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Large Intestine

Chronic Ulcerative Colitis

Colitis is inflammation of the lining of the colon (large intestine) that causes abdominal pain, diarrhea and bloody stools. A bout of colitis that lasts for several days and then decreases may result from certain foods, medications, or an infection. Chronic ulcerative colitis, however, is a more serious immune system disorder that can last decades and require long-term medical therapy. This type of colitis is closely associated with Crohn's disease, another inflammatory bowel disease (IBD).


Symptoms of Colitis

    • Diarrhea or loose stools
    • Abdominal pain
    • Urgent need to defecate
    • Cramps
    • Dehydration
    • Bloody stools


Symptoms of Chronic Ulcerative Colitis

Symptoms vary among patients depending upon where in the colon and rectum inflammation resides as well as its intensity. Inflammation may affect a small portion of the colon and rectum or, in worse cases, engulf the entire large intestine.

Patients with chronic ulcerative colitis are at risk of: anemia, from bleeding within the colon and rectum; bone disorders, including osteoporosis, because nutrients are not being absorbed by the intestines; and skin and eye disorders, common among patients with immune system diseases, such as rheumatoid arthritis. Patients with chronic ulcerative colitis also are at a higher risk of developing primary sclerosing cholangitis, a disorder of the bile ducts in the liver, and colon cancer.

Signs and symptoms of chronic ulcerative colitis can include:

    • Persistent diarrhea or loose stools
    • Bloody stools
    • Abdominal pain
    • Cramps
    • Urgent need to defecate
    • Dehydration
    • Constipation
    • Weight loss
    • Brittle bones
    • Malnutrition
    • Fatigue
    • Weakness
    • Anemia
    • Joint pain
    • Skin and eye disorders


Diagnosing Colitis and Chronic Ulcerative Colitis

Your gastroenterologist may suspect colitis based on your medical history and a review of your symptoms. He or she will have you undergo a colonoscopy procedure using a colonoscope to view the colon and rectum, and may take a tissue sample (biopsy) to help determine the cause. Other tests and procedures include:

    • BLOOD TESTS 

      Blood tests are taken to determine both red and white blood cell counts. A low red blood cell count can indicate anemia, from bleeding within the colon and rectum. Elevated white blood cells, which fight infection, indicate inflammation within the colon and rectum.

       
    • STOOL SAMPLE

      A stool sample may be taken to rule out a parasitic infection that can cause colitis.

       
    • CT SCAN

      In addition to a colonoscopy, a CT scan can determine what areas of the rectum and colon are inflamed.


Classification of chronic ulcerative colitis

Gastroenterologists categorize chronic ulcerative colitis based on the location and extent of inflammation within the colon and rectum. For most patients, the affected area remains the same during the course of the disease.

    • ULCERATIVE PROCTITIS

      Ulcerative proctitis is confined to the rectum (from the Greek, proktos, meaning anus) and symptoms will vary depending upon its severity. Some patients experience rectal bleeding while others may have rectal pain along with an urgent need to defecate. Pain associated with an urgent need to defecate is called tenesmus.

       
    • PROCTOSIGMOIDITIS

      Proctosigmoiditis involves the rectum and a small segment of colon on the left side of the body- the sigmoid colon -attached to the rectum. Symptoms can include rectal bleeding, an urgent need to defecate, tenesmus, cramps and bloody diarrhea.

       
    • LEFT-SIDED COLITIS

      Left-sided colitis affects primarily the sigmoid colon on the left side of the body and the descending colon. Symptoms can include pain on the left side, cramps, bloody diarrhea and weight loss.

       
    • UNIVERSAL COLITIS (PANCOLITIS)

      This type of ulcerative colitis affects the entire colon and rectum. Symptoms can include abdominal pain, cramps, bloody diarrhea, fever, fatigue and night sweats.

       
    • FULMINANT COLITIS

      Fulminant colitis is a severe form of universal colitis. This rare form can develop into a medical emergency. Symptoms are similar to universal colitis but also may include dehydration and perforation of the colon. Patients are treated in the hospital and in some cases the colon is surgically removed.


Treating Colitis and Chronic Ulcerative Colitis

Medications, and in severe cases surgery to remove the colon, are the mainstay of treatment for patients with chronic ulcerative colitis and Crohn's disease. Because these diseases are disorders of the immune system, in which the body attacks cells within the colon, the goals of treatment are to suppress inflammatory episodes (causing the disease to go into remission) and to improve quality of life. Unfortunately, as patients know all too well, the disease can flare up (relapse) repeatedly, the reason why treatment is usually life long.

  • MEDICATIONS
    Prescription anti-inflammatory medications and immune system modulators are two classes of drugs commonly used in treating chronic ulcerative colitis and Crohn's disease. Both classes of drugs have side effects when used long term. Your gastroenterologist will talk to you in more detail about side effects that can develop when taking these medications.

     
    • Anti-inflammatory medications

      Anti-inflammatory medications include 5-ASA (5-aminosalicylic acid) - sulfasalazine, olsalazine and mesalamine - that are also prescribed for patients with rheumatoid arthritis, as well as corticosteroids (prednisone).

       
    • Immune modulators

      Immune modulators suppress the body's immune system by interfering with the development of cells and proteins that lead to inflammation. These medications include 6-mercaptopurine (6-MP), azathioprine, cyclosporine and methotrexate.

       
    • Investigational drugs

      Newer medications coming onto the market are available within clinical trials, as are drugs used for other conditions that have been found to be effective against chronic ulcerative colitis and Crohn's disease. 

       
  • SURGERY
    Surgery to remove the colon may be recommended when medications are no longer effective or when severe cases (universal or fulminant colitis) are present. Your gastroenterologist and surgeon will talk with you in more detail about this treatment option.

     
  • NUTRITIONAL COUNSELING

    Patients with colitis and chronic ulcerative colitis often are at risk of malnutrition from the loss of nutrients as food and liquids make their way through the digestive tract. A nutritionist also can answer questions about what foods and liquids to avoid, such as milk products, alcoholic beverages, grains, and spicy foods that can make cramping and diarrhea worse when the disease recurs.