Ulcerative colitis is a chronic inflammation of the bowel that can occur in episodes. It usually begins in the rectum and spreads to the entire colon as it progresses. Typical signs are purulent and mucous diarrhea, sometimes accompanied by blood. In addition, severe abdominal pain and weight loss are evident. Ulcerative colitis should be examined and treated by a physician to rule out further complications.
What is ulcerative colitis?
Chronic-inflammatory bowel disease and affected regions in ulcerative colitis and Crohn’s disease compared. Ulcerative colitis is a chronic inflammatory bowel disease that affects the large intestine (colon). Ulcers (ulcerations) develop in the intestinal mucosa, which can extend from the rectum to the transition of the colon to the small intestine (ileocecal valve). At this point, the ileocecal valve, the involvement of the intestine ends, because in ulcerative colitis only the colon is affected. This is in contrast to another chronic inflammatory bowel disease, Crohn’s disease. Crohn’s disease can affect the entire gastrointestinal tract, which differentiates it from ulcerative colitis. The relapses occur repeatedly in ulcerative colitis and are promoted by many factors (stress, poor diet). Even though men and women are affected by the disease about equally often, there is a frequency of disease at younger age of adults. However, it can affect even small children and older people. Ulcerative colitis can be a trigger for colon cancer due to its long-lasting activity.
Causes
The causes of ulcerative colitis are still in the dark. A familial, genetic susceptibility is thought to be involved. Above all, an autoimmune reaction of the intestinal mucosa to certain substances plays a major role. This exaggerated reaction of the mucosa then manifests itself in the ulcers that are typical of ulcerative colitis. Evidence has also been found that various genetic changes favor an occurrence of the disease. A certain molecular protein, the so-called NF-κB transcription factor, is suspected of being permanently active and thus triggering ulcerative colitis. Once the disease has been diagnosed, a lifestyle with unfavorable hygiene or other environmental influences can cause constant flare-ups (relapses) of the disease. Influences also include diet and life circumstances, such as stress, worry and psychological strain.
Symptoms, complaints, and signs
In most cases, ulcerative colitis progresses in episodes, meaning that periods of severe symptoms alternate with symptom-free intervals. The severity of symptoms depends on which part of the colon is affected and how advanced the disease is. The leading symptom of ulcerative colitis is bloody, mucous diarrhea. In severe cases, patients have to deal with diarrhea up to several times a day and also suffer from a constant urge to defecate. However, the disease usually begins insidiously with few symptoms and a smaller number of diarrhea episodes. Before, during, or after bowel movements, patients may experience cramping pain, especially in the left lower and middle abdomen. These cramping pains are called tenesmus. The loss of blood through the stool can lead to iron deficiency and anemia as the disease progresses. During an acute episode, additional accompanying symptoms often occur, such as fever, loss of appetite, weight loss, fatigue and physical weakness. In childhood, growth disorders may also occur. In addition to the symptoms affecting the intestine, ulcerative colitis can also lead to inflammation of organs outside the intestine. Doctors refer to these as extraintestinal symptoms. Here, joint complaints, eye inflammation, skin changes or inflammation of the bile ducts in the liver may occur.
Course
The course of ulcerative colitis can be characterized by frequent relapses and periods of remission (recovery). Relapses are divided into acute, severe (fulminant), and chronic. In the latter, there is improvement but no real symptom-free period (remission). This chronic course usually occurs when the intestine no longer responds sufficiently to the therapy and a higher dosage of medication is no longer possible due to intolerance.This makes the course of ulcerative colitis very difficult. There are different degrees of severity of the course of the disease. These are the mild course, in which only the mucosa is swollen. The moderate course is characterized by ulcerations (ulcers) and bleeding, but not severe. In difficult courses, the intestinal mucosa is inflamed to a greater extent, resulting in severe changes. So-called pseudopolyps and abscesses may develop. The most severe acute course is megacolon (toxic enlargement of the colon), which can become life-threatening because peritonitis and intestinal rupture are imminent.
Complications
Due to the frequent diarrhea, patients sometimes suffer from massive losses of water, blood, and protein, and growth disorders may occur as a result, especially in adolescents. Ulcerative colitis may also spread to the entire intestinal wall under certain circumstances. In this case, there is a risk that the intestine will be overstretched and burst. In addition, it is possible that the inflammation then occurs throughout the abdomen, which is called toxic megacolon and is extremely dangerous. Toxic megacolon is associated with very severe pain and bloating, and there is also a risk of bacteria entering the blood and leading to sepsis (blood poisoning). Further complications can include bleeding, which can be very severe and life-threatening. Since patients can lose a lot of blood in the process, they have to undergo surgery or receive blood transfusions. Furthermore, people suffering from ulcerative colitis have a greater risk of developing colon cancer, which usually develops about ten to 15 years after the onset of ulcerative colitis. In some cases, narrowing or scarring of the bowel, known as stenosis, also occurs. In addition, organs may undergo pathological changes, mainly involving skin and eye disorders and joint inflammation. In rare cases, vascular, pulmonary, and cardiac involvement may also occur.
When should you see a doctor?
As with all chronic diseases, diagnosis by a specialist is important first. Thus, if persistent diarrhea and bloody stools are observed, a visit to an internist is inevitable. This also applies if pain in the lower abdomen is almost unbearable. Once the diagnosis has been established, the disease can be treated well. It is then up to the patient to decide how well he or she can live with it. A strict diet and taking the prescribed medication will reduce the symptoms. Not every diarrhea or bloody stool requires medical treatment. If the symptom occurs only for a short time, it is not necessary to go to a specialist. It is then only important that the further course is observed. Cramp-like abdominal pain is also not a compelling sign of ulcerative colitis. Every person knows himself best and knows how to assess the symptoms. In case of uncertainty or anxiety, however, the visit to the doctor should by no means be postponed. Only he will make the correct diagnosis and, if necessary, start treatment.
Treatment and therapy
Treatment of ulcerative colitis can be medicinal and surgical. In addition to mesalazine and sulfasalazine, cortisone is also used, either locally or systemically. Intestinal flora supporting probiotics are given for support. Another option is the use of immunosuppressors, TNF alpha blockers and biologics as newer forms of therapy. In individual cases with severe relapses, antibiotics may be helpful. In more severe courses, surgical removal of the colon may provide permanent relief.
Outlook and prognosis
The prognosis of ulcerative colitis depends on the course of the disease, the patient’s overall health, and the start of treatment. Ulcerative colitis has a chronic relapsing or chronic intermittent disease course in more than 80 percent of patients. In most patients, the disease therefore progresses in relapses. There are phases with and without inflammation. Between relapses, the majority of patients experience a complete recovery and thus a healing of their mucous membranes. Some patients are completely symptom-free for several years until the next relapse. Ten percent of patients experience a chronic, continuous course of the disease. In this case, the inflammation does not completely subside after the episode.Nevertheless, in particularly severe cases, the prognosis can also be very unfavorable. In acute situations, a sudden bloody and persistent diarrhea poses a threat to life. The risk of death thus increases considerably. In principle, the general risk of cancer also increases in patients with ulcerative colitis. The longer a patient has had ulcerative colitis, the higher the probability of developing colorectal cancer as a secondary disease. This significantly reduces the prognostic prospects. If the disease results in removal of the bowel, the vulnerability for further inflammatory disease of the bowel outlet increases.
Follow-up
Regular follow-up is advised for ulcerative colitis if only because people with the disease may be at increased risk for colorectal cancer. There may also be surgery-related abscesses or recurrences of inflammation. These must be treated immediately. Some colitis ulcerosa patients are at increased risk for colorectal cancer. According to statistics, about five percent of people with ulcerative colitis later develop colorectal cancer. The risk of developing it depends on the duration of the disease or the areas of the intestine that are chronically inflamed. It is a serious disease of the colon that persists throughout life. Ulcerative colitis causes recurrent inflammatory flares. With each inflammatory episode of the colon, a physician must evaluate what action to take. Surgical measures and postoperative follow-up are often necessary. Between inflammatory episodes, immunosuppressants and special nutritional measures can achieve extensive freedom from symptoms. Nevertheless, it is a chronic disease that has far-reaching consequences. Other organs can also be affected by ulcerative colitis. The treating physicians must also keep an eye on the extraintestinal concomitant diseases. These can also lead to complications that require treatment. Extraintestinal concomitant diseases to include open skin ulcers, eye inflammation, or bile problems. Sufferers cannot live symptom-free without regular doctor visits and expert follow-up care.
Here’s what you can do yourself
Because there are still many unknown components in the cause of chronic bowel disease, no comprehensive tips for self-help can be given at this time. A stress-free lifestyle is considered helpful. A regular daily routine, sufficient rest and recovery phases, and a healthy diet are central to this. The food intake should be rich in vitamins. Fats and foods that are difficult to digest should be avoided. Purification can be used and the intestines should be given sufficient rest between meals. If there are emotional or mental stress conditions, it helps to build up a stable environment so that a contact person is available at all times. In addition, the person affected should not be afraid to see a therapist in these cases. Exercise and sporting activities support well-being, as does a positive attitude to life. Optimism and confidence are conducive to supporting the organism. When taking medications, care should be taken to ensure that they do not burden the intestines as much as possible. Harmful substances and toxins such as nicotine, alcohol or drugs should also be avoided. The consumption of chili or other spicy ingredients should also be avoided. The pace of life is to be adapted to the possibilities of the person concerned, so that unnecessary stressors are avoided. Life circumstances that are perceived as dissatisfying or stressful are to be reviewed and can be changed or restructured with courage as well as confidence.
