Ulcerative colitis: Even the name is a mouthful. But let’s break it down. UC is a chronic autoimmune disease that causes inflammation of the colon (that’s the colitis part) and rectum. That inflammation leads to ulcers (that’s the ulcerative part), or open sores, in the intestinal lining that can bleed or leak pus and mucus. Along with that may come other symptoms like severe and frequent diarrhea and pain. You may also hear the term “colitis,” but know that ulcerative colitis and plain “colitis” are very different things. Colitis is short-term inflammation of the colon, whereas ulcerative colitis is a more serious chronic disease.
UC is one of two main types of inflammatory bowel disease (IBD). Crohn’s disease is the other. While Crohn’s and UC are similar, there are some key differences—the main one being that UC is typically related to inflammation concentrated in the large intestine, while Crohn’s may affect any part of the digestive tract.
Let’s start with the immune system. A healthy immune system protects the body from invaders, like bacteria and viruses, by triggering temporary inflammation (called the “immune response”) to help fight them off. After the infection is cleared, the inflammation typically goes away.
But that’s not how things go down with UC. Instead, the immune system doesn’t get the message that the fight is over, so the level of inflammation stays high—and healthy tissue becomes collateral damage. In the case of UC, the lining of the colon and rectum become the misdirected target. However, this kind of chronic inflammation can eventually lead to symptoms body-wide.
What Causes UC in the First Place?
If you’ve been diagnosed with UC, one of your first questions might be, “Why did this happen to me?” Unfortunately, there’s no easy answer. According to scientists, there are a number of factors that work together to determine whether a person develops UC.
Here are the main risk factors for ulcerative colitis include:
- Genetics. UC often runs in families, and a number of genetic differences have been identified in people with IBD, according to an article in The Lancet. If you have a parent or sibling with the disease, your own risk is increased 10-fold. But even with that big jump, it’s still hardly a given that you’ll develop it: Only about 10% to 25% of people with UC have a first-degree relative with IBD (either UC or Crohn’s).
- Age. Typically, UC first appears in people between the ages of 15 and 30. It’s also more likely to develop in people over 60, possibly because of the aging immune system and body as a whole.
- Race and ethnicity. While UC affects people of all races and ethnicities, Caucasian people and those of Ashkenazi Jewish descent are at increased risk.
- High-fat diet. While you may find that certain foods trigger your symptoms more than others, there’s no one diet that specifically causes UC. However, some research shows that consistently eating a lot of high-fat foods may slightly increase your risk.
One of the most common symptoms of UC is probably also the scariest: seeing blood in your poop. You can thank those intestinal ulcers for that. You may also have diarrhea that just won’t quit even after three to five days, persistent abdominal pain (ranging from squeezing and cramping to sharp pain), or frequent urges to relieve yourself even though there’s nothing much to show for it.
In other words, if you’re having these symptoms for days and you can rule out a bad batch of take-out, something UC-related could be going on.
UC symptoms can range from mild to severe, and your doctor will take all your symptoms into account when assessing your case. Here are some of the main symptoms to watch for:
- Blood or pus in your stool (It may be bright red, pink, or almost black.)
- Frequent, persistent diarrhea (Those with moderate disease may have 4 to 6 bowel movements per day because your inflamed colon just can’t process food properly.)
- Tenesmus (It’s the sudden and frequent feeling that you need to have a bowel movement, but nothing happens when you try to go.)
- Abdominal pain or discomfort (This may feel like squeezing pressure, cramping, or tenderness on the lower left abdomen.)
- Weight loss (Because a lot of what you’re eating isn’t being absorbed into your body.)
- Fever (It’s usually persistent but low-grade; chronic inflammation can literally heat your temp.)
- Fatigue (This is deep-in-your bones, can’t-get-through-the-day exhaustion.)
- Reduced appetite (Because who feels like eating when you’re pooping all the time?)
Also important to know: The systemic inflammation from UC can cause non-digestive symptoms too, including anemia (due to blood loss), eye and skin problems like skin ulcers and inflammation, and even arthritis-like joint pain.
What Is the Best Treatment for UC?
The key goal of UC treatment is to stop the inflammation and reduce your symptoms—hopefully to the point of remission (meaning you have few symptoms, if any). But how exactly your UC is treated comes down to the severity of your disease. Your GI will recommend different approaches based on whether your UC is mild, moderate, or severe.
You’re probably in the mild range if you’re having fewer than four bowel movements a day and just mild cramping. On the other end of the spectrum, severe disease may involve more than six bowel movements a day and more extreme abdominal pain.
Treatment options include medications and, in severe cases, surgery—along with certain lifestyle changes.
Medications for UC: You’ve Got Options
Good news: There are more medication options for UC available now than ever before. Work with your doctor to figure out the best treatment plan for you.
UC medications include:
- Aminosalicylates (5-ASAs). This group of drugs, which includes mesalamine, helps to reduce inflammation in your intestines. If your UC is mild to moderate, your doc may consider this option for you. These drugs can be taken daily as either an oral pill or a rectal suppository, depending on the location of the symptoms you want to target (for example, a suppository may work especially well if you’re experiencing inflammation mainly in your rectum, not your colon).
- Steroids. Steroids can help decrease inflammation throughout the body. They can be given orally, rectally, through an IV, or as an injection. Because they come with a high risk of side effects, steroids are a short-term treatment option, typically only prescribed if you’re in an active flare to get moderate-to-severe inflammation under control quickly.
- Immunomodulators: These immune system-modifying drugs are given in a daily pill or via weekly injection and help reduce your body’s immune response, thereby stopping further inflammation. Sometimes your doc will prescribe a short course of steroids along with an immunomodulator, since immunomodulators can take several months to take effect.
- Biologics: Biologic drugs target key proteins in the immune system that are involved in inflammation, going straight to the source of your UC. These drugs are usually prescribed for moderate-to-severe UC and can help you get to or maintain remission from your disease, according to a study in Gut and Liver. They’re either given as a self-injection, usually every two to four weeks or through an IV at a health care provider’s office every two to eight weeks.
Your doc also may suggest certain over the counter (OTC) drugs, including pain relievers and anti-diarrhea medications, along with supplements to help combat any nutritional deficiencies you have as a result of your UC, like iron or vitamin D.
Surgery for Ulcerative Colitis
Thankfully, surgery isn’t super common for people with UC nowadays, thanks to newer drugs that are effective even for severe UC (hello, biologics!). That said, there are some cases when surgery needs to be considered, such as when your UC doesn’t respond to medications or there are complications, such as uncontrolled bleeding or a perforated colon.
Typically, the surgery for severe UC is a proctocolectomy, which involves removing the colon and rectum. We know this probably sounds drastic, but many people actually get their life back after these procedures. There are two main versions of the surgery:
- J-pouch: This procedure involves creating a pouch inside your body to replace some of the function of the removed large intestine. It’s created from part of your small intestine and is connected to your anus, so once you heal, you’ll be able to go to the bathroom like usual.
- Ostomy: This one will require wearing an external pouch (called an ostomy bag) to collect waste moving forward. This second option can sound particularly daunting—and while it certainly is a big adjustment, know that it’s totally possible to live an active, happy life with an ostomy.
It’s also important to know that while surgery can stop many of your UC symptoms, some issues may persist even after this surgery, including complications like pouchitis (when your J-pouch gets inflamed).
Lifestyle Changes That Can Help
You may also find relief by making changes to your daily life, including your physical activity, diet, and more. Here are some areas to focus on: