Ulcerative Colitis (UC)
Ulcerative colitis is
a long-term (chronic) condition affecting the colon. Symptoms include:
- bloody diarrhoea
- abdominal pain
- a frequent need to go
to the toilet
- weight loss.
These can range
from mild to severe, with the condition being unpredictable. Symptoms can flare
up and then disappear (known as remission) for months or even years.
There is currently no
cure for ulcerative colitis so the aim of treatment is to relieve symptoms
during a flare-up and prevent symptoms from returning during remission –
this is known as maintenance therapy. Medications such as
aminosalicylates and corticosteroids (steroid medications) are used for this.
Mild to moderate
"flare-ups" can usually be treated at home. A severe
flare-up needs treating in hospital as there is a chance of
serious complications developing. Surgery may be
required to remove a section of the colon, if medication fails to work.
Ulcerative colitis is
thought to be what is known as an autoimmune condition. This means the immune
system – the body’s defence against infection – goes wrong in some way and
attacks healthy tissue.
One theory is the
immune system mistakes harmless bacteria inside the colon as a threat
and attacks the tissues of the colon, causing it to become inflamed. In
severe cases, painful sores may form which bleed and produce mucus and pus. Exactly what causes
the immune system to behave in this way is unclear. Most experts think a
combination of genetic and environmental factors is involved.
Complications
include:
- inflammation of the bile ducts
(tubes that transport bile out of the liver) – this is known as primary
sclerosis cholangitis and can cause symptoms such as itchy skin and
tiredness
- gases becoming trapped
inside the colon, causing it to swell – this is known as toxic megacolon
and requires emergency treatment as it can be life-threatening.
People with ulcerative
colitis also have an increased risk of developing bowel cancer. Because of
this, regular bowel cancer check-ups are recommended.
Ulcerative colitis is
an uncommon condition. It is estimated one new case will be diagnosed each year
for every 1,000 people in England. The condition
normally appears in a person between the ages of 15 and 30.
It is more common
in white people of European descent – especially those descended from
Ashkenazi Jewish communities – and black people. The condition is much rarer in
people of Asian background. The reasons for this are unclear. Both men and women
seem to be equally affected by ulcerative colitis.
The outlook for most
people with ulcerative colitis is usually quite good. Symptoms are often mild
to moderate and can be controlled with medication. However, an estimated
one-in-five people with ulcerative colitis have severe symptoms that fail to respond
to medication. In these cases, it may be necessary to surgically remove the
colon.
Schematic diagram showing the different stages of severity of Ulcerative Colitis.
Causes of ulcerative colitis
The exact cause of
the condition is unknown, but researchers believe there are a number of factors
involved. These are listed below.
Some researchers
believe a viral or bacterial infection triggers our body's natural defence
system against infection, the immune system. The immune system
responds to the infection by causing the inflammation associated with
ulcerative colitis, but for some reason the immune system doesn't "turn
off" once the infection has passed, and continues to cause inflammation.
Other scientists
think no infection is involved and the immune system just malfunctions by
itself. A leading theory is
that the immune system mistakes "friendly bacteria" found in the
colon (which aid digestion) as an infection. So it tries to halt the spread of
what it thinks is an infection by causing inflammation (swelling) of the colon.
Conditions where the immune system attacks healthy tissue are known as
autoimmune conditions.
It seems
that genes you inherit play a role in developing ulcerative colitis.
Studies have shown around one-in-six people with ulcerative colitis have a
close relative with the condition. Also, levels of ulcerative colitis are a lot
higher in certain ethnic groups than in others. Researchers have
identified several genes that seem to make people more vulnerable to developing
ulcerative colitis, although exactly how they do this is still uncertain.
Where and how we live
also seems to play a role in the development of ulcerative colitis. The
condition is more common in urban areas in northern parts of Western
Europe and America. Various environmental
factors have been suggested, including:
- air pollution
- diet:
the typical Western diet is high in carbohydrates and fats, which may
explain why Asian people, who tend to eat a diet lower in carbohydrates
and fats, are less affected by ulcerative colitis
- hygiene:
children are being brought up in increasingly germ-free environments, but
it is possible the immune system requires exposure to germs to develop
properly (this is known as the hygiene hypothesis, and has also been
suggested as a possible cause for the rise in allergic conditions such as
asthma).
However, no factors
have been positively identified.
Symptoms of ulcerative colitis
These can vary depending on how much of
the colon is affected and the level of inflammation. Common symptoms
include
- abdominal pain
- bloody diarrhoea with
mucus.
There may also be:
- tiredness and fatigue
- appetite and weight loss
- anaemia (shortness of
breath, irregular heartbeat, tiredness and pale skin)
- a high temperature (fever)
of or above 38C (100.4F)
- dehydration
- a constant desire to empty
the bowels (known as tenesmus).
Schematic diagram showing how Crohn's Disease and Ulcerative Colitis can affect the small and large bowel.
Symptoms are often
worse first thing in the morning. Many people living
with the condition will have long periods of months or years where they
experience very few, or no, symptoms. However, in all cases, without treatment
symptoms will eventually return. No specific trigger
that causes the return of symptoms has been identified, although it is thought
stress may play a factor.
If you experience a
severe flare-up of symptoms you may need to be admitted to hospital as a
precaution. A severe flare-up is
usually described as passing six or more blood stools in one day and having
symptoms that suggest you are very unwell such as fever, rapid heartbeat and
anaemia.
If you think you may
be having a severe flare-up, contact your doctor or the doctor in charge of your
care for advice. If this is not possible then visit the Accident and Emergency department of your nearest hospital. The exact cause of
the condition is unknown, but researchers believe there are a number of factors
involved.
Immune system
Some researchers
believe a viral or bacterial infection triggers our body's natural defence
system against infection, the immune system. The immune system
responds to the infection by causing the inflammation associated with
ulcerative colitis, but for some reason the immune system doesn't "turn
off" once the infection has passed, and continues to cause inflammation.
Other scientists
think no infection is involved and the immune system just malfunctions by
itself. A leading theory is
that the immune system mistakes "friendly bacteria" found in the
colon (which aid digestion) as an infection. So it tries to halt the spread of what
it thinks is an infection by causing inflammation (swelling) of the colon.
Conditions where the immune system attacks healthy tissue are known as
autoimmune conditions.
Genetic
It seems
that genes you inherit play a role in developing ulcerative colitis.
Studies have shown around one-in-six people with ulcerative colitis have a
close relative with the condition. Also, levels of ulcerative colitis are a lot
higher in certain ethnic groups than in others. Researchers have
identified several genes that seem to make people more vulnerable to developing
ulcerative colitis, although exactly how they do this is still uncertain.
Environmental
Where and how we live
also seems to play a role in the development of ulcerative colitis. The
condition is more common in urban areas in northern parts of Western
Europe and America. Various environmental
factors have been suggested, including:
- air pollution
- diet:
the typical Western diet is high in carbohydrates and fats, which may
explain why Asian people, who tend to eat a diet lower in carbohydrates
and fats, are less affected by ulcerative colitis
- hygiene:
children are being brought up in increasingly germ-free environments, but
it is possible the immune system requires exposure to germs to develop
properly (this is known as the hygiene hypothesis, and has also been
suggested as a possible cause for the rise in allergic conditions such as
asthma).
However, no factors
have been positively identified.
Treatment
The exact cause of
the condition is unknown, but researchers believe there are a number of factors
involved. These are listed below.
Immune system
Some researchers
believe a viral or bacterial infection triggers our body's natural defence
system against infection, the immune system. The immune system
responds to the infection by causing the inflammation associated with
ulcerative colitis, but for some reason the immune system doesn't "turn
off" once the infection has passed, and continues to cause inflammation.
Other scientists
think no infection is involved and the immune system just malfunctions by
itself. A leading theory is
that the immune system mistakes "friendly bacteria" found in the
colon (which aid digestion) as an infection. So it tries to halt the spread of
what it thinks is an infection by causing inflammation (swelling) of the colon.
Conditions where the immune system attacks healthy tissue are known as
autoimmune conditions.
Genetic
It seems
that genes you inherit play a role in developing ulcerative colitis.
Studies have shown around one-in-six people with ulcerative colitis have a
close relative with the condition. Also, levels of ulcerative colitis are a lot
higher in certain ethnic groups than in others. Researchers have
identified several genes that seem to make people more vulnerable to developing
ulcerative colitis, although exactly how they do this is still uncertain.
Environmental
Where and how we live
also seems to play a role in the development of ulcerative colitis. The
condition is more common in urban areas in northern parts of Western
Europe and America. Various environmental
factors have been suggested, including:
- air pollution
- diet:
the typical Western diet is high in carbohydrates and fats, which may
explain why Asian people, who tend to eat a diet lower in carbohydrates
and fats, are less affected by ulcerative colitis
- hygiene:
children are being brought up in increasingly germ-free environments, but
it is possible the immune system requires exposure to germs to develop
properly (this is known as the hygiene hypothesis, and has also been
suggested as a possible cause for the rise in allergic conditions such as
asthma).
However, no factors
have been positively identified.
Schematic diagram showing the treatment pyramid in inflammatory bowel disease, including Ulcerative Colitis.
Complications of ulcerative colitis
Primary sclerosing cholangitis
Primary sclerosis
cholangitis (PSC) is a common complication of ulcerative colitis that affects
about 1 in every 20 cases. PSC is where the bile
ducts become progressively inflamed and damaged over time. Bile ducts are small
tubes used to transport bile (digestive juice) out of the liver and into the
digestive system.
PSC does not usually
cause symptoms until it is in an advanced stage. Symptoms can include:
- fatigue (extreme
tiredness)
- diarrhoea
- itchy skin
- weight loss
- chills
- high temperature (fever) of
38C (100.4F) or above
- jaundice: yellowing of the
skin and the whites of the eyes.
There is no direct
treatment for PSC but medications, such as rifampicin, can be used to relieve
many of the symptoms, such as itchy skin. In more severe cases
of PSC, a liver transplant may be required.
People who have
ulcerative colitis have an increased risk of developing bowel cancer
(cancer of the colon, rectum or bowel), especially if the condition is severe
or extensive.
The longer you have
ulcerative colitis, the greater the risk is:
- After 10 years the risk of
developing bowel cancer is 1 in 50.
- After 20 years the risk of
developing bowel cancer is 1 in 12.
- After 30 years the risk of
developing bowel cancer is 1 in 6.
People with
ulcerative colitis are often unaware they have bowel cancer as the initial
symptoms of this type of cancer are similar to ulcerative colitis, such as
blood in your stools, diarrhoea and abdominal pain. Because of these
issues you will probably be advised to have a colonoscopy every few years to
check no cancer has developed. The frequency of the colonoscopy examinations
will increase the longer you live with the condition.
To reduce the risk of
developing bowel cancer, make sure you eat a healthy, balanced diet including
plenty of fresh fruit and vegetables. It is also important to take regular
exercise, maintain a healthy weight and avoid alcohol and smoking. Taking
aminosalicylates as prescribed should also help reduce your risk of bowel
cancer.
Osteoporosis is
a common complication affecting an estimated 1 in 6 people with ulcerative
colitis. Osteoporosis is a
condition that affects the bones, causing them to become thin and weak. The
condition is not directly caused by ulcerative colitis, but develops as a side
effect of prolonged steroid use.
Although risks
associated with steroid use are well-known, in some people long-term use of
steroids is the only way to control symptoms of ulcerative colitis. There are several
medications, such as bisphosphonates, that can be used to strengthen the bones. You may also be
advised to take regular supplements of vitamin D and calcium, as both of these
substances have bone-strengthening effects.
Toxic megacolon is a
rare and serious complication that occurs in approximately 1 in 20 of cases of
severe ulcerative colitis. In severe cases of inflammation, gases can get
trapped in the colon, causing it to swell. This is dangerous as it can:
- send the body into shock (a
sudden drop in blood pressure)
- rupture (split) the colon
- cause infection in the blood
(septicaemia).
The symptoms of a
toxic megacolon include:
- abdominal pain
- dehydration
- high body temperature (40C
or 104F)
- a rapid heart rate.
Toxic megacolon can
be treated with intravenous fluids, antibiotics and steroids. At the same time,
a tube will need to be inserted into your rectum and colon so the gas can be
drawn out and your colon decompressed. In more severe cases,
a colectomy will need to be performed. Treating symptoms of
ulcerative colitis before they become severe can help prevent a toxic megacolon
from developing.
Living with a
long-term condition that is as unpredictable and potentially debilitating as
ulcerative colitis, particularly if it is severe, can have an emotional impact. In some cases anxiety
and stress caused by ulcerative colitis can trigger depression. Signs of
depression include feeling very down, hopeless and no longer taking
pleasure in activities you used to enjoy.
If you think you
might be depressed, contact your family doctor for advice. You may find it
useful to talk to others affected by ulcerative colitis, either face to face or
via the internet. A good resource is
the Crohn's and Colitis UK’s website. This website, operated by the UK’s
leading charity for people affected by ulcerative colitis, contains details of
local support groups. The site also
contains a large range of useful information on ulcerative colitis and related
issues.
Living with ulcerative colitis
Although diet does
not seem to play a role in causing ulcerative colitis, it can help control the
condition. The following advice
may help:
- Keep a food diary:
you may find you can tolerate some foods, while others make your symptoms
worse. By keeping a record of what and when you eat, you should be able to
eliminate problem foods from your diet.
- Eat small meals:
eating five or six smaller meals a day, rather then three main meals, may
make you feel better.
- Drink plenty of fluids: it
is easy to become dehydrated when you have ulcerative colitis, as you can
lose a lot of fluid through diarrhoea. Water is the best source of fluids.
Avoid caffeine and alcohol as these will make your diarrhoea worse, and
fizzy drinks as these will cause gas.
- Food supplements:
ask your doctor or gastroenterologist whether you need food supplements, as
you might not be absorbing enough vitamins and minerals, such as calcium
and iron.
Schematic diagram showing the bowel mucosa can be affected in Crohn's Disease and Ulcerative colitis.
Again, although
stress does not cause ulcerative colitis, successfully managing stress levels
may reduce the frequency of symptoms. The following advice may help:
- Exercise:
exercise has been proven to reduce stress and lift your mood. Your family doctor or
gastroenterologist should be able to advise on a suitable exercise
plan.
- Relaxation techniques:
breathing exercises, meditation and yoga are good ways of teaching
yourself to relax.
- Communication:
living with ulcerative colitis can be frustrating and isolating. Talking
to others with the condition can be of great benefit.
Source: NHS Choices.
