Ulcerative colitis

Published by Bupa's Health Information Team, April 2010.

This factsheet is for people who have ulcerative colitis, or who would like information about it.

Ulcerative colitis is an inflammatory bowel disease that affects about one in every 500 people in the UK. It is a chronic condition (one that lasts for a long time) that causes inflammation and ulcers in the lining of the large bowel (colon).

About ulcerative colitis

In ulcerative colitis, the lining of your large bowel and back passage (rectum) becomes inflamed and develops ulcers. This means that your large bowel can't absorb as much water as usual, leading to diarrhoea. Sometimes ulcerative colitis only affects the rectum - this is called proctitis. Proctitis is less severe than ulcerative colitis.

Ulcerative colitis is known as a 'relapsing and remitting' condition. This means that your symptoms can disappear and then flare up again from time to time. Flare-ups of ulcerative colitis can be sudden and severe. You may then have long periods with few or no symptoms at all.

Ulcerative colitis usually develops between 15 and 30 years of age but it can be diagnosed at any time. It is equally common in men and women.

Symptoms of ulcerative colitis

The main symptom of ulcerative colitis is frequent diarrhoea that sometimes has blood and/or mucus in it. You may also have abdominal cramping during bowel movements.

Other symptoms include:

• urgently needing to have a bowel movement
  
• feeling like you haven't finished on the toilet
  
• feeling sick
  
• losing your appetite
  
• losing weight
  
• having a fever and night sweats
  
• feeling tired
  
• incontinence

If you have proctitis, you may not have diarrhoea, but may still frequently have an urgent need to have a bowel movement, and have bleeding from your back passage.

You may also get associated problems in other parts of your body if you have ulcerative colitis. These may include mouth ulcers, skin rashes and lesions and inflammation (redness or pain) in your eyes, skin or joints.

These symptoms aren't always due to ulcerative colitis but if you have them you should visit your GP.

Complications of ulcerative colitis

It's possible that your large bowel may expand and even tear if you have a severe flare-up. This is known as toxic megacolon. Symptoms of toxic megacolon include a high temperature and a painful and tender abdomen (tummy). You should seek immediate medical attention if you have these symptoms. Toxic megacolon can be life-threatening, but most people who receive prompt medical treatment recover.

Having ulcerative colitis increases your risk of developing bowel cancer. Your risk is greater if you have had ulcerative colitis for a long time (more than eight years) and if it is very severe.

Because of this, you will be advised to have regular colonoscopies to check for any signs of cancer developing. A colonoscopy is a procedure to look inside your large bowel. If any cancerous cells are found in a colonoscopy, you may need surgery to remove the affected area of your large bowel. Talk to your GP or gastroenterologist (doctor who specialises in conditions that affect the digestive system) for more information about this.

Causes of ulcerative colitis

The exact reasons why you may develop ulcerative colitis aren't fully understood at present. It may run in the family - about one in seven people with ulcerative colitis have a close relative who also has the condition. It is thought that other factors, such as eating certain types of food or having an infection, could also trigger it.

Diagnosis of ulcerative colitis

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP may ask you for a sample of faeces (also called a stool sample) to make sure you don't have a bacterial infection. He or she may also ask you to have a blood test. This is to check for anaemia and signs of inflammation. Depending on the results, your GP might refer you to a gastroenterologist for more tests. These may include the following.

• A colonoscopy. This allows your doctor to look inside your large bowel using a narrow, flexible, tube-like telescopic camera called a colonoscope. The colonoscope is carefully passed through your anus and rectum, and the image of inside your bowel is relayed to a monitor.
  
• A flexible sigmoidoscopy. This allows your doctor to look inside your rectum and the lower part of your bowel using a sigmoidoscope, a tube-like telescopic camera similar to a colonoscope.
  
• A biopsy. A biopsy is a small sample of tissue. Your doctor may take a small sample of the tissue from inside your bowel. This will be sent to a laboratory for testing.
  
• A barium enema X-ray. This test involves placing a fluid containing barium (a substance which shows up on X-rays) into the bowel via your rectum. X-ray images of the abdomen then show the inside of your bowel more clearly.

Treatment of ulcerative colitis

At the moment there is no cure for ulcerative colitis without the need for surgery. However, there are treatments that can help ease your symptoms and prevent complications.

Medicines

Your doctor may prescribe you different treatments for when you have a flare-up and for when you are in remission.

When you are in remission, he or she will probably prescribe you a medicine called an aminosalicylate to help keep your symptoms under control.

If you have a moderate flare-up, your doctor may increase your dose to try to control your symptoms. If this doesn't work or your flare-up is quite severe, your doctor may prescribe you steroids. Steroids are very effective because they act quickly to reduce the inflammation. However, they can have serious side effects over the long term so your doctor will gradually reduce the dose to the minimum needed to control your symptoms.

If these treatments don't work, your doctor may give you medicines to suppress your immune system (immunosuppressants).

You can take steroids and aminosalicylates as tablets, suppositories or as enemas (a liquid injected into your rectum). Immunosuppressants usually come as tablets. Always ask your doctor for advice and follow the patient information leaflet that comes with your medicine.

Surgery

Your symptoms can usually be controlled with medicines. However, if a number of different treatments don't work, your doctor may suggest surgery. You may also need surgery if you develop toxic megacolon.

Surgery for ulcerative colitis involves completely removing your colon and redirecting your small bowel so that your body is still able to get rid of waste products. This can be done in two ways.

• Your surgeon may join the end of your small bowel to your anus. He or she also creates a pouch from the end of your small bowel, which will replace your colon and allows your bowel movements to carry on as usual. This is called a proctocolectomy and ileoanal pouch and is the most common type of procedure for ulcerative colitis.
  
• Your surgeon may attach your small bowel to an opening in your abdomen. You then use an external pouch placed over the opening, called an 'ileostomy bag', to collect waste. This is called an ileostomy and is the traditional type of operation for ulcerative colitis.

Your doctor will discuss your treatment options with you.

Living with ulcerative colitis

Having ulcerative colitis can be both physically and emotionally stressful. Stress does not cause ulcerative colitis. However, it's thought that it can make your symptoms worse and may contribute to flare-ups.

Some of these simple stress-reduction techniques may help stabilise your condition.

• Hypnosis - treatment by a trained professional may help reduce abdominal bloating and pain.
  
• Relaxation and breathing exercises - try yoga or meditation.
  
• Exercise - gentle activity can lower stress and help settle your bowel.
  
• Down time - set aside time each day to do something relaxing, such as reading or having a bath.

Frequent bouts of diarrhoea can make it harder to work. Talk to your employer about any help that may be available to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.