Ulcerative colitis
Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) to develop on the inner lining of your large intestine, also known as the colon. This inflammation leads to a variety of unpleasant symptoms that can significantly disrupt your daily life.
A Misdirected Immune Response
The exact cause of ulcerative colitis remains unknown. However, researchers believe a combination of factors plays a role, including:
- Immune system malfunction: In UC, the immune system mistakenly attacks healthy tissues in the colon, leading to inflammation.
- Genetics: Having a close family member with UC increases your risk.
- Environmental factors: Smoking is a significant risk factor, while diet and gut bacteria may also play a role.
The Spectrum of Inflammation
Ulcerative colitis can affect any part of your colon, but it typically starts in the rectum and spreads upwards. The extent of inflammation determines the severity of symptoms.
Symptoms of Ulcerative Colitis
The hallmark symptoms of UC can vary depending on the location and severity of inflammation. Here are some common ones:
- Diarrhea, often bloody: This is a frequent symptom, with stools containing mucus or blood.
- Abdominal pain and cramping: This can be constant or come and go in waves, often worse after eating.
- Urgent need to have a bowel movement (urgency): You may feel a sudden and urgent need to use the bathroom, even if you haven’t passed much stool.
- Rectal bleeding: Blood may be visible in the stool or on toilet paper.
- Weight loss and fatigue: Chronic inflammation can lead to difficulty absorbing nutrients and reduced energy levels.
- Dehydration: Frequent diarrhea can lead to dehydration, causing dizziness and lightheadedness.
Diagnosing Ulcerative Colitis
There’s no single test to diagnose UC. Doctors typically rely on a combination of:
- Medical history and physical examination: Discussing your symptoms and a thorough examination can provide clues.
- Stool tests: These check for infections, blood, or white blood cells in your stool.
- Blood tests: These can reveal signs of inflammation or anemia.
- Imaging tests: X-rays, CT scans, or MRIs can visualize inflammation or blockages in the colon.
- Colonoscopy: A thin, flexible tube with a camera is inserted into your colon to directly visualize inflammation and ulcers.
What is the management for ulcerative colitis?
- A consultation with your GP and subsequent referral to a colorectal surgeon will ensure that your symptoms are appropriately assessed and treated
- Diagnosis of UC is based on the clinical picture and the appearance of large bowel inflammation at colonoscopy. Biopsies are taken.
When is surgery indicated?
- Medical treatment fails to control the symptoms / persistent chronic disease state
- Presence of complications e.g. severe haemorrhage, toxic colon, colonic perforation
- Cancer or large area of high grade dysplasia
What type of surgical options are available
The aim of surgery is to remove all your colon and rectum (collectively called the large bowel) and this can be done in one of more stages.
There are 2 options following this
- Permanent ileostomy: Ileostomy (stoma) is formed using the end of small bowel where it passes through a hole made in the abdominal wall. A stoma bag is attached to this to allow stool emptying.
- Pouch surgery: Small bowel is used to form a pouch which is later connected to the anus. This removes the need for a permanent stoma. This operation is not suitable for all patients and is more complex than the former option. It may result in an increased number of loose but well-controlled bowel actions per day.
If cancer has complicated UC, the surgical treatment may be modified.
