conditions. Once the colon is inflamed and the ulcers begin to spread, UC irritates and inflames the entire colon. However, ulcerative colitis is only located in the colorectal area (the colon and rectum).

In contrast, Crohn’s disease may present with similar symptoms, but it is not localized to one area of the body. In fact, a Crohn’s flare-up can happen at any point in the gastrointestinal tract, from the mouth to the anus. Crohn’s also differs from UC in that it typically appears in patchy spots, which means that some parts of the digestive tract are still “healthy.” However, a patient still experiences uncomfortable symptoms during a flare-up.

What Are the Symptoms of Ulcerative Colitis?

Like many other diseases and conditions, ulcerative colitis can affect some patients severely, while others may show little to no symptoms at all between flare-ups. Symptoms can also change (improve or worsen) over time. Some of the most common symptoms of ulcerative colitis include:

• Diarrhea
• Blood in the stool
• Unexplained weight loss
• Rectal pain
• Abdominal pain
• Increased “sounds” coming from the stomach

Those who have more severe types of ulcerative colitis may experience more profound symptoms. UC can also cause:

• Joint pain
• Joint swelling
• Eye inflammation
• Mouth sores
• Skin conditions
• Nausea and lack of appetite

Generally, whenever you notice gastrointestinal disturbances that don’t fade after several days, you should consult your healthcare provider, particularly if there are alarming symptoms like blood in the stool or joint swelling. Your gastroenterologist has several tests that can confirm your ulcerative diagnosis or another GI condition.

What Causes Ulcerative Colitis?

Ulcerative colitis (and Crohn’s disease) are both considered autoimmune disorders, which means that the body attacks healthy cells (as opposed to ridding the body of pathogens and unhealthy cells). Researchers are not sure of the exact cause of UC and why some patients have autoimmune disorders and others don’t. However, they have identified some risk factors that are associated with ulcerative colitis. If inflammatory bowel diseases are present in your immediate history, you may have a predisposition to developing ulcerative colitis, Crohn’s, or other less serious conditions, such as irritable bowel syndrome (IBS). 

Also, if you have another autoimmune condition, such as lupus, your chances are much higher of developing another autoimmune condition with the other one (this is known as comorbidity). There are also things in our daily environment that can trigger an immune response, such as antigens, bacteria, and viruses. 

How Is Ulcerative Colitis Diagnosed?

Because ulcerative colitis and so many other gastrointestinal problems share the same set of symptoms, your physician will have to perform some diagnostic tests to determine what disease you have. A complete blood count (CBC) and other metabolic tests are typically the first steps after a patient consultation and physical exam. If you have a low red blood cell count, this is a sign of anemia, which can be a sign of UC. Your team may also look for elevated levels of inflammation or antibody tests specific to UC. 

The next step is most often a stool test. Your doctor will collect a stool sample to have it analyzed for bacteria, parasites, inflammatory markers, and blood. 

If your blood and stool tests indicate more testing, your gastroenterologist will perform diagnostic tests, which could include a CT scan, colonoscopy, or sigmoidoscopy. What the team orders depend on what your doctor suspects is wrong, combined with the results of your blood and stool tests. 

Colonoscopy is a very common way to diagnose ulcerative colitis, and it is the first-line diagnostic test for the detection of colorectal cancer. It takes 24 to 48 hours (depending on your physician’s instructions) to prep for the procedure. You will be under anesthesia during a colonoscopy, and the doctor will insert a small, thin tube with a minute camera attached, into the anus. This provides your healthcare provider with enough information to either rule out UC, or they may be able to diagnose another condition via colonoscopy. 

What Is the Treatment for Ulcerative Colitis?

If ulcerative colitis isn’t treated, over time, it can do serious damage to the colon and put you at a higher risk for developing colorectal cancer. There is no cure for UC; instead, treatment is focused on keeping flare-ups and symptoms at bay. Common and initial line treatment for ulcerative colitis is 5-aminosalicylates, which are a group of drugs that help to minimize inflammation. 

Corticosteroids and biologic drugs are also types of medicine used to help treat UC. Corticosteroids reduce inflammation, but many patients are sensitive to their side effects, and long-term use of steroids can lead to diabetes, weight gain, and bone loss. Thus, they are used for a short duration to control acute flares of ulcerative colitis. 

Biologics are drugs made from antibodies that target molecules in the body to reduce intestinal inflammation. They are very effective in controlling UC for the long term and are now one of the primary means to treat moderate to severe forms of ulcerative colitis. Examples of biologics are infliximab, adalimumab, vedolizumab, and ustekinumab. 

Surgery to remove the entire colon and rectum is now reserved for patients who fail biologic therapy or develop severe complications of UC like blockage, perforation, or colon cancer. 

What Is the Outlook for Ulcerative Colitis?

Those who have UC can lead full, happy lives, provided they follow their doctor’s orders for treatment. If your symptoms are too severe, you will lose electrolytes and become dehydrated, which may require hospitalization. Also, in rare cases, UC can cause colon perforation, blood loss, or blockage.