Ulcerative colitis (UC) is a type of Inflammatory Bowel Disease (IBD) with unknown causes. It primarily affects the gastrointestinal tract all the way down to the rectum.
Ulcerative colitis is a long-term condition that often starts gradually and has the potential to get worse over time. The severity of the symptoms can range from mild to severe, and many UC patients experience remission that can last for years. However, specific triggers may result in relapses. This is why these patients often work closely with a gastroenterologist or a digestive diseases specialist who recommends a medical treatment that will get their symptoms under control during a relapse and then induce remission, which will ultimately improve their quality of life.
Main Symptoms of Ulcerative Colitis
The main symptoms of ulcerative colitis are recurring diarrhoea with pus, blood, or mucus and stomach pain.
Small ulcers and abscesses can occur on the lining of the large intestine, which can bleed and produce pus, causing stomach pain and bloody diarrhoea. Scarring on the intestinal lining can also occur, which can lead to obstructions and cause pain in different areas of your abdomen or rectum. For instance, you may experience mild to sharp pain on the left side of your stomach if there is inflammation in the lower section of the large intestine and rectum.
Other Signs and Symptoms of Ulcerative Colitis
The severity of UC symptoms varies depending on how acute the inflammation is and where it occurs in the GI tract. At the onset, some patients may experience frequent, bloody diarrhoea, while others may have a high fever and sharp abdominal pain or rectal pain.
You may also experience some of these signs and symptoms:
- Urge to empty your bowels frequently. Aside from loose bowel movements, you will also feel a strong and sudden need to defecate, even though there’s nothing to get rid of.
- Unexpected weight loss. Sharp abdominal pain can make it difficult for you to eat, which can lead to sudden weight loss and nutritional deficiency. Losing pounds of weight without trying to is enough reason to see your doctor.
- Fatigue. If you always feel an overwhelming sense of exhaustion along with stomach pain or diarrhoea, then it could be due to ulcerative colitis. In fact, about 75% of people with IBD suffer from fatigue when they’re having a flare-up, according to a study published in the 2011 IBD journal.
- Anaemia. Small ulcers and abscesses on the intestinal lining may bleed, and when you lose blood, your body loses iron, too. Other possible causes of anaemia include malabsorption of nutrients and frequent bloody diarrhoea, which can result in pale skin, dizziness, and fatigue.
Symptoms of Ulcerative Colitis Relapse
You may carry on like normal for weeks or months with mild symptoms or with UC in remission, then go through days where your symptoms can cause significant discomfort (relapses), making it difficult for you to perform your usual, everyday tasks.
During a relapse, some UC patients may notice symptoms appearing elsewhere in their body, such as:
- Mouth ulcers
- Arthritis or swollen joints
- Irritated eyes
- Tenderness and pain in some areas of the skin
Meanwhile, those with severe cases may feel the need to pass stools at least six times a day. They may also have these other symptoms:
- High body temperature
- Arrhythmia or irregular heartbeat
- Shortness of breath
- An increased amount of blood in the stools
Researchers have yet to identify specific triggers for these flare-ups, although some studies have shown that seasonal factors and medication non-adherence may contribute to both onset and reactivation of ulcerative colitis.
Stressful life events and experiences that produce bouts of anxiety and depression are also among the most common triggers.
How is Ulcerative Colitis Diagnosed?
Your gastroenterologist may diagnose you with ulcerative colitis after careful consideration of your medical and family history, physical exam, medical tests, and endoscopy of the large intestine.
Conducting a series of lab tests is also important to rule out other digestive diseases like Irritable Bowel Syndrome, coeliac disease, or Crohn’s disease that have similar signs and symptoms as that of ulcerative colitis.
Medical and Family History
Your medical and family history can help your gastroenterologist understand your symptoms and diagnose ulcerative colitis. You will be asked about your past and current health conditions and medications.
During a physical exam, your doctor will check for stomach distension, tap on your abdomen to check for tenderness, and listen to bowel sounds with a stethoscope.
Your doctor may request medical tests to help diagnose ulcerative colitis. These tests generally require blood or stool samples.
In a blood test, your blood sample will be analysed by a lab technician to look for inflammation markers, signs of anaemia, low protein or albumin levels, and infection in your body.
As for stool tests, you will be given a container for catching and storing faecal samples at home. The results of your stool test – which are based on the analysis of a lab technician – will help your doctor to rule out other causes of digestive diseases, such as gut infections.
Standard Ulcerative Colitis Treatments
The goal of any UC treatment is to manage symptoms during a relapse and maintain remission for as long as possible.
If you are diagnosed with ulcerative colitis, the type of treatment you will receive will depend on the severity of your inflammation, the course of your disease, and any underlying medical condition.
If you have mild UC or IBD, you may be treated with antibiotics, aminosalicylates, and corticosteroids to relieve your symptoms. Your doctor may also give you some types of immunomodulator drugs, such as methotrexate, mercaptopurine, and azathioprine to help maintain remission.
On the other hand, if you have severe IBD, you may need to stay in a hospital to receive intravenous steroids and prednisone (a type of oral steroid). Unfortunately, steroids aren’t recommended for everyone. They might do more harm than good when used long term or increase your dependence on them. They can also cause serious complications like osteoporosis, weight gain, hypertension, cataracts, type 2 diabetes, or thinning of the skin.
If steroids aren’t the best type of medication for you, a biologic is then often recommended. This drug works by suppressing your immune system to stop or relieve gut inflammation, as well as lessen other UC-related symptoms. Biologics are thought to be effective for patients who have not responded well to other types of drug therapies, who are at risk for serious complications from long-term use of steroids, and who have become dependent on steroids.
How do you take biologics?
There are two ways to take them: through IV injection or IV infusion. With IV injection, your doctor will give you a device containing the biologics to allow self-administration every two to four weeks at home. Conversely, with IV infusion, you will be required to go to a hospital every two months to put the medication directly into your bloodstream.
But as with any other drugs, biologics also come with side effects, such as an increased risk of lymphoma, moderate to severe infection (e.g., common cold to TB), and non-melanoma skin cancer. If you have any pre-existing medical condition, talk to your doctor to help you decide if the benefits of this drug therapy outweigh the potential risks for you.
If you don’t respond adequately to biologics, your doctor may either increase the dosage or recommend switching to another type of biologic. And depending on how severe your condition is, you may end up needing surgery to remove your entire large intestine (colectomy), although this is rarely the route for many people with ulcerative colitis. In fact, only about 20% of UC patients receive this kind of treatment throughout the duration of their disease.
Apart from these drug therapies, dietary changes and healthier lifestyle choices may also help alleviate your symptoms. General health management is typically recommended, which involves avoiding certain foods and beverages that can trigger gut inflammation and potentially reactivate the disease. Consult with your doctor or dietitian to figure out the best dietary management strategies and routine health maintenance measures for you.
With the right medical treatment and health management methods, it is possible to keep your ulcerative colitis symptoms under control or remain in remission for a longer period of time.
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