Ulcerative Colitis Causes, Symptoms, Diagnosis, Treatment, Prevetntion, Home Remedies

Ulcerative Colitis Causes, Symptoms, Diagnosis, Treatment, Prevetntion, Home Remedies


What is Ulcerative Colitis?


Ulcerative colitis is a disease that causes inflammation and sores, called ulcers, in the top layers of the lining of the large intestine. The inflammation usually occurs in the rectum and lower part of the colon, but it may affect the entire colon. Ulcerative colitis rarely affects the small intestine except for the lower section, called the ileum. Ulcerative colitis may also be called colitis, ileitis, or proctitis.

The inflammation makes the colon empty frequently, causing diarrhea. Ulcers form in places where the inflammation has killed colon lining cells; the ulcers bleed and produce pus and mucus.

Ulcerative Colitis Causes, Symptoms, Diagnosis, Treatment, Prevetntion, Home Remedies
Ulcerative Colitis

Ulcerative colitis is an inflammatory bowel disease (IBD), the general name for diseases that cause inflammation in the intestines. Ulcerative colitis can be difficult to diagnose because its symptoms are similar to other intestinal disorders such as irritable bowel syndrome and to another type of IBD called Crohn's disease. Crohn's disease differs from ulcerative colitis because it causes inflammation deeper within the intestinal wall. Crohn's disease usually occurs in the small intestine, but it can also occur in the mouth, esophagus, stomach, duodenum, large intestine, appendix, and anus.

Ulcerative colitis is found worldwide, but is most common in the United States, England, and northern Europe. It is especially common in people of Jewish descent. Ulcerative colitis is rarely seen in Eastern Europe, Asia, and South America, and is rare in the black population. For unknown reasons, an increased frequency of this condition has been observed recently in developing nations.

Ulcerative colitis occurs most often in people ages 15 to 40, although children and older people sometimes develop the disease. Ulcerative colitis affects men and women equally and appears to run in some families.

There's no known cure for ulcerative colitis, but therapies are available that may dramatically reduce the signs and symptoms of ulcerative colitis and even bring about a long-term remission.

What Causes Ulcerative Colitis?


Like Crohn's disease, ulcerative colitis causes inflammation and ulcers in your intestine. But unlike Crohn's, which can affect the colon in various, separate sections, ulcerative colitis usually affects one continuous section of the inner lining of the colon beginning with the rectum.

No one is quite sure what triggers ulcerative colitis, but there's a consensus as to what doesn't. Researchers no longer believe that stress is the main cause, although stress can often aggravate symptoms. Instead, current thinking focuses on the following possibilities:

Ulcerative Colitis Causes, Symptoms, Diagnosis, Treatment, Prevetntion, Home Remedies
Ulcerative Colitis

Immune system


Some scientists think a virus or bacterium may trigger ulcerative colitis. The digestive tract becomes inflamed when your immune system tries to fight off the invading microorganism (pathogen). It's also possible that inflammation may stem from an autoimmune reaction in which your body mounts an immune response even though no pathogen is present.

Heredity


Because you're more likely to develop ulcerative colitis if you have a parent or sibling with the disease, scientists suspect that genetic makeup may play a contributing role. However, most people who have ulcerative colitis don't have a family history of this disorder.

Environmental


Where and how we live also seems to play a role in the development of ulcerative colitis. The condition is more common in urban areas in northern parts of Western Europe and America.

Various environmental factors have been suggested, including:
  • air pollution
  • diet: the typical Western diet is high in carbohydrates and fats, which may explain why Asian people, who tend to eat a diet lower in carbohydrates and fats, are less affected by ulcerative colitis
  • hygiene: children are being brought up in increasingly germ-free environments, but it is possible the immune system requires exposure to germs to develop properly (this is known as the hygiene hypothesis, and has also been suggested as a possible cause for the rise in allergic conditions such as asthma)
However, no factors have been positively identified.

What are the symptoms during a flare-up of ulcerative colitis?


Diarrhoea. This varies from mild to severe. The diarrhoea may be mixed with mucus or pus. An urgency to get to the toilet is common. A feeling of wanting to go to the toilet but with nothing to pass is also common (tenesmus). Water is not absorbed so well in the inflamed colon, which makes the diarrhoea watery.
Blood mixed with diarrhoea is common (bloody diarrhoea).

Crampy pains in the tummy (abdomen).

Pain when passing stools.

Anaemia (shortness of breath, irregular heartbeat, tiredness and pale skin).


Ulcerative Colitis Causes, Symptoms, Diagnosis, Treatment, Prevetntion, Home Remedies
Ulcerative Colitis


Inflammation of the rectum (proctitis). Symptoms may be different if a flare-up only affects the rectum and not the colon. You may have fresh bleeding from the rectum and you may form normal stools (faeces) rather than have diarrhoea. You may even become constipated further up in the unaffected higher part of the colon but with a frequent feeling of wanting to go to the toilet.

Feeling generally unwell is typical if the flare-up affects a large amount of the colon and the rectum (the large intestine), or lasts for a long time. High temperature (fever), tiredness, feeling sick (nausea.)

Tiredness and fatigue.

Appetite and weight loss.

While the intensity of colon inflammation in ulcerative colitis waxes and wanes over time, the location and the extent of disease in a patient generally stays constant. Therefore, when a patient with ulcerative proctitis develops a relapse of his or her disease, the inflammation usually is confined to the rectum. Nevertheless, a small number of patients (less than 10%) with ulcerative proctitis or proctosigmoiditis can later develop more extensive colitis. Thus, patients who initially only have ulcerative proctitis can later develop left-sided colitis or even pancolitis.

Symptoms are often worse first thing in the morning.

Many people living with the condition will have long periods of months or years where they experience very few, or no, symptoms. However, in all cases, without treatment symptoms will eventually return.

When to see a doctor


See your doctor if you experience a persistent change in your bowel habits or if you have any of the signs and symptoms of ulcerative colitis.

Although ulcerative colitis usually isn't fatal, it's a serious disease that, in some cases, may cause life-threatening complications.

Are there any complications with ulcerative colitis?


A very severe flare-up


This is uncommon but, if it occurs, it can cause serious illness. In this situation the whole of the colon and the rectum (the large intestine) becomes ulcerated, inflamed and dilated (megacolon). A part of the colon may puncture (perforate), or severe bleeding may occur. Urgent surgery may be needed if a flare-up becomes very severe and is not responding to medication (see later).

Related conditions


Other problems in other parts of the body occur in about 1 in 10 cases. It is not clear why these occur. The immune system may trigger inflammation in other parts of the body when there is inflammation in the gut. These problems outside the gut include:

Those that may flare up when gut symptoms flare up. That is, they are related to the activity of the colitis and go when the gut symptoms settle. These include:
  • An unusual rash on the legs (erythema nodosum).
  • Mouth ulcers (aphthous ulcers).
  • A type of eye inflammation (episcleritis).
  • Painful joints (acute arthropathy).
Those that are usually related to the activity of the colitis and usually go but not always, when the gut symptoms settle. These include:
  • An unusual skin condition called pyoderma gangrenosum.
  • A type of eye inflammation called anterior uveitis.
Those that are not related to the activity of the colitis; so, they may persist even when the gut symptoms settle. These include:
  • Inflammation of the joints between the sacrum and the lower spine (sacroiliitis).
  • A type of arthritis affecting the spine (ankylosing spondylitis).
  • A condition causing inflammation of the bile ducts of the liver (primary sclerosing cholangitis).
  • A disease causing fragile bones (osteoporosis), associated with vitamin D deficiency and occurring especially in people on long-term steroid medication.
  • Anaemia, usually due to iron deficiency but sometimes caused by vitamin B12 and/or folic acid deficiency.

Cancer


The risk of developing cancer of the colon is increased if you have Ulcerative Colitis (more details later).

How is ulcerative colitis diagnosed?


Doctors ask about the symptoms, do a physical exam, and do a number of tests. Testing can help the doctor rule out other problems that can cause similar symptoms, such as Crohn?s disease, irritable bowel syndrome, and diverticulitis.

Tests that may be done include:

  • A colonoscopy. In this test, a doctor uses a thin, lighted tool to look at the inside of your entire colon. At the same time, the doctor may take a sample (biopsy) of the lining of the colon.
  • Blood tests, which look for infection or inflammation.
  • Stool sample testing to look for blood, infection, and white blood cells.

Treatments and drugs for Ulcerative Colitis


The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission. Ulcerative colitis treatment usually involves either drug therapy or surgery.

Doctors use several categories of drugs that control inflammation in different ways. But drugs that work well for some people may not work for others, so it may take time to find a medication that helps you. In addition, because some drugs have serious side effects, you'll need to weigh the benefits and risks of any treatment.

Anti-inflammatory drugs 


Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:

  • Sulfasalazine (Azulfidine). Sulfasalazine can be effective in reducing symptoms of ulcerative colitis, but it has a number of side effects, including nausea, vomiting, diarrhea, heartburn and headache. Don't take this medication if you're allergic to sulfa medications.
  • Mesalamine (Asacol, Lialda, others), balsalazide (Colazal) and olsalazine (Dipentum). These medications are available in oral forms and also in topical forms, such as enemas and suppositories. Which form you take depends on the area of your colon that's affected by ulcerative colitis. These medications tend to have fewer side effects than sulfasalazine and are generally very well tolerated. Your doctor may prescribe a combination of two different forms, such as an oral medication and an enema or suppository. Mesalamine can relieve signs and symptoms in more than 90 percent of people with mild ulcerative colitis. People with proctitis tend to respond better to combination therapy with oral mesalamine and suppositories. For left-sided colitis, a combination of oral mesalamine and mesalamine enemas seems to work better than either agent alone if symptoms are mild to moderate. Rare side effects include headache, kidney problems and pancreas problems (pancreatitis).
  • Corticosteroids. Corticosteroids can help reduce inflammation, but they have numerous side effects, including weight gain, excessive facial hair, mood swings, high blood pressure, type 2 diabetes, osteoporosis, bone fractures, cataracts, glaucoma and an increased susceptibility to infections. Doctors generally use corticosteroids only if you have moderate to severe inflammatory bowel disease that doesn't respond to other treatments. Corticosteroids aren't for long-term use, and the dose is usually tapered down over two to three months.
They may also be used in conjunction with other medications as a means to induce remission. For example, corticosteroids may be used with an immune system suppressor — the corticosteroids can induce remission, while the immune system suppressors can help maintain remission. Occasionally, your doctor may also prescribe short-term use of steroid enemas to treat disease in your lower colon or rectum.

Immune system suppressors 


These drugs also reduce inflammation, but they target your immune system rather than treating inflammation itself. Because immune suppressors can be effective in treating ulcerative colitis, scientists theorize that damage to digestive tissues is caused by your body's immune response to an invading virus or bacterium or even to your own tissue. By suppressing this response, inflammation is also reduced. Immunosuppressant drugs include:

Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol)

Because azathioprine and mercaptopurine act slowly — taking three months or longer to start working — they're sometimes initially combined with a corticosteroid, but in time, they seem to produce benefits on their own and the steroids can be tapered off.

Side effects can include allergic reactions, bone marrow suppression, infections, and inflammation of the liver and pancreas. There also is a small risk of development of cancer with these medications. If you're taking either of these medications, you'll need to follow up closely with your doctor and have your blood checked regularly to look for side effects. If you've had cancer, discuss this with your doctor before starting these medications.

Cyclosporine (Gengraf, Neoral, Sandimmune)

This potent drug is normally reserved for people who don't respond well to other medications or who face possible surgery because of severe ulcerative colitis. In some cases, cyclosporine may be used to delay surgery until you're strong enough to undergo the procedure. In others, it's used to control signs and symptoms until less toxic drugs start working. Cyclosporine begins working in one to two weeks, but because it has the potential for severe side effects, including kidney damage, seizures and fatal infections, talk to your doctor about the risks and benefits of treatment. There's also a small risk of cancer with these medications, so let your doctor know if you've previously had cancer.

Infliximab (Remicade)

This drug is specifically for those with moderate to severe ulcerative colitis who don't respond to or can't tolerate other treatments. It works quickly to bring on remission, especially for people who haven't responded well to corticosteroids. This drug can sometimes prevent surgery for some people. It works by neutralizing a protein produced by your immune system known as tumor necrosis factor (TNF). Infliximab finds TNF in your bloodstream and removes it before it causes inflammation in your intestinal tract.

Some people with heart failure, people with multiple sclerosis, and people with cancer or a history of cancer can't take infliximab. The drug has been linked to an increased risk of infection, especially tuberculosis and reactivation of viral hepatitis, and may increase your risk of blood problems and cancer. You'll need to have a skin test for tuberculosis, a chest X-ray and a test for hepatitis B before taking infliximab.

Also, because infliximab contains mouse protein, it can cause serious allergic reactions in some people — reactions that may be delayed for days to weeks after starting treatment. Once started, infliximab is generally continued as long-term therapy, although its effectiveness may decrease over time.

Adalimumab (Humira)

Adalimumab (Humira) is an alternative to inflixmab for people whose ulcerative colitis has not been helped by other medications such as azathioprine or 6 mercaptopurine. It may also be considered for people who initially improve with infliximab but then improvement stops; but its benefit in this situation remains unproven. Adalimumab, like infliximab, carries a small risk of infections, including tuberculosis and serious fungal infections. Before taking adalimumab, you should have a skin test for tuberculosis, a chest X-ray and a test for hepatitis B. The most common side effects of adalimumab are skin irritation and pain at the injection site, nausea, runny nose and upper respiratory infection.

Other medications 


In addition to controlling inflammation, some medications may help relieve your signs and symptoms. Depending on the severity of your ulcerative colitis, your doctor may recommend one or more of the following:

  • Antibiotics. People with ulcerative colitis who run fevers will likely be given antibiotics to help prevent or control infection.
  • Anti-diarrheals. For severe diarrhea, loperamide (Imodium) may be effective. Use anti-diarrheal medications with great caution, however, because they increase the risk of toxic megacolon.
  • Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others). Don't use ibuprofen (Advil, Motrin, others), naproxen (Aleve) or aspirin. These are likely to make your symptoms worse.
  • Iron supplements. If you have chronic intestinal bleeding, you may develop iron deficiency anemia. Taking iron supplements may help restore your iron levels to normal and reduce this type of anemia once your bleeding has stopped or diminished.

Surgery


If diet and lifestyle changes, drug therapy, or other treatments don't relieve your signs and symptoms, your doctor may recommend surgery.

Surgery can often eliminate ulcerative colitis. But that usually means removing your entire colon and rectum (proctocolectomy). In the past, after this surgery you would wear a small bag over an opening in your abdomen (ileal stoma) to collect stool. But a procedure called ileoanal anastomosis eliminates the need to wear a bag. Instead, your surgeon constructs a pouch from the end of your small intestine. The pouch is then attached directly to your anus. This allows you to expel waste more normally, although you may have more-frequent bowel movements that are soft or watery because you no longer have your colon to absorb water.

Maintaining remission


Once the symptoms are in remission, taking a regular dose of aminosalicylates should help prevent symptoms reoccurring. If the condition frequently reoccurs, a regular dose of an immunosuppressant such as azathioprine may be recommended.

If your ulcerative colitis was extensive, a lifelong maintenance therapy is normally recommended.
If your ulcerative colitis was limited to a small part of your colon, you may be able to stop therapy, if two years pass without a return of symptoms.

Pregnancy


Women with ulcerative colitis can usually have successful pregnancies, especially if they can keep the disease in remission during pregnancy. Ideally, you'll become pregnant when your disease is in remission. Some medications may not be indicated for use in pregnancy, especially during the first trimester, and the effects of certain medications may linger after you stop them. Talk with your doctor about the best way to manage your illness before you conceive. If you stop certain medications, their effects may linger. It's estimated that the risk of passing ulcerative colitis to your unborn child if your partner doesn't have ulcerative colitis is less than 10 percent.

Cancer surveillance


Screening for colon cancer often needs to be done more frequently because people who have ulcerative colitis have an increased risk of colon cancer. It's recommended that people with pancolitis begin colon cancer screening with a colonoscopy eight years after diagnosis. For those who have left-sided colitis, screening with colonoscopy is recommended beginning 10 years after diagnosis. People with proctitis can follow the usual colon cancer screening guidelines that call for a colonoscopy every 10 years beginning at age 50.

Help and support


Living with a condition such as ulcerative colitis, especially if your symptoms are severe, can be a frustrating and isolating experience. Talking to others with the condition can provide support and comfort.

Living with ulcerative colitis  - Home Remedies for Ulcerative Colitis


Diet


There's no firm evidence that what you eat causes inflammatory bowel disease. But certain foods and beverages can aggravate your symptoms, especially during a flare-up in your condition. It's a good idea to try eliminating from your diet anything that seems to make your signs and symptoms worse. Here are some suggestions that may help:

  • Limit dairy products. If you suspect that you may be lactose intolerant, you may find that diarrhea, abdominal pain and gas improve when you limit or eliminate dairy products. You may be lactose intolerant — that is, your body can't digest the milk sugar (lactose) in dairy foods. If so, try using an enzyme product, such as Lactaid, to help break down lactose. If you need help, a registered dietitian can help you design a healthy diet that's low in lactose. Keep in mind that with limiting your dairy intake, you'll need to find other sources of calcium, such as supplements.
  • Experiment with fiber. For most people, high-fiber foods, such as fresh fruits and vegetables and whole grains, are the foundation of a healthy diet. But if you have inflammatory bowel disease, fiber may make diarrhea, pain and gas worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them. Check with your doctor before adding significant amounts of fiber to your diet.
  • Avoid problem foods. Eliminate any other foods that seem to make your symptoms worse. These may include "gassy" foods, such as beans, cabbage and broccoli, raw fruit juices and fruits, popcorn, caffeine, and carbonated beverages.
  • Eat small meals. You may find that you feel better eating five or six small meals rather than two or three larger ones.
  • Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.
  • Ask about multivitamins. Because ulcerative colitis can interfere with your ability to absorb nutrients and because your diet may be limited, vitamin and mineral supplements can play a key role in supplying missing nutrients. They don't provide essential protein and calories, however, and shouldn't be a substitute for meals.
  • Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.

Stress


Although stress doesn't cause inflammatory bowel disease, it can make your signs and symptoms much worse and may trigger flare-ups. Stressful events can range from minor annoyances to a move, job loss or the death of a loved one.

When you're stressed, your normal digestive process can change, causing your stomach to empty more slowly and secrete more acids. Stress can also speed or slow the passage of intestinal contents. It may also cause changes in intestinal tissue itself.

Although it's not always possible to avoid stress, you can learn ways to help manage it. Some of these include:

  • Exercise. Even mild exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your doctor about an exercise plan that's right for you.
  • Biofeedback. This stress-reduction technique helps you reduce muscle tension and slow your heart rate with the help of a feedback machine. You're then taught how to produce these changes yourself. The goal is to help you enter a relaxed state so that you can cope more easily with stress. Biofeedback is usually taught in hospitals and medical centers.
  • Regular relaxation and breathing exercises. An effective way to cope with stress is to perform relaxation and breathing exercises. You can take classes in yoga and meditation or practice at home using books, CDs or DVDs.
  • Hypnosis. Hypnosis may reduce abdominal pain and bloating. A trained professional can teach you how to enter a relaxed state.
  • Other techniques. Set aside time every day for activities you find relaxing — listening to music, reading, playing computer games or just soaking in a warm bath.

What are the treatment options to prevent flare-ups of symptoms?


Medication


Once an initial flare-up of symptoms has cleared, you will usually be advised to take a medicine each day to prevent further flare-ups. If you have Ulcerative Colitis and do not take a regular preventative medicine, you have about a 5-7 in 10 chance of having at least one flare-up each year. This is reduced to about a 3 in 10 chance if you take a preventative medicine each day.

An aminosalicylate medicine, usually mesalazine (described above), is commonly used to prevent flare-ups. A lower maintenance dose than the dose used to treat a flare-up is usual. You can take this indefinitely to keep symptoms away. Most people have little trouble taking one of these medicines, as side-effects are uncommon. However, some people develop side-effects such as tummy (abdominal) pains, feeling sick (nausea), headaches, or rashes.

If a flare-up develops whilst you are taking an aminosalicylate then the symptoms will usually quickly ease if the dose is increased, or if you switch to a short course of steroids. Another medicine may be advised if an aminosalicylate does not work, or causes difficult side-effects. For example, azathioprine or 6-mercaptopurine are sometimes used.

Probiotics


Probiotics are nutritional supplements that contain 'good' germs (bacteria). That is, bacteria that normally live in the gut and do no harm. Taking probiotics may increase the 'good' bacteria in the gut, which may help to ward off 'bad' bacteria that may trigger a flare-up of symptoms. There is little scientific proof that probiotics work to prevent flare-ups. However, a probiotic strain (Escherichia coli Nissle 1917) and the probiotic preparation VSL3 have shown promise. Further research is needed to clarify the role of probiotics.

Who needs surgery?


Not everyone with Ulcerative Colitis has their symptoms well controlled with medication. About a quarter of people with Ulcerative Colitis need surgery at some stage. The common operation is to remove the colon and the rectum (the large intestine). There are different techniques used for this. It is helpful to discuss the pros and cons of the different operations with a surgeon. Removing the large intestine will usually cure symptoms of Ulcerative Colitis permanently.

Surgery is considered in the following situations:

  • During a life-threatening flare-up. Removing the large intestine may be the only option if it swells greatly (megacolon), punctures (perforates), or bleeds uncontrollably.
  • If Ulcerative Colitis is poorly controlled by medication. Some people remain in poor health with frequent flare-ups which do not settle properly. To remove the large intestine is a serious step but, for some people, the operation is a relief after a long period of ill health.
  • If cancer or pre-cancer of the large intestine develops.

Is Colon Cancer a Concern?


About 5 percent of people with ulcerative colitis develop colon cancer. The risk of cancer increases with the duration and the extent of involvement of the colon. For example, if only the lower colon and rectum are involved, the risk of cancer is not higher than normal. However, if the entire colon is involved, the risk of cancer may be as great as 32 times the normal rate.

Sometimes precancerous changes occur in the cells lining the colon. These changes are called "dysplasia." People who have dysplasia are more likely to develop cancer than those who do not. (Doctors look for signs of dysplasia when doing a colonoscopy and when examining tissue removed during the test.)

Recent studies indicate that the risk of cancer is reduced in people who take regular long-term aminosalicylate medication (described above). In one study, people with Ulcerative Colitis who regularly took mesalazine had a 75% reduced risk of developing colon cancer.

According to 1997 guidelines on screening for colon cancer, people who have had IBD throughout their colon for at least 8 years and those who have had IBD in only the left colon for at least 15 years should have a colonoscopy every 1 to 2 years to check for dysplasia. Such screening has not been proven to reduce the risk of colon cancer, but it may help identify cancer early should it develop. (These guidelines were produced by an independent expert panel and endorsed by numerous organizations, including the American Cancer Society, American College of Gastroenterology, American Society of Colon and Rectal Surgeons, and the Crohn's & Colitis Foundation of America Inc., among others.)