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What Is Ulcerative Colitis and How Can I Treat It?

When Jordan Wilson noticed blood in the toilet after going to the bathroom, he did what most 26-year-old stubborn males would do: nothing.

But when Wilson noticed more blood in the toilet than water several months later, he couldn’t ignore the beet-red problem. After he also began experiencing stomach pain and cramping, he dragged himself to his primary care doctor. “This shouldn’t be happening; something’s wrong,” Wilson, now a 35-year-old real estate agent in Orange County, California, remembers thinking.

After the doctor ruled out a bacterial infection (antibiotics didn’t work), Wilson saw a gastroenterologist, who recommended a colonoscopy. The procedure revealed Wilson had ulcerative colitis, a term Wilson had never heard before.

“I actually had a little bit of relief upon diagnosis,” he says. “I had been feeling poorly for three or four months, and I thought, ‘Now we know what it is. Now we can develop a treatment plan.'”

What Is Ulcerative Colitis?

Ulcerative colitis is a chronic autoimmune disease that affects the large intestine (also known as the colon). The condition — which, like Crohn’s disease, falls under the umbrella term “inflammatory bowel disease” or IBD — causes the lining of the colon to become inflamed and develop sores known as ulcers, which can lead to stomach pain, bleeding and needing to have a bowel movement upwards of 20 times a day.

[See: How Often Should I Poop, and Other Toilet Topics.]

“It’s like food poisoning that doesn’t go away,” explains Dr. David Rubin, a professor of medicine and chief of the section of gastroenterology, hepatology and nutrition at the University of Chicago Medical Center.

While a healthy rectum — or the last six inches of the large intestine — “stretches, stores, squeezes and senses,” a rectum in people with ulcerative colitis doesn’t. “It can’t sense to know when you need to pass gas or something else, it doesn’t stretch properly and it cramps and can cause immense pressure on the bottom,” Rubin says. “People … take their rectum for granted until it doesn’t work.”

What Causes Ulcerative Colitis?

No one knows exactly what causes ulcerative colitis, but researchers and clinicians do know that, like other immune conditions, UC involves genes, the immune system and environmental triggers. “Foreign substances (antigens) in the environment may be the direct cause of the inflammation, or they may stimulate the body’s defenses to produce an inflammation that continues without control,” according to the Crohn’s and Colitis Foundation of America.

In general, ulcerative colitis tends to affect men and women about equally, but U.S. studies suggest it’s more common in men, according to the foundation. You can have ulcerative colitis at any age, but it often occurs between the ages of 15 and 30 years, or later in life, from the ages of 50 to 70 years. It is more common in whites and those of Jewish descent.

What Are the Symptoms of Ulcerative Colitis?

While symptoms and their severity vary between people and with each “flare,” or period with symptoms, they can include:

— Rectal bleeding

— Rectal pain

— Urge for bowel movements (even when nothing is produced)

Diarrhea

— Bloody stools

— Abdominal cramps

— Fever

— Pain (usually on the left side of the abdomen)

— Unintended weight loss

— Fatigue

— Dehydration

— Joint pain

— Mouth sores, nausea and vomiting

— Skin lumps or ulcers

— Anemia

Left untreated, the symptoms of ulcerative colitis can be debilitating and dramatically inhibit your daily life, especially due to the frequency and urgency with which patients need to use the bathroom, finds Dr. Marla Dubinsky, co-director of the Susan and Leonard Feinstein IBD Clinical Center at Mount Sinai in New York. “Knowing where every bathroom is is not an uncommon phenomenon among people who have active disease,” she says.

That was true for Wilson, who would literally run to the bathroom 40 or 50 times during a flare soon after his diagnosis. “I couldn’t eat, I couldn’t sleep, I couldn’t work, I couldn’t exercise,” says Wilson, who lost about 35 pounds in six weeks. “My quality of life was zero. I was a shell of my former self.”

What Are the Complications of Ulcerative Colitis?

Beyond pain, discomfort and inconvenience, ulcerative colitis can cause serious long-term damage if left untreated. Some potential complications of ulcerative colitis are:

— Incontinence

Colon cancer

— Inflammation in other parts of the body, such as the skin, eyes and joints

Liver disease

Osteoporosis, or weakened bones

— Toxic megacolon, a life-threatening condition involving the widening of the large intestine

How Is Ulcerative Colitis Treated?

The good news is that ulcerative colitis is manageable, and treatment options are expanding and improving. Not only can they help people feel better, but increasingly, they promise to actually help repair the lining of the colon. “The goal of managing colitis is remission … which means feeling perfect,” Rubin says. “No blood, no urgency, sleeping through the night without bowel movements, and able to pass gas without fear of leaking.”

[See: 10 Weird Things That Can Make You Poop.]

To achieve that, medical treatments target inflammation. “The future is exciting because we’re figuring out different immune mechanisms of inflammation and there’s a large interest in drug development in this field … because the consequences of uncontrolled inflammation are (expansive),” says Dubinsky, who is also chief of gastroenterology and nutrition at Mount Sinai’s Icahn School of Medicine.

There are four main types of drugs that are used to treat the inflammation from ulcerative colitis:

Aminosalicylates, which limit digestive tract inflammation

Corticosteroids (aka “steroids”), which can suppress the immune system short term

Immunomodulators, which work to calm your immune system longer term

Biologics, which interrupt inflammation-causing pathways

In some cases, people with colitis undergo surgery to remove the colon and reconnect the small intestine to the rectum. Wilson went this route after other treatments failed. While he still has to use the bathroom up to 10 times a day, which inevitably interrupts his work and social calendars, and needs to drink lots of water to account for his missing colon (which absorbs water), Wilson’s life is far more “normal” than it was before. “I wouldn’t wish my ‘normal’ on anybody, but it’s a lot better than being sick,” he says.

How Else Can Ulcerative Colitis Be Managed?

While lifestyle factors like diet can affect when symptoms occur and how intense they are, the condition itself is not caused — or cured — by diet or lifestyle choices alone, Dubinksy points out. That’s why it’s important to seek medical treatment; even if patients feel OK for a stretch, their colons can still be severely inflamed. “It’s important for patients to understand the purpose of their maintenance therapy (to prevent relapse) so they stay on it,” Rubin says.

[See: 10 Lessons From Empowered Patients.]

That said, there are some things patients can do to make living with the condition easier, like noticing which foods and drinks seem to aggravate them, seeking support groups or seeing a therapist to help with the psychological effects of the condition. Depression and anxiety are more common among IBD patients, Rubin says. Wilson urges patients to “ask the tough questions” when working with clinicians, and says he’s remained positive about the condition by maintaining a sense of humor and perspective. “There’s always something to be thankful for,” he says. “I’ve gotten a new lease on life.”

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What Is Ulcerative Colitis and How Can I Treat It? originally appeared on usnews.com



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