Ulcerative colitis

Ulcerative colitis is one type of a condition called inflammatory bowel disease (IBD).
New Zealand has the third highest rate of inflammatory bowel disease in the world with the number increasing at an alarming rate. It is estimated to affect 15,000 New Zealanders.

What is it?

Ulcerative colitis is a long-term condition where the lining layer of the large bowel or colon becomes inflamed and develops many tiny breaks in its surface (ulcers) which may contain some pus. Ulcerative colitis always involves the rectum, but involvement of the rest of the colon varies from patient to patient.

What is the colon?

The colon (otherwise known as the large bowel) is the part of the bowel between the small intestine (where your digested food is absorbed into your system), and the anus or back passage, from which faeces (stools, motions, wastes) are discharged. The part of the colon immediately above the anus is the rectum.

What does the colon do, and how does ulcerative colitis alter its functions?

The colon does two things. Firstly, it extracts fluid from the liquid waste which enters it from the small intestine, concentrating this waste down to make solid faeces. In more severe ulcerative colitis, this concentrating function becomes defective and the patient has liquid diarrhoea in addition to the discharge of blood and mucus. Secondly, the colon acts as a reservoir for solid faeces, allowing about 1-3 bowel motions daily. In active or longstanding ulcerative colitis, this reservoir capacity is decreased, leading to more frequent bowel motions even in the absence of diarrhoea.

What are the symptoms?

Symptoms do vary from one patient to the next and can range from mild to severe depending on how much of the colon and rectum is inflamed and its severity. Symptoms usually develop over time and most cases of ulcerative colitis are mild, but once symptoms are identified it is important to receive prompt medical attention.

The main symptoms of ulcerative colitis are:

  • Frequent episodes of diarrhoea, which may contain blood, mucus or pus
  • Lower abdominal pain
  • Needing to empty your bowels frequently
  • Fatigue
  • Loss of appetite and weight loss.

Ulcerative colitis is a chronic condition – you may experience periods of time where you have no signs or symptoms (remission) which can be followed by relapses where the symptoms may flare-up and increase in severity.

In the long term, relapsing disease is a threat to good health rather than to life. Ulcerative colitis is most dangerous if the attack is very severe, particularly is this attack fails to come under control with medical treatment and requires emergency surgery.

What causes ulcerative colitis?

It is not known exactly what causes ulcerative colitis, although it is thought to be an autoimmune condition and there are clearly some genetic factors that make some people more likely to develop ulcerative colitis as well as other environmental factors that might cause the initial inflammatory insult to occur. 

The disease probably represents an abnormal and prolonged response of the body to various forms of damage, infections and other similar injuries to the bowel wall that would normally be of trivial importance.

Ulcerative colitis can begin at any age but usually begins between the ages of 15 and 30 years. The condition also has an increased incidence between the ages of 50 and 70 years. Women are more commonly affected by the condition than men.

Diagnosing ulcerative colitis

Ulcerative colitis is suspected on a history of bleeding from the colon, with or without diarrhoea, mucus, and discomfort or pain.

An examination of the abdomen, stool sample and blood test are the first steps in diagnosis followed by a more definitive diagnosis usually made by a Gastroenterologist.

Treating ulcerative colitis

Treatments for ulcerative colitis can usually be divided into medications that are used to treat active inflammation, and medications that are used to maintain control and lessen the likelihood of future flare-ups.

Non-surgical treatment

Gut specific anti-inflammatories known as aminosalicylates are often the first treatment option, often with good effect for mild-moderate symptoms. These drugs are related to the aspirin that is commonly used and they settle inflammation from within the gut.

Treatment may be given by tablets and self administered liquid or foam enemas. Medicines such as Pentasa®, AsacolTM, Asamax®, or Salazopyrin® are aimed at reducing the likelihood of a flare-up.

Surgical treatment

All or most of the colon may be removed at an operation for various reasons:

  • If a very severe attack of ulcerative colitis is not getting better in spite of intensive medical treatment
  • If repeated attacks over the years are harming the patient’s well-being and not responding quickly to medical treatment, particularly in patients with involvement of most or the entire colon
  • If the patient has repeated attacks of inflammation in other systems, such as the eyes, skin or joints, accompanying their attacks of ulcerative colitis
  • If there are any pre-cancerous changes in the colon

Living with

There are no specific things that can improve the disease course, but simple and common sense advice is to keep active and fit, eat a well-balanced diet, and avoid drinking excess alcohol.

People with ulcerative colitis will naturally make adjustments in their patterns of work, domestic and social activities in order to help cope with the frequency and urgency of bowel actions which can accompany active phases of the disease. Prolonged travel and visits to supermarkets, for example, may be viewed as distressing prospects. Here, the sympathy and understanding of your family will lessen the stress of desperate searches for a ‘toilets’ sign.

Though ulcerative colitis may start at any age from newborn to well over 80, it most commonly appears for the first time in the 15-35 age group, when one hopes for good health in order to cope with a career, relationships and bringing up a family. As with any other chronically recurring disorder, sympathy and understanding from the patient’s partner and family will help greatly to lessen the strains imposed by that feeling of “not being quite up to it”. The intimate details of one’s bowel functions are not something easily discussed, even with a partner.

Pregnancy in ulcerative colitis should be a planned event and discussed with your specialist first.

Regarding contraception, the pill will not worsen your ulcerative colitis and ulcerative colitis should not affect the efficacy of the pill.

Find out more:

The Canterbury Crohn’s and Colitis Support Group are very active and have a large amount of information.

They also provide a very useful handbook for people living with IBD. You can download the handbook here.