Ulcerative colitis – Symptoms, Types, and its Complications

Introduction

Ulcerative colitis affects the lining of the large intestine. Here, the body’s own immune cells start affecting the bowel lining creating ulcers and inflammatory issues.

Some individuals have a single episode and never get it again, while certain populations have frequent flares with or without triggering factors.

Symptoms to look out for

People with Ulcerative colitis exhibit the following symptoms.

• Blood in stools
• Diarrhoea  
• A sensation of the inability to empty the bowel completely
• Abdominal bloating
• Weight loss
• Low appetite
• Painful defaecation
• Dehydration
• Fever
• Nutritional deficiencies  
• Fatigue

Predisposing factors

There is no clear-cut reason for developing Ulcerative colitis. Many researches are ongoing to figure it out. For now, all we know is that genes play a major role.

Few risk factors that predispose a person to Ulcerative colitis are

• Certain ethnic populations, such as Ashkenazi Jewish descent, have a very high rate of developing Ulcerative colitis.

• Family history- The risk of developing UC is 30 per cent for a person with a first-degree relative with the disease.

• Age groups from 15 to 30 years and beyond 60 years predominantly get diagnosed with this inflammatory bowel condition.

• Other autoimmune conditions can also present with Ulcerative colitis.

• Stressful situations such as fever, cold, anxiety, any infectious condition, sudden dietary changes and many more can trigger this inflammatory issue.  

Types of Ulcerative colitis  

Pancolitis

The entire large intestine presents with inflammation. Bloody stools, fatigue and weight loss, are commonly noticeable.

Proctosigmoiditis

Here, the distal part of the colon and rectum is affected. Urge to defecate will be present, but the patient will not be able to. This is called tenesmus. Bloody diarrhoea, pain, abdominal cramps, weight loss and fatigue, are common.

Left-sided colitis

As the name suggests, the left side portion of the colon is affected. Abdominal discomfort over the left side is more prominent, and bloody stools are noticed. Unexpected weight loss occurs in patients with this type of UC.

Acute severe Ulcerative colitis

This is a rare manifestation in Ulcerative colitis types and presents with an acute onset along with fever, bloody diarrhoea and severe pain.

Ulcerative proctitis

This is the mildest form among the varied types of Ulcerative colitis.  The symptom is only rectal bleeding. Here, only the rectum is affected.

Diagnosis of Ulcerative Colitis

Initially, lab tests are done to rule out certain complications.

•  Blood tests are done to exclude anaemia and infections.

•  Stool samples are tested to check for parasites that can only be seen microscopically.

Following lab tests, the main confirmative diagnosis comes from endoscopy and biopsy.

 Colonoscopy  

This endoscopic test gives a view of the inflammatory action in the whole colon. A slim tube with a camera at one end is inserted via the anus, and a tissue sample is also taken for review in the laboratory to confirm the diagnosis.

 Flexible sigmoidoscopy

A very slim tube with a light and a camera is inserted to capture the rectum with the sigmoid colon instead of the whole colon, which was done in colonoscopy. A biopsy is also taken  for diagnostic confirmation.

Flexible sigmoidoscopy is preferred over colonoscopy in situations where there is severe inflammation of the colon.

Imaging procedures can also be done to rule out complications and assess the severity.

• An X-ray can be done in severe conditions to rule out a perforated colon.

• CT scan can be done to assess the severity and spread of the inflammation.

• MR enterography or CT enterography is a non-invasive test done to exclude inflammatory signs in the small intestine. If a radiation-free alternative option is required, MR enterography is preferred. These tests are preferable for pinpointing inflammation.

Management of Ulcerative colitis

The main change that needs to be made is in mindful eating. Diet plays a crucial role in managing flare-ups in Ulcerative colitis. It is better to avoid certain foods since a weak gut cannot digest them smoothly. An anti-inflammatory diet is a way to go.

Foods to avoid

• Caffeine
• Alcohol
• Dairy products
• Seed skins
• Fizzy drinks
• Sugary foods and beverages
• Raw vegetables
• Fried greasy foods
• Foods that are extra spiced up
• Dried fruits
• Cocoa and
• Corn syrup.

Foods to consume

• Cooked vegetables
• Bananas
• Lean proteins such as fish and eggs
• Unsweetened dishes
• Rice
• Oats
• Nut butter

There are also medications to manage Ulcerative colitis. Always consult your doctor before starting medications since self-treatment is harmful.

Conservative management under a doctor’s guidance can include antibiotics, aminosalicylates, corticosteroids, immunomodulators and biologics. Surgery is the last resort in severe conditions when conservative management does not work.

Complications of Ulcerative Colitis

 Below-mentioned conditions are the complications of UC.

• Megacolon – swelling of the large bowel followed by perforation is a complication that needs surgery.
• Colon cancer – Prolonged duration of Ulcerative colitis can lead to carcinoma.
• Inflammation of skin, eyes and joints.
• Osteoporosis
• Anaemia
• Dehydration

Conclusion

Ulcerative colitis is an inflammatory gut condition that can be managed by lifestyle modifications and medications in severe conditions.

Diet is the mainstay key to management. It can be passed down by family members and is not a communicable disease.

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