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Ulcerative Colitis

Dr. Loretta Lanphier, ND, CN, HHP, CH

Imagine how upsetting it would be to suddenly experience pain and bleeding at every bowel movement, as well as consistently suffering from abdominal cramps and diarrhea. At first, you might think you caught a nasty case of the flu or some other bug, but when it didn’t go away after a few weeks, you might begin to get worried. What strange illness could you possibly have come down with? Chances are, it might be Ulcerative Colitis. Let’s find out some of the hows and whys of this intestinal condition.

What is Ulcerative Colitis?

Ulcerative Colitis is an inflammatory disease of the intestinal tract. It is a member of the family of diseases labeled inflammatory bowel disease (IBD). Ulcerative colitis causes swelling, ulcerations, and functional damage to the large intestine (colon). It can be painful and debilitating, and may lead to life threatening complications.

It is similar to another major IBD called Crohn’s disease. In fact the two are so similar, that they are often mistaken for one other. The main difference between the two is that Crohn’s can occur anywhere in the digestive tract and often invades deep into affected tissues. Ulcerative colitis, on the other hand, only attacks the lining of the large intestine (colon) and the rectum.

Ulcerative colitis is a relatively rare disease that affects only about one in 10,000 people in North America. It can be found in individuals of any age group, but most cases affect folks between the ages of 15 and 35. Men and women are both equally at risk for this illness, but there is some disparity of race. Caucasians have a higher incidence than other races, and people of Jewish descent have a four to five times greater chance of developing ulcerative colitis or any IBD. There is a slightly higher incidence in northern climates.

Ulcerative colitis inflames the innermost lining of the colon and rectum. Inflammation typically begins in the last segment of the large intestine called the sigmoid colon, which empties directly into the rectum. Ulcerative colitis may spread through the entire large intestine, and rarely into a section at the very end of the small intestine called the ileum. The remainder of the small intestine is not affected by ulcerative colitis.  As the inflammation progresses, the tissue of the colon begins to deteriorate, and pits or ulcerations may form which can easily become infected.

What Are the Symptoms of Ulcerative Colitis?

The symptoms of ulcerative colitis vary widely from patient to patient. Signs also depend on the severity of the inflammation, and where it is found. Therefore, ulcerative colitis is often classified by its location. Here are the main divisions, and their accompanying symptoms:

• Ulcerative proctitis:  In this form of ulcerative colitis, inflammation is only found in the rectum. Typical symptoms include rectal bleeding (which is often the only symptom), rectal pain, or tenesmus (an urgency to defecate coupled with the inability to do so).
• Left-sided colitis:  Inflammation starts at the rectum, and moves up the left side of the colon, through the sigmoid and into the descending colon. Symptoms are abdominal cramps, abdominal pain, bloody diarrhea, and weight loss. Left-sided colitis has the best prognosis for a full recovery.
• Pancolitis:  This type of ulcerative colitis affects the entire large intestine. Signs include potentially severe bloody diarrhea, abdominal cramps and pain, weight loss, night sweats, and fatigue.
• Fulminant colitis:  This is the rarest and most dangerous form of ulcerative colitis. It affects the entire colon and may cause intense pain, profuse diarrhea, dehydration, and even shock. It is often life threatening. Patients with fulminant colitis are at increased risk of serious complications such as colon rupture or intestinal perforation, and toxic megacolon, conditions that we will discuss further in a moment.

What Are the Possible Complications of Ulcerative Colitis?

There are three major complications of ulcerative colitis that are considered dangerous:

• Intestinal perforation: Also known as colon rupture, this is a potentially life threatening event that occurs when inflammation and ulceration weaken the walls of the large intestine to the point where a hole develops. The contents of the colon, which contain large numbers of bacteria, are then allowed to spill into the abdomen. This is a very toxic situation that can lead to a massive infection called “peritonitis” (inflammation of the lining of the abdomen).
• Toxic megacolon:  This involves abnormal enlargement of the colon due to the inflammation and ulceration of the muscles that normally control the large intestine. Another name for this condition is toxic dilation of the colon. As the diameter of the colon increases, the inflamed walls become thinner and thinner. This increases the risk of intestinal perforation and peritonitis, as discussed above.
• Colon cancer:  Ulcerative colitis increases the risk for colon cancer. The risk does not appear to be significant for the first ten years of the illness. From that point on, the risk of cancer progresses exponentially. Here are the approximate figures for the increased risk of colon cancer in ulcerative colitis patients:
  • At 10 years, risk = < 1%
  • At 15 years, risk =  12%
  • At 20 years, risk =  23%
  • At 24 years, risk =  42%
  • Research has shown that the cancer risk is greatest for those patients who have the largest amount of the colon impacted by ulcerative colitis.

Other, less critical, complications may include:

• Arthritis
• Spondylitis (inflammation of the vertebrae)
• Ulcers in the mouth
• Ulcers and painful, red bumps on the skin
• Eye inflammations
• Liver and gallbladder disorders

What Causes Ulcerative Colitis?

No one knows for sure what triggers the colonic inflammation associated with ulcerative colitis. Until recently, the effects of stress were thought to be the main trigger, but most researchers no longer believe that to be true. However, stress is still considered an aggravating factor that can worsen the symptoms of ulcerative colitis. There are several theories that are currently being studied:

• Viral or bacterial:  Some researchers think a microorganism like a virus or bacteria may be responsible. It is known that an immune system response is responsible for the inflammation that causes ulcerative colitis. Some assume that the reason for this response is an invader that has yet to be identified.
• Autoimmune disease:  Another possible explanation for the response of the immune system is that it mistakes something in the colon for an enemy, and sends out antibodies to attack it. This is how a classic autoimmune disorder works. The body actually turns on itself, and begins to attack healthy tissue as it would an unwanted virus or bacteria. Another clue that points to a possible immune system connection is the fact that there are other immune disorders that are often associated with ulcerative colitis.
• Heredity:  There is a slightly greater risk for ulcerative colitis (about 20%) if you have a close relative with the disease. Researchers are continuing to investigate the possibility of certain inherited genes or genetic mutations that may be a factor. As of yet, no culprits have been identified.
• Environment:  Statistically, people who live in cities, especially in affluent industrialized nations like the U.S., have a higher incidence of ulcerative colitis. Could it have something to do with their diets? A diet loaded with low-fiber, fatty, refined foods is a likely suspect when it comes to intestinal disorders. Perhaps we should label this the “McDonald’s Factor…?”
• Antibiotics:  These drugs tend to seriously mess with the balance of “friendly” bacteria in the intestinal tract. There is hard evidence that links the affects of antibiotics to other kinds of colitis such as acute colitis and pseudomembranous colitis, a particularly serious condition. No evidence has surfaced yet linking antibiotics specifically to ulcerative colitis, but research is ongoing.

How is Ulcerative Colitis Diagnosed?

The first step in diagnosis is a physical exam by your health care provider. Blood tests may be ordered that can reveal the presence of certain antibodies that are associated with IBD, but not specific to ulcerative colitis. You may also be tested for levels of white blood cells in your blood which can indicate an immune system response. If you are anemic (low levels of red blood cells), this is also an indicator of infection. A stool sample can also be analyzed. The presence of pus indicates a high white blood cell count in the intestine.

Other diagnostic tests include:

• Colonoscopy:  This is a procedure that involves the insertion of a thin, flexible scope into the rectum that is equipped with a light and a camera. It gives the doctor the ability to look around inside your colon. It can also be used to take a small bit of tissue as a biopsy for laboratory analysis. One word of caution here: the test can be very useful, but make sure that you use an experienced, capable technician. Many people have gotten tears or holes in their colon when the colonoscopy is poorly administered.
• Barium enema:  This is basically an x-ray that is taken of the colon after a contrast dye composed of barium is introduced into the colon through an enema. You should be aware that there are possible dangerous complications associated with this procedure. I would definitely get a second opinion and explore all my options before submitting to a barium enema.
• Small bowel x-ray:  This also involves the use of barium, and I am not thrilled about putting this into my system. The value of this test is that it can see parts of the colon that a colonoscopy cannot. It is also useful for differentiating between Crohn’s disease and ulcerative colitis.

What Treatments Are Available for Ulcerative Colitis?

Anti-inflammatory drugs are the normal first step in treatment of ulcerative colitis. As you might expect, there are significant side effects with these, especially the steroid medications.

In most cases, the reason people get an illness like ulcerative colitis is because they have succumbed to an unhealthy lifestyle of bad food and a sedentary lifestyle. The best treatment is prevention, and that starts with the choices we make years before we might contract a disease.

One interesting item I ran across is that some patients have been experiencing short-term relief from ulcerative colitis symptoms using a nicotine patch! No one is sure why, but apparently the nicotine has a positive effect, at least for a while, and some doctors are prescribing it. This is in no way an endorsement for tobacco use or the use of “the patch”!  Just another interesting fact from the wacky world of mainstream medicine.