What Is Ulcerative Colitis? Key Facts to Know

Ulcerative colitis is a chronic inflammatory bowel disease (IBD). It causes irritation, swelling, and sores (ulcers) on the inner lining of the colon. It has been estimated that over 35,000 Americans are diagnosed with ulcerative colitis each year, according to the Crohn’s and Colitis Foundation of America.

Ulcerative colitis is the result of an abnormal immune response. Normally, the immune system fights foreign invaders that can make you sick. In people with IBD, however, the immune system thinks non-foreign substances, like food and healthy bacteria, are trying to invade. Because it thinks these generally non-harmful things passing through our intestines are foreign invaders, the body fights back by sending white blood cells to the intestinal lining. This causes chronic inflammation and ulcers, or, ulcerative colitis.

“The precise reasons for ulcerative colitis are unknown, but there are several theories behind disease development,” says Sergey Khaitov, MD, a surgeon specializing in colon and rectal surgery at Mount Sinai Hospital.

Ulcerative colitis is more common among people between the ages of 15 and 30, and after age 60. Genetic predisposition, an overactive immune system, or certain lifestyle habits may also contribute to the development of ulcerative colitis.

The different types of ulcerative colitis

There are four main types of ulcerative colitis: ulcerative proctitis, proctosigmoiditis, left-sided colitis, and pan-ulcerative colitis (or pancolitis). “This is a variable terminology that describes how much colon is involved,” says Dr. Khaitov.

• Ulcerative proctitis is when the inflammation occurs primarily in the rectum, located in the last few inches of the colon. About 30 percent of UC patients are diagnosed with ulcerative proctitis, according to the Crohn’s and Colitis Foundation.

• Proctosigmoiditis means the inflammation occurs in the rectum and right above the rectum in the sigmoid colon.

• Left-sided colitis is when the inflammation starts at the rectum and extends to the bend in the colon near the spleen, known as the splenic flexure.

• Pan-ulcerative colitis, or pancolitis, is when the inflammation affects the entire colon.

Diagnosing ulcerative colitis: symptoms to look for

Ulcerative colitis often begins gradually and becomes worse over time. Symptoms of ulcerative colitis depend on the type of ulcerative colitis a person has and the severity of their disease.

The combination of inflammation and ulceration that comes with ulcerative colitis can cause production of blood, pus, and mucus, as well as these symptoms:

• Loose and urgent bowel movements

• Persistent diarrhea

• Abdominal pain

• Bloody stools

“The symptoms are really the same whether someone is having a new presentation or a flare-up,” says Todd Linden, MD, a gastroenterologist in New York City. “As it becomes more severe, the pain becomes worse. People feel more tired, they lose their appetite, and sometimes people have a fever.”

How ulcerative colitis is treated

“Most patients who are diagnosed with ulcerative colitis will require consultation with a gastroenterologist, full colonoscopy to confirm the diagnosis, and they will need to initiate medical therapy for their disease,” says Dr. Khaitov.

The medications used to treat ulcerative colitis often suppress inflammation in the colon. These medications may include:

• Aminosalicylates

• Corticosteroids

• Immunomodulators

• Antibiotics

• Biologics

Along with following a treatment regimen, it’s also important to eat a well-balanced diet. No foods “cause” ulcerative colitis, but some foods may worsen symptoms. A healthy diet can help ease ulcerative colitis symptoms and promote healing.

Ulcerative colitis can’t be cured, but with the right treatment regimen and a healthy lifestyle, it can controlled. The treatment goal is to remain in remission (a period of no symptoms) for the long-term. Many people with ulcerative colitis maintain remission for years and years and are able to live active and productive lives.