Ulcerative Colitis (UC), along with Crohn’s Disease, is often known as Inflammatory Bowel Disease. UC affects around 120,000 people in the UK. It most often affects individuals between the ages of 15 and 25 and affects men and women equally, though it can strike much younger (the mean age for diagnosis in under 18s is 12).
Around 1 in 7 people with the disease have a close relative who is also a sufferer. It causes inflammation of the lining of the large bowel (colon) which leads to ulceration. The underlying cause of UC remains unknown – though the disease is associated with dysfunction of the immune system, the body’s own T-cells attack the lining of the bowel, causing inflammation. This fools the immune system into treating this as an infection, increasing the response of the immune system and aggravating symptoms. There is no cure currently for the condition though various treatments exist which help to manage the symptoms.
UC symptoms will vary depending on the severity of inflammation and where it occurs in the colon, these are outlined below:
- Ulcerative proctitis. In this form of ulcerative colitis, inflammation is confined to the area closest to the anus (rectum), and for some people, rectal bleeding may be the only sign of the disease. Others may feel pain in the rectum and/or experience feelings of needing to go to the loo. This type of UC tends to be more mild than others.
- Proctosigmoiditis. This form involves the rectum and the lower end of the colon, known as the sigmoid colon. Bloody diarrhoea, abdominal pain and cramping, and an inability to move the bowels in spite of the urge to do so (tenesmus) are common problems associated with this form of the disease.
- Left-sided colitis. As the name suggests, inflammation extends from the rectum up through the sigmoid and descending colon, which are located in the upper left part of the abdomen. Signs and symptoms include bloody diarrhoea, abdominal cramping and pain on the left side, and unexplained weight loss. This is the most common form of the disease in UK patients (c. 40%)
- Pancolitis. Affecting more than the left colon, and often the entire colon, pancolitis causes bouts of bloody diarrhoea that can be severe, abdominal cramps and pain, fatigue, and significant unexplained weight loss. Though some people experience mild pancolitis which can be readily managed with medication, this form of the disease often appears more aggressive and is more difficult to manage than other more locally confined forms. This form of the disease affects about 1 in 5 sufferers.
- Fulminant colitis. Thankfully rare, this life-threatening form of colitis affects the entire colon and causes severe pain, profuse diarrhoea and, sometimes, dehydration and shock. People with fulminant colitis are at risk of serious complications, including colon rupture and toxic megacolon, a condition that causes the colon to rapidly dilate. Unless people with this form of the disease are treated successfully in hospital very quickly, the colon is surgically removed to prevent it perforating.
UC can also generate symptoms in other parts of the body, and may include mouth ulcers, skin rashes and lesions and inflammation (redness or pain) in the eyes, skin or joints.
Like Crohn’s Disease, UC is a life-long condition, with periods of acute illness often alternating with periods of remission. Over time, the severity of the disease usually remains the same, i.e. most people with a milder condition, such as Ulcerative proctitis, won’t go on to develop a more severe form of the disease.
As with Crohn’s Disease, there are a number of tests which can be used to diagnose UC and rule out other conditions. This will begin with a visit to the GP who will discuss symptoms and medical history, carry out initial external examination and decide on which specialist tests it may be appropriate to refer for. Usually this will mean referral for a colonoscopy, other methods include a sigmoidoscopy, and stool and blood tests can rule out other conditions. A barium X ray will assist in pinpointing areas of the digestive system which are affected.
There is no cure currently for UC, unless surgery is considered. However various medications can be used at various times to help manage symptoms. When in remission an aminosalicylate will often be prescribed to keep symptoms under control. During periods of flare up the prescription can be increased or steroids used. Steroids are very effective but care needs to be taken if using them over the long term, so the dose needs to be managed over time to the minimum needed to control symptoms. Aminosalicylates and steroids can be taken as tablets, suppositories or enemas.
If neither of these are effective then immunosuppresants may be used to suppress the immune system.
In very severe cases which can’t be brought under control in a hospital environment or which have a persistent and major detrimental impact on quality of life, surgery will be offered. This will involve the removal of the entire colon and either the rejoining of the small bowel (ileum) to the anus and the formation of an ileoanal pouch ( the most common procedure carried out ensuring that full continence is retained) or the joining of the small bowel to an opening in the abdominal wall (a stoma) through which waste will be collected into an ileostomy bag.
Outcomes and further sources of support
Depending on the severity of the disease, the medicines outlined above will be very helpful in its management. Should surgery be required it can be very effective in tackling current and future symptoms. The National Association for Colitis and Crohn’s Disease, known as Colitis and Crohn’s UK provides support and information and CORE also provides a very useful booklet available online.