Ulcerative Colitis: Symptoms and Treatment

Ulcerative colitis is a type of inflammatory bowel disease (IBD) that causes inflammation of the colon or large intestine, leading to sores or ulcers. It is closely related to Crohn's disease, another type of inflammatory bowel disease or IBD. In ulcerative colitis, the inflammation or ulcer develops in the inner lining of the rectum or large intestine. On the other hand, Crohn's disease is characterized by inflammation in the deep layers of the intestinal wall; more commonly in the ileum or lowest part of the small intestine.

Types of Ulcerative Colitis
Depending on the location and extent of inflammation, ulcerative colitis can be classified into the following five types:

Ulcerative proctitis: The rectum and the lower portion of the colon is affected in this type of colitis.
Proctosigmoiditis: This occurs when the rectum, along with a small part of the colon adjacent to rectum namely, the sigmoid colon is affected.
Pancolitis: When the entire colon or large intestine is affected, pancolitis is said to have occurred.
Limited or distal colitis: This type of colitis affects the left side of the colon.
Fulminant colitis: It is a very severe form of pancolitis, having serious complications, which may involve the need for surgical removal of the diseased colon, to prevent colon rupture.

Causes of Ulcerative Colitis
The exact causes of the disease are still unknown. So, the disease is said to be idiopathic, which means that it develops on its own, without any apparent external reasons or factors. However, researchers believe that there are two factors which could be responsible for triggering the disease. They are:

Abnormal activation of the immune system in the intestine: The immune system is composed of immune cells and proteins produced by these cells. This is normally activated whenever harmful bacteria, virus or any other foreign elements enter the body. But, in case of ulcerative colitis, the immune system in the intestine gets activated even in the absence of any foreign element, and starts attacking the 'good' bacteria within, thereby causing inflammation and sores.

Genetic factors: Although 85% of people with ulcerative colitis do not have any close relative suffering from the disease, the remaining 15% do. The fact that this disease is more prevalent among close-bred communities, points to the genetic code as a triggering factor.

Symptoms of Ulcerative Colitis
Common symptoms of ulcerative colitis include rectal bleeding, pain in the abdomen, and diarrhea. But, the symptoms may vary in different individuals, depending on the extent of the disease.

Patients of ulcerative proctitis and Proctosigmoiditis may experience mild rectal bleeding. If the rectal inflammation is severe in nature, then, in addition to rectal bleeding, they may also experience rectal pain, urgency to defaecate, and difficulty and pain during defecation (tenesmus).

The symptoms of limited or distal colitis are bloody diarrhea, pain in the left side of the abdomen, abdominal muscle cramps and loss of weight, while those suffering from pancolitis may also experience fever and night sweat.

The symptoms of fulminant colitis include dehydration, prolonged bloody diarrhea, severe pain in the abdomen and shock. Patients of fulminant colitis may also develop toxic megacolon (dilation of the colon due to severe inflammation), resulting in colon rapture.

Diagnosis and Treatment
Bacteria and parasites can sometimes cause colitis that imitates the symptoms of ulcerative colitis. A stool test needs to be conducted in order to differentiate between the two.

A blood sample of the patient is also tested to determine the severity of the inflammation. If the individual is suffering from ulcerative colitis, then the blood test will show anaemia, and an increased level of sedimentation rate (the rate at which red blood cells sediment or settle in a test-tube per hour).

A confirmed diagnosis can be made with the help of endoscopy. In endoscopy, thin and lighted flexible tubes called colonoscopes and sigmoidoscopes are inserted through the anus and rectum, in order to examine the interior of the colon. Small samples of tissue are also collected from the colon to determine the severity of the disease. This process is known as biopsy.

Barium enema X-ray, is another test that is used in the diagnosis of ulcerative colitis. In this test, rectum and colon are filled with a chalky substance containing barium. Since barium is radio-opaque, it can sketch the colon in the X-ray, thus helping in the diagnosis of ulcerative colitis.

Although, there is no cure for ulcerative colitis available today, there are medicines to relieve the symptoms and some complications associated with the disease. Generally, steroids and 5-aminosalicylate (5-ASA) compounds are used to reduce inflammation. They can be taken as tablets, enemas and suppositories, depending on the severity of the disease. However, use of steroids for a long time can give rise to some side effects.

Immunomodulators are medicines that suppress the immune system and help to stop the abnormal immune response and inflammation, either by reducing the number of immune cells, or by interfering with their production of proteins. They are used as medicines for patients who do not respond to regular anti-inflammatory medicines.

Patients suffering from ulcerative colitis limited to the rectum and a small portion of the colon, usually respond to anti-inflammatory medicines and immunomodulators. However, those suffering from severe ulcerative colitis, may require surgical removal of the colon.

Proctocolectomy is a method of surgery in which the rectum, and all or a part of the colon is removed and the end of the small intestine is attached to the anus. Another method is Ileostomy, in which the colon and rectum are removed and the end of the small intestine (the ileum) is brought to the surface of the skin, through the stoma, an opening in the abdominal wall. The intestinal waste passes through the stoma, out into an external pouch on the surface of the skin, usually on the right side of the abdomen.

Alternative Treatment
Herbal medicines are free from any side effects and can be used for the treatment of ulcerative colitis. Steamed apples can help in curing the ulcers of the intestine. The patients of ulcerative colitis can also take one teaspoon of drumstick leaf juice mixed with an equal amount of honey and a glass of tender coconut water, two to three times daily.

Buttermilk and coconut water have been found to be very effective in treating the disease. Ripe bananas are also beneficial, as they are easily digestible and have a laxative property. Boiled rice mixed with buttermilk and a ripe banana makes a healthy, nutritious diet for the patients of ulcerative colitis.

Wheat-grass juice can be used as an enema for cleansing the rectum and colon. It has detoxifying properties, and is hence effective in curing any kind of disorder associated with colon.

Ulcerative colitis is associated with many complications like colon cancer, arthritis (inflammation of the joints), and appearance of small painful red nodules on the skin. Sometimes, victims of the disease have to go through tremendous mental pressure, as there is no permanent cure. Social support groups help the patients in dealing with the mental stress associated with the disease. Along with medical treatment, a patient should take the help of such social support groups to cope with the pain arising from this disease.