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What is Ulcerative Colitis?

Symptoms, Medications, And Surgery For This Form Of IBD

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Updated May 17, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

What Is Ulcerative Colitis?

Ulcerative colitis is a chronic disease that causes inflammation in the rectum, colon (large intestine), and, infrequently, the last part of the small intestine (ileum). The inflammation affects the inner lining of the colon, causing small sores, or ulcers.

Ulcerative colitis, along with a similar condition known as Crohn's disease, are collectively called inflammatory bowel disease (IBD). Below, find the most important information about ulcerative colitis and links to more in-depth coverage on each topic.

Forms of Ulcerative Colitis

Ulcerative colitis actually has several subtypes within it:
  • Ulcerative proctitis is located in the rectum
  • Proctosigmoiditis involves the rectum and sigmoid colon
  • Left-sided colitis affects the entire left side of the colon
  • Pancolitis is when the colitis has affected the entire colon

Symptoms of Ulcerative Colitis

The symptoms of ulcerative colitis include:

Ulcerative Colitis Causes

The cause of ulcerative colitis, and IBD in general, is still unknown, although there are some theories. There is a genetic component to IBD -- you are more likely to develop IBD if a family member has it. However, the majority of people with IBD don't have a family history of the disease.

It is thought that IBD may be an autoimmune disease, and one theory about the cause is that it could be a result of an allergic response. Another possibility is that IBD may be caused by some combination of environmental factors. The actual cause of IBD could be a result of one or more of these theories, or there may still be a cause that research hasn't uncovered.

How Ulcerative Colitis is Diagnosed

A physician's first clue to suspecting ulcerative colitis is often the hallmark symptoms of cramping, pain, and bloody diarrhea. Ulcerative colitis is typically diagnosed by examining a biopsy of tissue taken from the colon during a colonoscopy. Other tests such as x-rays, barium enema, upper gastrointestinal series, sigmoidoscopy, and upper endoscopy have less value in diagnosis but may also be used.

Blood tests can also offer helpful information about the status of IBD, especially the red blood cell and white blood cell counts. Blood tests can also monitor levels of electrolytes such as sodium and potassium, which may be depleted because of chronic diarrhea.

Treatment for Ulcerative Colitis

Medication: A variety of medications are used to treat ulcerative colitis. Medications fall into two categories: maintenance drugs, which are taken all the time to prevent flare-ups, and fast-acting drugs, which are taken occasionally to stop a flare-up.

Types of drugs commonly used to treat ulcerative colitis include:

Surgery: Surgery for ulcerative colitis is often called a "cure," because removing the large intestine effectively eliminates many of the symptoms of ulcerative colitis, such as diarrhea, bloody stool, and abdominal pain.

The most common surgery done to treat ulcerative colitis is a proctocolectomy with creation of pelvic pouch (j-pouch). During this surgery, the large intestine is removed and the last part of the small intestine (the ileum) is used to create an internal pouch. The internal pouch is then connected to the rectum, which allows for more normal elimination.

Proctocolectomy with creation of ileostomy is another surgery that is used to treat ulcerative colitis. In this surgery, the large intestine is removed, and a stoma is created. An ileostomy pouch is worn on the abdomen to collect waste.

Alternative Therapies for Ulcerative Colitis

Many people who have ulcerative colitis turn to alternative therapies in addition to medical management of their disease. Some of the herbs and supplements that have been studied include aloe vera, boswellia, butyrate, licorice root, slippery elm, and omega-3 fatty acids. Some of these remedies have shown promise for ulcerative colitis, but others have not been shown to have any value, and may actually be harmful.

Colorectal Cancer Risk in Ulcerative Colitis

People with ulcerative colitis are at increased risk for colorectal cancer, particularly those who have had extensive disease for 8 to 10 years. Those who are at increased risk will need to work with their gastroenterologist to develop an individualized plan to regularly monitor for colorectal cancer, such as with colonoscopy.

Ulcerative Colitis Complications

  • Extra-intestinal: Ulcerative colitis can cause a number of complications, some of which are outside the colon and called "extra-intestinal" complications. This includes delayed growth in children, eye diseases, arthritis, skin conditions, and mouth ulcers. Most of these extra-intestinal symptoms follow the course of the ulcerative colitis -- they may get worse when the ulcerative colitis is flaring, and improve when the ulcerative colitis is under control.

  • Intestinal: Intestinal, or local, complications of ulcerative colitis can include bowel perforation, fissures, toxic megacolon, and worsening of symptoms during menstruation. Some of these complications can be treated with medications or other non-invasive methods, but others, such as a bowel perforation or toxic megacolon, are true medical emergencies and need prompt treatment to prevent more serious disease.

Heritability of Ulcerative Colitis

We know that ulcerative colitis does run in families, but the exact mechanism for this is still being studied. In fact, most people who have IBD have no family history of the disease. However, first-degree relatives of people who have IBD are more likely to have IBD themselves. Research into the genes that play a role in the development of ulcerative colitis is ongoing.

Ulcerative Colitis Prognosis

For the first 10 years after diagnosis, the prognosis for people with ulcerative colitis is very good. Most people see their symptoms improve and do not need surgery.

After 10 years with ulcerative colitis, the risk of colorectal cancer does increase, but only develops in about 5% of people.

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