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Ulcerative Colitis

Ulcerative colitis is one of the Inflammatory Bowel Diseases (IBD). Ulcerative colitis affects only the colon. It is a chronic (long term) disease that recurs over a lifetime, which is marked by periods of remission (few symptoms) and exacerbation (heavy symptoms). The inflammation involves the entire rectum and extends up the colon in a solid wave. Ulcerative colitis does not skip from one area to the next.  With ulcerative colitis the lesions affect only the innermost lining of the colon.

  • Signs and Symptoms of Ulcerative Colitis

    The following are the most common symptoms of ulcerative colitis. However, each individual may experience symptoms differently. Symptoms may include:

    • Abdominal pain or cramping
    • Diarrhea
    • Rectal bleeding 
    • Weight loss
    • Fatigue 
  • Testing for Diagnosis

    People who experience the signs and symptoms of IBD may have further testing done to receive an accurate diagnosis. The specific tests include:  

    Blood Tests

    Blood testing may be necessary for a diagnosis of IBD. You can expect to have a nurse or a phlebotomist use a needle to collect blood from a vein. The blood that is collected will be examined for:

    • Anemia (low red blood cells) due to blood loss
    • White blood cells - increased white blood cells indicates inflammation
    • Antibodies - certain antibodies can help to differentiate between Crohn's and Ulcerative Colitis
    • Nutritional deficiencies - some nutritional deficiencies might be present due to the disease process.

    Stool Examination

    A stool examination may be necessary to confirm a diagnosis of IBD. You can expect to be given a container to take home to use to collect a stool sample, which will be sent to a laboratory by your physician's office. In two or three days, the results will be in. The stool will be tested for:

    • Bacteria - possible source for abdominal discomfort; to rule out IBD 
    • Parasites - possible source for abdominal discomfort; to rule out IBD 
    • Blood - To determine if there is blood loss

    EGD

    An EGD (esophagogastroduodenoscopy) may be needed to diagnose you properly. 

    • You can expect to have an EGD scheduled as a follow up visit.
    • You will be instructed to not eat for 8 hours prior to your EGD.
    • When you arrive for your EGD you will have an IV inserted to deliver fluids.
    • You will be sedated for your comfort and safety while the procedure is underway, so remember to have someone drive you to and from the procedure.
    • A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus (the tube that connects the mouth to the stomach), stomach, and duodenum (the beginning of the small intestine). The endoscope allows the physician to view the inside of this area of the body, and to insert instruments or tools through a scope to remove a sample of tissue for biopsy if necessary. During biopsy, the physician will take a small sample of the tissue that lines the digestive tract, which will be examined under a microscope. 

    Colonoscopy

    A colonoscopy may be required to diagnose you properly.

    • You can expect to have a colonoscopy scheduled as a follow up visit.
    • You will be instructed to not eat or drink for 8 hours prior to your colonoscopy.
    • When you arrive for your colonoscopy you will have an IV inserted to deliver fluids.
    • You will be sedated for your comfort and safety while the procedure is underway, so remember to have someone drive you to and from the procedure.
    • A thin, lighted tube is guided through rectum and into the colon. This procedure allows the physician to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding.

    Capsule Endoscopy

    Pill cam

    Another option for visualizing the digestive tract is by using capsule endoscopy. Capsule endoscopy is a pill-sized video capsule with a lens and its own light source. By using capsule endoscopy, UK doctors can examine the lining of the small intestine. A capsule endoscopy does not replace a colonoscopy or an EGD; it is used as an additional assessment. 

    Upper GI Series

    An upper GI series (sometimes called a barium swallow) might be needed to come to an accurate diagnosis of IBD.

    • An upper GI series will be scheduled as a follow up visit and you will be asked not to eat or drink for at least 8 hours. 
    • When you arrive for the procedure you will be asked to drink a liquid called barium.
    • After drinking the barium a series of X-rays will follow the barium through the digestive tract.  The reason barium is swallowed is because it shows up on X-rays and coats the inside of your digestive tract, allowing the physician to find problem areas such as ulcers.
    • Since the barium liquid is not absorbed by the body it will pass in your stools, so your stools might be lighter in color until all of the barium passes.
    • Barium may cause constipation after the procedure if it is not completely eliminated from your body. You may be advised to drink plenty of fluids and eat foods high in fiber to expel the barium from the body.

    Lower GI Series

    A Lower GI series (sometimes called a barium enema) might be needed to properly diagnose IBD.

    • A lower GI series will be scheduled as a follow up visit and you will be asked to not eat or drink for 8 hours.
    • You will be asked to remove your clothing and given a gown to wear. You will be placed on your side on the X-ray table and a rectal tube will be inserted into your rectum to allow the barium to flow into your colon.
    • A series of X-rays will then be taken. A barium enema is used because it shows up on X-rays and coats the inside of your digestive tract, allowing the physician to find problem areas such as ulcers.
    • Following the examination, some barium will be expelled immediately. You will be assisted to the bathroom or given a bedpan.
    • Since the barium liquid is not absorbed by the body it will pass in your stools, so your stools might be lighter in color until all of the barium passes.
    • Barium may cause constipation after the procedure if it is not completely eliminated from your body. You may be advised to drink plenty of fluids and eat foods high in fiber to expel the barium from the body.

    Biopsy

    During a Colonoscopy or EGD the physician might find it necessary to perform a biopsy of your digestive tract. The physician will take a small sample of the tissue that lines the digestive tract, which will be examined under a microscope to assess the status of the cells lining your digestive tract.

  • Treatment of Ulcerative Colitis

    Treatment of ulcerative colitis disease is highly individualized. Factors that affect your treatment are:

    • Your age
    • Overall health
    • Extent of the disease
    • Your tolerance to specific treatments
    • Your expectations of the disease
    • Your preference of treatment

    So you have IBD. . .

    If you have recently been diagnosed with Inflammatory Bowel Disease (IBD) this could be a scary time in your life. It is normal to be anxious about a recent diagnosis of IBD, but you and your health care team can work together to make you feel better and improve your quality of life. You should not hesitate to ask your health care provider questions.

    The following topics help answer questions you might have and to give suggestions on how to manage your life if you have been diagnosed with IBD.

    Treatment for for Ulcerative Colitis

    Treatment of ulcerative colitis disease is highly individualized.  Factors that affect your treatment are:

    • Your age
    • Overall health
    • Extent of the disease
    • Your tolerance to specific treatments
    • Your expectations of the disease
    • Your preference of treatment

    Generally medication is the first approach at treating ulcerative colitis. The goal of the pharmacological (medication) treatment of ulcerative colitis is to:

    • relieve abdominal pain
    • control inflammation
    • decrease bleeding
    • decrease number of bowel movements
    • correct nutritional deficiencies 

    Medications for Ulcerative Colitis

    The medications that are used for treating ulcerative colitis are aimed at relieving the symptoms of the disease. Without surgery ulcerative colitis is a chronic (long term) disease. Unfortunately, your use of medications will probably also be chronic and lifelong. There are several different approaches to medicating ulcerative colitis disease.

    These are some of the more common medications used to treat symptoms of ulcerative colitis:   

    Oral: 

    • sulfasalazine (Azulfidine)
    • olsalazine sodium (Dipentum)
    • balsalazide disodium (Colazal)
    • mesalamine (Asacol)
    • mesalamine CR (Pentasa)
    • infliximab (Remicade)
    • methotrexate
    • cyclosporine
    • Prednisone
    • Budesonide (Entocort) 
    • Analpram
    • Proctocream
    • Anusol
    • Canasa
    • Cortifoam
    • Proctofoam

    Surgery for Ulcerative Colitis

    Removal of the colon and rectum is the standard treatment for ulcerative colitis and is often considered a cure of the symptoms.   

    Types of surgeries:

    Ileostomy (or Proctocolectomy) 

    Depending on the severity of your Crohn's disease it may be necessary to remove the rectum and the entire colon.  Once the rectum and colon are removed the free end of the small intestine, called the ileum, is attached to the stoma.  Stool will be collected in an ileostomy bag that will need to be emptied periodically.  An ileostomy can be an effective way of treating Crohn's.  It can be an overwhelming change at first, but with time, patients, and good support, you can return to a relatively normal lifestyle.  There are many support groups available for people with ileostomies such as United Ostomies Association of America, Inc.  

    Ileoanal reservoir (or J-pouch or Restorative Proctocolectomy) 

    An ileonal reservoir is an alternative procedure to a permanent ileostomy. This procedure is popular because it does away with external pouches and allows the patient to have bowel movements. This procedure is completed in two surgeries. First, the colon and rectum are removed and part of the small intestine is used to create an internal pouch to hold stool. While the pouch is healing you will have a temporary ileostomy. Once the pouch has healed, the ileostomy is closed. This pouch is attached to the anus. The muscle of the rectum is left in place, so the stool in the pouch does not leak out of the anus. People who have this surgery are able to control their bowel movements.

  • Lifestyle modifications for Ulcerative Colitis

    Without surgery, ulcerative colitis can be a serious, lifelong disease. However, with proper treatment and lifestyle changes, it is possible to live a normal life. The following topics offer some advice on how to manage your life now that you have been diagnosed with ulcerative colitis.

    Diet and Nutrition

    As you are already finding out, there are certain foods that cause the symptoms of your ulcerative colitis to be worse. There is no specific diet for ulcerative colitis. What you can eat is discovered through trial and error. If it causes your symptoms to be worse then you should avoid eating it. Some foods that should be tested with caution include:

    • Milk and other dairy products
    • Nuts
    • Fresh vegetables
    • Coffee
    • Foods that are greasy or spicy

    If you are sensitive to a large number of foods you should speak with your health care provider about using meal replacement shakes or other meal supplementation.     

    There is no specific diet, but because of the nature of ulcerative colitis, it is extremely important that you focus on quality foods that will meet your nutrition requirements. It is also very important that you keep yourself hydrated by drinking plenty of fluids. Do not hesitate to speak with your health care provider about any nutrition questions that you might have.

    Sexuality

    Newly diagnosed people can have lower self-esteem that can lead to a decreased sex drive. This lowered self-esteem might result from a side effect of the medication, fatigue resulting from the disease processes, or body image related to corrective surgeries. It is important that you discuss your fears and concerns with your partner. With practice and patience your sex life can return to normal and can be fulfilling. Although sex is a private act, you should not feel ashamed to voice any concerns you might have to your health care provider. 

    Depression and Anxiety

    Once you have received a diagnosis of IBD it is important that you assess your mental status on a regular basis. Depression and anxiety are often associated with illnesses and hospitalization.  With IBD there are a several factors that can cause depression or anxiety.  These factors include:

    • New diagnosis of a long-term disease
    • Surgical procedures
    • Change in body image (ostomies or other surgical incisions)
    • Side effect of medications
    • Embarrassment because of the disease processes
    • Changes in lifestyle

    It is important to keep these factors in mind when addressing your mental status.  Depression and anxiety can be a serious complication of the disease.  It is important for you to seek help if you are unable to cope with the disease effectively.  Your health care provider will be able to refer you to the appropriate mental health professional.  Your health care provider might also be able to make adjustments to medications that could be causing your depression or anxiety. 

    Tips for dealing with IBD and School

    Education is an important part of your life that does not need to suffer due to IBD.  Planning is very important when managing IBD while receiving an education. Some tips that you might find helpful are:

    • Locate restrooms when in a new building
    • Sit close to the exit when in class
    • Inform your teachers and professors of your illness
    • Make arrangements for receiving missed assignments at the beginning of the term
    • Download a printable IBD information sheet that you can give to your instructors 

    Sports and IBD

    Sports and exercise are an important part of a healthy lifestyle. Mild physical exercise, such as walking, is not discouraged with IBD. Generally, it is up to you to decide what you can tolerate, but there are certain activities that are not recommended. Often with IBD there are changes with electrolytes (small nutrients such as sodium or potassium that are used by your body's cells) and a potential for dehydration. Because of these fluid and electrolyte changes the following activities should be avoided:

    • Endurance sports
    • Extreme temperatures (hot or cold)
    • Activities in remote areas (in case of emergency it is important to receive care quickly) 

    Certain aspects of your drug therapy might include lowering your immune system. Activities that could possibly put you at risk for infection should be avoided. These include:

    • Swimming in untreated waters (such as lakes, ponds, rivers)
    • Sharing of equipment
    • Sharing or drinking from the same container 

    If you are unsure about a certain event speak with your health care provider prior to the event.

    Tips for IBD in College or at Work

    Often when people start college or have a busy work life they sometimes can experience lifestyle changes such as taking shortcuts on their meals, not taking time to exercise and and increasing alcohol consumption. 

    Alcohol can cause many complications with IBD. The most dangerous complication is the interaction of prescription medications with alcohol. All alcohol use should be avoided completely until speaking with your health care provider about specific medication interactions. The heavy use of alcohol should always be avoided with IBD.