Ulcerative colitis can take different forms, depending on how much of the colon is involved. Ulcerative colitis can affect any part of the colon, but it does not skip areas as Crohn's disease does -- the inflammation is continuous throughout the affected area. Your physician may refer to your condition based on the primary area involved in your case.
The most common forms are:
- Ulcerative proctitis
- Left-sided colitis
Ulcerative proctitis is defined by inflammation that is located in the rectum, most commonly the last 6 inches or less. For about 30 percent of patients, their ulcerative colitis starts in this form. Symptoms include diarrhea, bloody stool, rectal pain, and an urgent need to move the bowels (tenesmus). With the inflammation limited to a smaller area than in the other forms of ulcerative colitis, ulcerative proctitis is considered a milder type of ulcerative colitis, with fewer incidences of complications.
Because the inflammation is at the end of the colon, treatment can include medication in suppository, enemas, and foam form. These forms are topical and can be administered through the anus and may include anti-inflammatory drugs or steroids.
When inflammation is located in the rectum and sigmoid colon (the last section of the colon), it is known as proctosigmoiditis. Symptoms include diarrhea, bloody diarrhea, crampy pain, tenesmus, and pain on the left side of the abdomen.
This type of ulcerative colitis may be treated with topical medications in the form of suppositories, enemas, and foam. Enemas can reach further up into the colon, making them more effective in treating inflammation higher in the sigmoid. This form of ulcerative colitis may also be treated with a 5-ASA (5-aminosalicylic acid) drug or sulfasalazine, which are given orally and used for long-term maintenance and continuation of remission. An oral corticosteroid may also be used as a short-term therapy during a flare up.
Also known as limited or distal colitis, left-sided colitis is when inflammation is in the left side of the colon (the rectum, sigmoid colon, and descending colon). Symptoms include diarrhea, bloody stools, weight loss, loss of appetite, and occasionally severe left-sided pain. This type of ulcerative colitis may be treated with a combination of topical medication (suppositories, enemas, or foam) as well as a 5-ASA drug, sulfasalazine, or a corticosteroid.
Pancolitis is when there is inflammation throughout the whole colon. Symptoms include diarrhea, cramps, significant weight loss, and severe abdominal pain. This form of colitis must be treated with oral medications (5-ASA drugs, sulfasalazine, or a corticosteroid) in order for the medication to reach all the areas of the colon. Moderate to severe cases may require treatment in the hospital where drugs can be given intravenously.
Health Information Publications. "Classifying Ulcerative Colitis." ehealthMD 17 Apr 2013. 11 Mar 2014.
Crohn’s and Colitis Foundation of America. "What is Ulcerative Colitis?" CCFA 2014. 11 Mar 2014.
Mark A Peppercorn, MD. "Patient information: Ulcerative colitis." UpToDate 18 Dec 2013. 11 Mar 2014.