Ulcerative colitis is a chronic disease that causes inflammation and ulcers in the inner wall of the colon, which includes the colon and rectum (part of the rectum).
Ulcerative colitis is one of the two main forms of chronic inflammatory diseases of the gastrointestinal tract called inflammatory bowel disease (IBD). The other representative is Crohn’s disease.
Functioning of the intestine
The digestive system is a long tube that starts at the mouth and ends at the anus.
The food passes through the esophagus, stomach and small intestine.
The small intestine consists of three sections: duodenum, jejunum, and ileum.
The small intestine is the part of the digestive system where food is digested and then transported into the bloodstream.
In the further course, the intestinal structure changes and becomes the colon and rectum (large intestine).
The colon absorbs water and stores undigested foods, such as fiber. These pass through the last part of the colon and are excreted as feces.
The feces are expelled through the anus into the toilet.
What is ulcerative colitis?
1. Colitis means inflammation of the colon.
2. Ulcerosa means that there is a tendency to ulcer formation in the places of inflammation.
An ulcer occurs when the intestinal wall is injured and the underlying tissue is exposed.
If one could look inside the gastrointestinal tract (intestinum), an ulcer inside the colon would look like a small red crater.
The ulcers that occur in ulcerative colitis develop in the colon and can bleed.
The different types of ulcerative colitis are classified according to their localization and the extent of inflammation:
- Ulcerative proctitis refers to inflammation that is limited to the rectum. Many patients with ulcerative proctitis may experience only mild intermittent rectal bleeding.
Other patients with severe rectal inflammation may experience pain in the rectal area, as well as violent urge to defecate (sudden feeling of having to go to the toilet and having bowel movements, with the fear of soiling oneself) and tenesma (painful stimulus and continued urge to defecate, even if there is no feces).
- Proctosigmoiditis is an inflammation of the rectum and sigmoid colon (a short segment of the colon adjacent to the rectum).
The symptoms of proctosigmoiditis are, as with proctitis, rectal bleeding, urge to defecate and tenesma.
Some patients with proctosigmoiditis also have cramps and diarrhea (with blood in the stool).
- Left-sided or distal colitis causes inflammation that begins in the rectum and extends to the left colon (sigmoid colon and descending colon). The symptoms of left-sided colitis are bloody diarrhea, abdominal cramps, weight loss and left-sided abdominal pain.
- Pancolitis is an inflammation of the entire colon (right colon, left colon, transversal colon and rectum).
Symptoms of pancolitis include bloody diarrhea, abdominal pain and cramps, weight loss, weakness, fever and night sweats. Some patients with pancolitis have only mild inflammation and mild symptoms that respond well to medication.
In general, however, patients with pancolitis suffer from more severe colitis variants and are more difficult to treat than those who have limited forms of ulcerative colitis.
- Fulminant colitis is a rare but severe form of colitis. Patients with fulminant colitis are seriously ill with dehydration, severe abdominal pain, bloody diarrhea and even shock.
You run the risk of developing toxic megacolon (dilation of the intestine due to severe inflammation) and rupture of the colon (perforation).
Patients with fulminant colitis and toxic megacolon are hospitalized in the hospital with potent intravenous drugs.
If these patients do not respond immediately to therapy, surgical removal of the diseased colon is required to avoid perforation or toxic megacolon.
Causes of ulcerative colitis
Like Crohn’s disease, ulcerative colitis causes inflammation and ulceration in the intestine. Unlike Crohn’s disease, which can affect the colon in different individual sections, ulcerative colitis usually occurs in a continuous section of the inner wall of the colon, starting at the rectum.
No one knows for sure what can trigger ulcerative colitis, but many agree on what the cause cannot be. The researchers do not believe that stress is the main cause, although stress can often worsen symptoms.
Current theories focus on the following possibilities:
Immune system Some scientists believe that a virus or bacterium can trigger ulcerative colitis. The digestive tract becomes inflamed when the immune system tries to fight invading microorganisms (pathogens). It is also possible that the inflammation stems from an autoimmune reaction in which the body gives an immune response, even in the absence of pathogenic microorganisms.
Heredity Since there is some likelihood of developing ulcerative colitis if a parent or sibling has the condition, scientists believe that genetic material increases the likelihood of developing the condition.
However, most people who have ulcerative colitis do not have a family history.
Symptoms of ulcerative colitis
Symptoms of ulcerative colitis include:
- Diarrhea and urge to defecate. Some people may have diarrhea 10 to 20 times a day. The urge to go to the toilet can also wake people up at night.
- Rectal bleeding. The disease usually causes diarrhea with mucus and blood discharge. One may feel rectal pain and a rushed urge to empty the intestines.
- Abdominal pain, often described as cramps. The abdomen can be painful when touching.
- Constipation. This symptom may occur depending on which parts of the intestine are affected. Constipation is much less common than diarrhea.
- loss of appetite.
- Fever. In severe cases, fever or other symptoms that affect the entire body may occur.
- Weight loss. Symptoms such as diarrhea can lead to weight loss.
- Lack of red blood cells (anemia). Some people have anemia due to low iron levels caused by blood in the stool or intestinal inflammation.
Other conditions with symptoms similar to ulcerative colitis include Crohn’s disease, diverticulitis, irritable bowel syndrome (IBS), and colon cancer.
How does ulcerative colitis develop?
Ulcerative colitis is a chronic and recurrent disease. Chronic means that it persists constantly. Recurrent means that there are moments when the symptoms come back (relapse) and moments when there are few or no symptoms (remission).
The severity and frequency of symptoms vary from person to person. The first onset of symptoms (first episode) is often the worst.
In most cases, ulcerative colitis begins in the rectum. This leads to proctitis, i.e. inflammation of the rectum. In some cases, the disease affects only the rectum, but the colon is not affected. In other cases, the disease spreads to the point where it affects some or all of the intestinal areas of the colon.
Between two exacerbations, the inflamed areas of the colon and rectum heal and the symptoms pass.
The severity of an exacerbation can be classified as mild, moderate or severe:
Mild – you go to the toilet less than four times a day, with and without blood loss. Usually there is no malaise (no systemic disorder).
Moderate – you go to the toilet four to six times a day and feel easily unwell (low malaise).
Severe – there are more than six emptyings with blood loss every day. The patient feels unwell and has other systemic symptoms such as fever, tachycardia and anemia.
On average, about half of people with ulcerative colitis experience remission each year with few or no symptoms. The other half suffer a relapse with exacerbation of symptoms at certain times during the year.
During the acute phase, some people develop symptoms gradually.
In other cases, symptoms appear quickly and in a few days.
Possible complications of ulcerative colitis include:
• Severe bleeding • Injury to the colon (perforated colon) • Severe dehydration • Liver disease (rare) • Inflammation of the joints, skin and eyes
• Growth retardation in some children
• Increase in the risk of colon cancer
• Rapid dilation
of the colon (toxic megacolon)
Diagnosis of ulcerative colitis
Ulcerative colitis can be diagnosed relatively easily, as it usually affects only the colon and rectum. As a rule, the most striking symptoms are the frequent diarrhea with mucus and blood admixtures.
The doctor can do the following:
• Take the clinical history and perform the physical examination.
• Using flexible sigmoidoscopy or colonoscopy, look at the colon and rectum inside. To do this, the doctor uses a small illuminated camera to examine the intestine.
Usually, a colonoscopy makes more sense because it allows you to look at the entire colon.
Both procedures can be used to take a tissue sample (biopsy) from the intestine.
The biopsies are obtained during sigmoidoscopy or colonoscopy to determine if ulcerative colitis is present.
A biopsy is also used in the search for cancer.
Other examinations and tests that may be performed:
- Radiography of the abdomen. This creates an image of the inner intestinal sections.
- Barium enema. It allows the doctor to examine the colon.
- CT or magnetic resonance imaging. These examinations show detailed images of the body.
- Stool examination (including a test for occult blood in the stool). This test looks for blood and for signs of a bacterial infection, parasite, or white blood cell.
- Blood and urine tests are used to detect anemia, inflammation or malnutrition.
- The rate of erythrocyte lowering (BKS) or testing for C-reactive protein (CRP) may indicate signs of infection or inflammation.
Some people have symptoms of inflammatory bowel disease, but Crohn’s disease or ulcerative colitis cannot be diagnosed.
These individuals have a form of IBD called indeterminate colitis.
However, doctors believe that the indeterminate colitis has the characteristics of Crohn’s disease and ulcerative colitis.
Treatment of ulcerative colitis
Currently, there is no cure for ulcerative colitis, except surgical rehabilitation. However, there are therapies that can relieve symptoms and prevent complications.
There are many people who suffer from this condition, but thanks to natural remedies and medicines, they have had no symptoms for many years.
Among the latest therapies discovered, aloe vera gel has been shown to reduce inflammation and relieve symptoms in ulcerative colitis.
Turmeric is another substance with anti-inflammatory properties that can help patients with ulcerative colitis.
Probiotics have been shown to be useful in maintaining the remission phase of the disease.Medication
Symptoms can usually be controlled with medication. The family doctor may prescribe other medications in the remission period than at the time of exacerbation.
For example, during remission, the doctor may prescribe a drug called 5-aminosalycilate (azulfidine – active ingredient sulfasalazine) to reduce inflammation and keep symptoms under control.
Side effects of this medication include: nausea, lack of appetite, abdominal pain, diarrhea, inflammation of the pancreas (pancreatitis), vomiting and fever.
With only mild exacerbations, the doctor may increase the dose to control symptoms.
If this is not enough, the doctor can prescribe cortisone.
Corticosteroids (for example, Rectodelt and Betnesol) reduce inflammation very quickly and effectively.
However, they can have serious side effects in the long term, so the doctor must gradually reduce the dose to the minimum necessary to control symptoms. Corticosteroids and aminosalicylates can be taken as tablets or used as suppositories or enemas (introducing fluid into the rectum).
If these treatments are unsuccessful, the doctor may recommend medications that suppress the immune system (immunosuppressants) and are usually taken as tablets.
One should always ask the doctor and read the patient information enclosed with the drug.
If the symptoms are very severe, admission to a clinic may be required to administer the steroids intravenously.
When does surgery have to be performed?
If medication doesn’t work, the doctor may recommend surgery.
Emergency surgery may be necessary if a toxic megacolon develops.
Surgery for ulcerative colitis involves complete removal of the colon and reorientation of the intestine to allow the excretory products to be drained. This type of surgery is called a colectomy and can be done in two ways:
The surgeon can remove the colon and rectum and connect the ends of the small intestine to the anus. The doctor creates a reservoir at the end of the small intestine that replaces the colon and allows defecation as before.
The surgeon can remove the colon, rectum and anus and place the new end of the small intestine to an exit in the abdominal wall. This operation is called ileostomy. At the opening, an external bag is applied, in which stool and intestinal gases are absorbed.
Diet and nutrition
Some foods can worsen the symptoms of diarrhea and flatulence, especially during periods of exacerbation.
Some suggestions for nutrition are:
- Consume small portions throughout the day.
- Drink plenty of water (small amounts throughout the day).
- Avoid high-fiber foods (bran, beans, walnuts, green leafy vegetables, seeds, and popcorn).
- Avoid citrus fruits and bananas.
- Avoid fatty or fried foods and sauces (butter, margarine and cream).
- Chili and ginger are very suitable foods for diarrhea.
- Anyone who has lactose intolerance should limit the consumption of dairy products. Dairy products are a good source of protein and calcium.
There are studies that show a slight improvement from nicotine, although many other serious side effects exist.
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