Related topics: •  Crohn's Disease •  Digestive Disorders Center

Nobody likes to have a stomachache. But if you have a stomachache along with bloody diarrhea and a fever, it's a lot more unsettling. That's what it's like if you have ulcerative colitis: Part of the lining of your digestive tract has become inflamed, and it can take days to get better. The inflammation usually occurs in the rectum or the lower part of the colon, but it can involve the entire colon (pancolitis).

Ulcerative colitis is very similar to another intestinal condition called Crohn's disease. In fact, both ulcerative colitis and Crohn's disease are often called inflammatory bowel disease (IBD), and it's not always possible to tell them apart. But unlike Crohn's disease, which damages the deep part of the intestine's tissues and can affect any part of the digestive system, ulcerative colitis only affects the top mucous lining, and it can be cured with surgery.

In most people, the symptoms of ulcerative colitis are mild, although they may gradually get worse. You may get extremely tired and notice an increased urge to defecate, stomach cramps, and blood and mucous in your stool.

If the disease has affected your rectum or the lower part of your colon, your stool may appear normal or may be hard and dry. Inflammation in the upper part of the colon opens the floodgates. You may have up to 20 bowel movements a day along with severe cramps and painful spasms in the rectum. The stool may consist almost entirely of blood and mucous. Not surprisingly, this can lead to dehydration, poor appetite, and weight loss.

Some people with ulcerative colitis suffer violent attacks with little warning. The attacks can cause explosive diarrhea along with a high fever and severe abdominal pain.

If you have any of the above symptoms, call your doctor promptly for advice and to set up an appointment.

The good news is that most people with ulcerative colitis, if given proper treatment, can lead normal, productive lives. Ulcerative colitis isn't usually a constant malady, and between attacks people usually feel well. The symptoms may disappear for months or years. Although some people experience frequent distress, about 10 percent of people who recover from a bout of the disease never suffer another attack.

Every colon contains billions of bacteria, and many experts believe some of these germs may help trigger ulcerative colitis. The exact mechanisms, however, are very unclear. It's possible that some bacteria cause inflammation by invading the lining of the intestine. More likely, the germs can set off an overly aggressive response from the immune system. Antibodies released to destroy germs may actually end up damaging the intestinal wall, creating large sores where healthy tissue should be.

Emotional stress won't cause ulcerative colitis. However, stress may make the pain feel worse. For more information on the link between mood and gastrointestinal trouble, see Gut Feelings: The Surprising Link Between Mood and Digestion.

Ulcerative colitis can strike people of any age, from children to the elderly, but most people report their first symptoms between 15 and 30. It's equally common in men and women. Ulcerative colitis sometimes seems to run in families, but the trend isn't especially strong. No more than 20 percent of all patients have a family history of the disorder.

Ulcerative colitis can turn into a serious health threat if it goes untreated. If your first bout of ulcerative colitis is sudden and severe, you may develop massive bleeding and widespread infections. At this point, quick medical help is crucial to your survival.

Toxic colitis (also called toxic megacolon) is another potentially deadly complication. In this condition, part of the colon becomes paralyzed, causing a blockage in the system. If this happens, you'll feel severe abdominal pain along with a fever. If not treated right away, the colon can burst, leading to life-threatening infections.

Ulcerative colitis increases your risk for colon cancer. Your doctor will want to perform regular colonoscopies or other exams to check for the disease.

An overactive immune system can give people with ulcerative colitis other conditions. When your gastrointestinal symptoms flare up, you may develop arthritis in your joints, the whites of your eyes may become inflamed, and you may see sores on your mouth and blue-red, pus-filled sores on your skin. Even when you're not feeling the pain of ulcerative colitis, you may get painful inflammation in other parts of your body, including your spine, pelvic joints, or eyeballs.

If your doctor suspects ulcerative colitis, he or she may run blood tests to check for anemia (a possible sign of internal bleeding) or elevated white blood cells (a sign of inflammation). In order to confirm the diagnosis, your doctor will have to take a close look at your colon with a sigmoidoscope, a thin, flexible tube equipped with a camera on one end.

This instrument provides clear pictures of the lower third of the colon. If your doctor needs a more complete view, he or she may order a colonoscopy -- a similar test that covers the entire colon -- or a barium enema. However, both barium enemas and colonoscopies can poke holes through the colon if done during a flare-up of ulcerative colitis. This complication is rare but the risk shouldn't be ignored.

Controlling ulcerative colitis will take some work. Your doctor can prescribe medications to slow the disease and ease the symptoms, but you may have to adjust your diet.

If you have relatively mild diarrhea, your doctor may suggest small doses of loperamide (Imodium) or a similar drug. More severe cases call for larger doses.

Your doctor may also use sulfa drugs such as sulfasalazine or mesalamine to ease the inflammation. If the inflammation is especially severe, your doctor may prescribe large doses of an oral corticosteroid such as prednisone. You can take them orally, intravenously, through an enema, or in a suppository. But because these drugs can cause serious side effects, your doctor will start lowering the dose as soon as your symptoms subside. Corticosteroids can cause you to gain weight and can bring on a case of acne, facial hair, hypertension, mood swings, and other problems. (Some studies suggest budesonide, a newer corticosteroid not yet approved in the United States for ulcerative colitis, may offer relief with fewer side effects.) Once the corticosteroids have done their job, your doctor may prescribe sulfasalazine or mesalamine to prevent flare-ups.

If neither the sulfa drugs or the corticosteroids do the trick your doctor may prescribe drugs that modulate your immune system, like azathioprine and 6-mercapto-purine (6-MP.) These drugs can have serious side effects, including pancreatitis, hepatitis, a reduced white blood cell count, and an increased risk of infection, so your doctor will want to monitor you carefully.

Sometimes if medication fails, the only cure for ulcerative colitis is surgical removal of all or part of the colon. About 25 percent to 40 percent of all patients eventually take this drastic step. As a result of the surgery, you may need a colostomy or ileostomy, procedures that reroute your bodily wastes through a hole to a bag on the outside of your body. There are alternatives, however. Doctors can save some of your rectum and attach it to a pouch created from the small intestine. That way you don't have to wear an external bag.

Getting the right medical treatment is only part of the battle. You should also talk to your doctor about diet and other lifestyle changes that can speed your recovery. Many patients do their part by drinking plenty of fluids and avoiding alcohol, caffeine, spicy foods, dairy products, and hard-to-digest foods such as seeds and nuts.

To avoid irritating the lining of your colon, you may also have to go easy on raw fruits and vegetables. Instead of eating three big meals each day, try several smaller meals.

A study in the October, 2004 issue of Gut found that the risk for an ulcerative colitis relapse increased three to five times in those who ate a diet high in meat -- especially red meat or processed meats. The same study showed that those who drank the most alcohol were three times as likely to have a relapse as those who were moderate drinkers.

Ulcerative colitis can make you feel frustrated, but by watching your diet and making sure your medications are working, you can at least feel that it's under control.

-- Chris Woolston, M.S., is a health and medical writer with a master's degree in biology. He is a contributing editor at Consumer Health Interactive, and was the staff writer at Hippocrates, a magazine for physicians. He has also covered science issues for Time Inc. Health, WebMD, and the Chronicle of Higher Education. His reporting on occupational health earned him an award from the northern California Society of Professional Journalists.

References

First published August 29, 2001
Last updated April 25, 2007
Copyright © 2001 Consumer Health Interactive

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