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Common Ailments ~ Ulcerative Colitis

Colitis

Age: onset most common between the ages of 15 and 35

Genetics: sometimes runs in families; more common in white people and in certain other ethnic groups

Lifestyle: more common in non-smokers and ex-smokers

Colitis is a long-term, intermittent inflammatory disorder that most commonly develops in young adults. The disorder causes ulceration of the rectum and the colon; it may either affect the rectum alone or extend from the rectum further up the colon. In some cases, the disorder involves the entire colon.

Ulcerative colitis affects about 1 in 1,000 people. It occurs most frequently in white people, particularly those of Jewish descent. Smoking may give some protection against the disease.

Crohn’s disease is a long term inflammatory disease that can affect any part of the digestive tract. Parts most frequently affected are the small intestine leading to the large intestine and colon.

What is the cause?

The exact cause is unknown. However, there is some evidence that genetic factors are involved, since about 1 in 10 people with Crohn’s Colitis has a close relative who has the disease. There may also be a family history of intestinal diseases, and of allergic disorders, such as eczema

What are the symptoms?

The symptoms are often intermittent and there may be several months or years in which there are few or no symptoms. In a mild episode, symptoms often develop over a few days and may include the following:

  • Diarrhoea, sometimes with blood and mucus in the stool
  • Abdominal pain
  • Tiredness
  • Loss of appetite
  • General feeling of ill health

In a severe attack, the symptoms may begin suddenly, developing over just a few hours. Symptoms may include:

  • Severe bouts of diarrhoea. At least six times a day
  • Passage of blood and mucus from the anus
  • Pain and swelling in the abdomen
  • Fever
  • Weight loss

People with Ulcerative Colitis often have other associated disorders. These include pain in the joints and in the spine, inflammation in the eye, and the skin condition erythema nodosum

Are there complications?

A severe, sudden attack may lead to toxic megacolon. In this condition, the colon becomes inflamed and greatly distended. As a result, the wall of the colon can perforate, allowing intestinal contents containing bacteria to leak into the abdominal cavity. This leakage can cause peritonitis, a potentially fatal disorder.

Further complications may include pus-filled cavities near the anus. These cavities can develop into abnormal passages between the anal canal and the skin around the anus, called anal fistulas.

Intestinal obstruction caused by thickening of the intestinal walls is a fairly common complication. Damage to the small intestine may prevent the absorption of nutrients and thus lead to anaemia or vitamin deficiencies.

Inflammation of the colon over a long period of time may also be associated with an increased risk of developing colorectal cancer. The risk is increased further if the condition is severe and began at an early age.

How is it medically diagnosed?

If your symptoms are fairly mild, your doctor will probably ask you for a faecal sample, which will be tested to exclude the possibility of an infection. You may also have a colonoscopy during which a small sample of tissue may be removed from the lining of the rectum of the colon for microscopic examination. Sometimes, a specialised contrast X-ray called a barium enema, which detects abnormalities in the intestinal lining, may be performed. You may also have blood tests to look for anaemia and to assess the extent of inflammation of the colon

What is the medical treatment?

Ulcerative colitis is usually treated with drugs, but surgery may be necessary if you are experiencing frequent severe attacks or if complications develop.

Drugs

Your doctor may prescribe the anti-inflammatory drug sulfasalazine to prevent attacks or treat mild episodes. Alternatively, you may be given mesalazine, which has fewer side effects. If the inflammation is confined to the rectum of the lower part of the colon, your doctor may prescribe aminosalicylate drugs for you to self administer in the form of an enema or suppositories. If the Crohn’s colitis has spread further up the colon, you will be given the drugs to take orally.

If you have severe, sudden attacks of the disorder, your doctor will probably prescribe corticosteroids to be taken orally or as an enema. Long-term use of corticosteroids may cause side effects, such as weight gain and a moon-shaped face. For this reason, the doctor will reduce the dose once your symptoms have started to subscribe and stop the treatment as soon as possible.

Surgery

Surgical treatment is usually necessary for people who experience persistent symptoms despite treatment with drugs. It may also be recommended for people who have a sudden, severe attack that does not respond to medical treatment and that may lead to toxic megacolon. In addition, surgery may be advisable for people with an increased risk of colorectal cancer. Surgery usually involves the removal of the diseased colon and rectum and creation of a stoma, which is an artificial opening in the abdominal wall through which the small intestine is used to create a pouch that connects the small intestine to the anus. This operation avoids the need for a stoma, but the pouch may become inflamed and the frequency of bowel movements often increases.

 

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