The cause of ulcerative colitis is unknown. People with this condition have problems with the immune system, but it is not clear whether immune problems cause this illness. Although stress and certain foods can trigger symptoms, they do not cause ulcerative colitis.
Ulcerative colitis may affect any age group, although there are peaks at ages 15 - 30 and then again at ages 50 - 70.
The disease can begin the rectal area, and may involve the entire large intestine over time. It may also start in the rectum and other parts of the large intestine at the same time.
Risk factors include a family history of ulcerative colitis, or Jewish ancestry.
The symptoms vary in severity and may start slowly or suddenly. About half of people only have mild symptoms. Others have more severe attacks that occur more often. Many factors can lead to attacks, including respiratory infections or physical stress.
Colonoscopy is also used to screen people with ulcerative colitis for colon cancer. Ulcerative colitis increases the risk of colon cancer. If you have this condition, you should be screened with colonoscopy about 8 - 12 years after being diagnosed. You should have a follow-up colonoscopy every 1 - 2 years.
Other tests that may be done to help diagnose this condition include:
Hospitalization is often needed for severe attacks. Your doctor may prescribe corticosteroids to reduce inflammation. You may be given nutrients through a vein (intravenous line).
DIET AND NUTRITION
Certain types of foods may worsen diarrhea and gas symptoms, especially during times of active disease. Diet suggestions include:
Eat small amounts of food throughout the day.
Drink plenty of water (drink small amounts throughout the day).
Avoid high-fiber foods (bran, beans, nuts, seeds, and popcorn).
Avoid fatty, greasy or fried foods and sauces (butter, margarine, and heavy cream).
Limit milk products if you are lactose intolerant. Dairy products are a good source of protein and calcium.
You may feel worried, embarrassed, or even sad or depressed about having a bowel accident. Other stressful events in your life, such as moving, or losing a job or a loved one can cause digestive problems.
Ask your doctor or nurse for tips on your to manage your stress.
Medicines that may be used to decrease the number of attacks include:
5-aminosalicylates such as mesalamine or sulfazine, which can help control moderate symptoms
Immunomodulators such as azathioprine and 6-mercaptopurine
Corticosteroids (prednisone and methylprednisolone) taken by mouth during a flare-up or as a rectal suppository, foam, or enema
Infliximab (Remicade) or other biological treatments, if you do not respond to other medications
Surgery to remove the colon will cure ulcerative colitis and removes the threat of colon cancer. Surgery is usually recommended if you have:
Colitis that does not respond to complete medical therapy
Changes in the lining of the colon that are thought to be precancerous
Serious complications such as rupture (perforation) of the colon, severe bleeding (hemorrhage), or toxic megacolon
Most of the time, the entire colon, including the rectum, is removed (total proctocolectomy with ileostomy). Afterwards, you may need a surgical opening in the abdominal wall (ileostomy), or a procedure that connects the small intestine to the anus to gain more normal bowel function.
Social support can often help with the stress of dealing with illness, and support group members may also have useful tips for finding the best treatment and coping with the condition.
For more information, visit the Crohn's and Colitis Foundation of America (CCFA) web site at www.ccfa.org.
Symptoms are mild in about half of people with ulcerative colitis. You are less likely to respond well to medicines if your disease is more severe.
Permanent and complete control of symptoms with medications is unusual. Cure is only possible through complete removal of the large intestine.
The risk of colon cancer increases in each decade after ulcerative colitis is diagnosed.
Repeated swelling (inflammation) leads to thickening of the intestinal wall and rectum with scar tissue. Death of colon tissue or severe infection (sepsis) may occur with severe disease.
You develop persistent abdominal pain, new or increased bleeding, persistent fever, or other symptoms of ulcerative colitis
You have ulcerative colitis and your symptoms worsen or do not improve with treatment, or new symptoms develop
Because the cause is unknown, prevention is also unknown.
Nonsteroidal anti-inflammatory drugs (NSAIDs) may make symptoms worse.
Due to the risk of colon cancer associated with ulcerative colitis, screening with colonoscopy is recommended.
The American Cancer Society recommends having your first screening:
8 years after you are diagnosed with severe disease, or when most of, or the entire, large intestine is involved
12 - 15 years after diagnosis when only the left side of the large intestine is involved
Have follow-up examinations every 1 - 2 years.
Sands BE, Siegel CA. Crohn's disease. In: Feldman M, Friedman LS, Brandt, LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap 111.
Burger D, Travis S. Conventional medical management of inflammatory bowel disease. Gastroenterology. 2011 May;140(6):1827-1837.e2.
Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011 May;60(5):571-607.
Rutgeerts P, Vermeire S, Van Assche G. Biological therapies for inflammatory bowel diseases. Gastroenterology. 2009;136(4):1182-1197.
George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, and Stephanie Slon.