Dear Alice,

Ulcerative colitis: What is it?

What are the symptoms?

How would one know if they have it?

Dear Reader,

Ulcerative colitis is an inflammatory disease that affects the colon (the part of your intestinal tract leading up to your anus). It spreads, as medical professionals would say, proximally, that is, backwards in the direction of the large intestine. It’s an inflammatory disease, which means that the symptoms are a result of your body’s immune system attacking the lining of your colon, and not due to a virus or bug. You may have also heard of Crohn’s disease, which is another inflammatory bowel disease. The difference between the two is that ulcerative colitis occurs in the lining of the colon (and is diagnosed more frequently) whereas Crohn’ disease can occur anywhere in the digestive tract.

There are four levels of severity to the disease: mild, moderate, severe, and fulminant. Another way the disease is characterized is by the extent that it affects your intestine: procitis is limited to the rectum whereas prosigmoiditis includes the rectum and the sigmoid rectum (the lower part of the colon). Ulcerative colitis can also involve the entire colon. If you have ulcerative colitis, your symptoms may include:

  • Bloody stool or diarrhea
  • Abdominal pain
  • Fatigue
  • Weight loss
  • Frequent urge to urinate or defecate
  • Inflammation in the bile duct
  • Arthritis
  • Skin lesions

To find out whether you have ulcerative colitis, your health care provider may want to rule out another health issue with similar symptoms, including Crohn’s disease, microscopic colitis, or colitis caused by an infectious agent like bacteria, a virus, or a pathogen. In order to rule out these conditions, s/he may want to do an endoscopy, perform biopsies of the rectum and colon, and examine your stool.

Though what happens to the body when someone has ulcerative colitis has been established, unfortunately, there’s no clear reason why it happens when it does. Your intestine is home to a huge number of different microorganisms that are part of what is called the “flora” of the gut. Rather than being dangerous, many of these microorganisms are critical to maintaining the healthy balance of your intestines and colon. When the balance gets tipped and a pathogen is recognized (e.g., bacteria, a virus, or a foreign substance), the body will launch an immune response to get rid of it. The response includes secreting antibodies that will attack an unwanted agent. Swelling and inflammation typically result, which is why it’s called an inflammatory response.

A healthy immune response will subside after an infection or illness has cleared up. However, with ulcerative colitis, the immune system fails to shut off properly once the condition has resolved. Researchers have found that having had a previous intestinal infection (particularly ones caused by the Salmonella, Shigella, and Campylobacter bacteria) doubles the risk of developing ulcerative colitis. It is thought that these types of infections may disrupt the gut flora and trigger the intestinal immune response in certain people. The inflammation in the lining of the colon due to the atypical immune response is what leads to the symptoms associated with the condition. Eating a diet high in fat, sugar, or animal products and taking certain medications may also increase the risk of developing the condition. There is also evidence that the disease is genetically linked, so having a parent or a sibling with the disease puts you at risk for developing it.

There isn’t a cure for this condition, but health care providers can help reduce symptoms. It isn’t a fatal illness. However, persistent inflammation in the colon could increase the risk of colorectal cancer and even osteoporosis, so managing the disease can play a acritical role in your body’s overall health. Anti-inflammatory drugs or steroids can be helpful to reduce inflammation in the long-term or short-term respectively. Severe and fulminant cases may require surgery to remove part of or the entire colon. For even more information, check out the Crohn’s & Colitis Foundation of America.


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