IBDLiving - Ulcerative Colitis

Ulcerative Colitis

Ulcerative Colitis(UC) is a chronic disease that causes inflammation and ulcerations in the
colon or large intestine. It is a non-infectious and non-contagious disease. There is no known
cause.

Symptoms vary from person to person but may include:

Abdominal pain
Diarrhea - often times severe
Rectal bleeding
Nausea
Loss of appetite
Weight loss
Fatigue

Ulcerative Colitis affects an estimated 1 million Americans and approximately one million more
throughout Canada, Europe, Australia, Japan, South America and other countries. It is
worldwide.   There is no known cause for Ulcerative Colitis. There is a "cure". The only way to
permanently cure Ulcerative Colitis is to remove the entire colon and rectum.

UC affects men and women equally and is often diagnosed between the ages of 15 and 40 but
can affect people at any age. When the diagnosis is made in older patients, 50 - 60 years old,
more men are diagnosed. The disease is more prevalent in Caucasians and Jews.

Ulcerative Colitis is genetic but not in every case. Actually, only in about one
fifth of all cases is it genetic. There is a higher risk of developing UC if you have a family member
with the disease. There has been no genetic link discovered yet.

Ulcerative Colitis is chronic which means it is a lifelong disease. There will be periods of time that
the disease is quiet and there are periods that the disease is active. The active times are "flares"
or "flare-ups" and are when symptoms are present. The flares can be mild to severe and can last
for days to months. There are medicines to help keep flares at bay but not everyone will respond
to the medicines.

Complications
There are complications from the disease that may arise. These include bleeding, hemorrhoids,
fistulas, bowel perforations, obstructions and rarely toxic mega-colon. Long-standing Ulcerative
Colitis poses a greater risk factor for developing colon cancer. Please see your doctor if you have
any abnormal symptoms

Bleeding
Bleeding is a concern because it may lead to anemia. Treatment usually includes iron
supplements but if the bleeding is severe, blood transfusions may be necessary. For more info
on bleeding associated with UC click here.

Hemorrhoids
Hemorrhoids are swollen and inflamed veins around the lower rectum and anus. There are
internal hemorrhoids which are inside the anus and there are external which are under the skin
around the anus. Common symptoms include itching, burning, and bright red blood on the toilet
paper after wiping, on the stool and/or in the toilet. Hemorrhoids are usually caused by chronic
diarrhea and constipation in those with IBD. Treatments range from sitz baths, over the counter
meds to prescription meds. For more info on hemorrhoids, please click here.

Fistulas
Fistulas are abnormal connections between organs. In IBD, fistulas will connect part of the
intestine to another part of the intestine, other organs, and/ or to the skin. There are four types
of fistulas; blind (open on one end of connection), incomplete (unopen and not connected),
horseshoe (goes around rectum and connects anus to the skin surface) and complete (open at
both ends of connection). Fistulas may require IBD patients to cease from using steroids as they
will not allow fistulas to heal. For more info on fistulas, please click here.

Bowel Perforation
A perforation occurs when there is a hole in the intestinal wall. This is a medical emergency. A
hole in the intestinal wall allows the bowel contents to spill in to the abdominal cavity causing
peritonitis. Peritonitis is inflammation of the tissue lining the abdominal wall. Symptoms of a
perforation include severe pain, nausea, vomiting and fever. Treatment commonly involves
surgery. For more info, please click here.

Intestinal Blockages (Obstructions)
Intestinal obstructions are either partial blockages of the bowel or complete blockages of the
bowel. Symptoms include distention, pain, cramping, spasming, failure to pass gas, failure to
pass stool, diarrhea(common for partial blockage), nausea and sometimes fever. Stool may be
passed if it was below the obstructed area.

Partial obstructions are usually treated in the hospital and may require medicines to alleviate the
pain and nausea. You are not allowed to eat or drink as you wait to see if the blockage resolves
itself. IV fluids are usually given to prevent dehydration.

A complete obstruction is almost always a surgical emergency. Most surgeries are laproscopically
performed. A resection is commonly the first attempt to remove the damaged area. An ostomy
may be performed if the resection is not possible.
For more info on intestinal blockages, please click here.

Toxic Megacolon
When inflammation is severe, the colon can dilate to a very large size, creating life-threatening
toxic megacolon. Symptoms include abdominal pain, abdominal distention, fever, dehydration,
and malnutrition. Unless medications can improve the patient rapidly, surgery is usually
necessary to prevent the colon from rupturing. For more info, please click here.

Colon Cancer Risk
After eight to ten years of having IBD, the increased risk of colon cancer rises 20%. Colon cancer
in IBD patients usually develops from a polyp but may develop from pre-cancerous cells
developing in the intestinal tissue. Yearly colonoscopies are recommended to look for dysplasia
(pre-cancerous cells) and remove them. A colectomy (removing the colon) can also be performed
surgically to prevent cancer. The risks are more associated with ulcerative colitis because it only
involves the colon. However, beings as Crohn’s affects the colon in patients as well, colon cancer
risks remain high with Crohn’s disease too. For more info on colon cancer, please click here.

Extraintestinal Manifestations
There are extraintestinal manifestations of Inflammatory Bowel Disease that develop frequently
along with the intestinal and perianal disease. In patients with one extraintestinal manifestation,
the likelihood of developing another increases. These manifestations include forms of arthritis,
eye inflammation, skin conditions and liver abnormalities.

Arthritis and IBD
Arthritis is a common manifestation in UC patients. It presents as ankylosing spondylitis,
sacroiliitis and most commonly as peripheral arthritis of the large joints. The course of these
arthritis manifestations runs independently of the disease and may occur years before the
intestinal disease presents.

Ankylosing Spondylitis (AS) primarily affects the spine, but may involve other joints. It causes
inflammation of the spinal joints and can lead to chronic pain. Pain and discomfort associated
with AS is often times severe. Other areas that may be affected by AS include the hips, ribs,
shoulders, heals and the hands and feet.

Sacroiliitis is inflammation of the sacroiliac joint which connects your lower spine and your pelvis.
This manifestation can be extremely painful and uncomfortable. Sacroiliitis may present months
or years before any symptoms of IBD appear.

Arthritis of the large joints, peripheral arthritis, is characterized by inflammation in large joints of
the arms and legs such as the knees, ankles and wrists. It may be the first sign of a flare as it
occurs during the period of active inflammation in the intestines.

For more information on AS and the other arthritis manifestations, you can visit :
http://www.spondylitis.org/main.aspx

Eye Inflammation Manifestations
Inflammation of the eye may also occur during the course of IBD. The most common
manifestations are iritis and episcleritis.

Inflammation of the iris is known as iritis. Iritis is often referred to as uveitis as the uvea is the
layer of the eye that contains the iris. Symptoms include pain, blurred vision, sensitivity to light,
decreased vision and red, teary eyes. Only one eye is usually affected during an iritis attack. For
more information on iritis, please click here.

Episcleritis is inflammation of the episclera. The episclera is the membrane that covers the
sclera, or white outer wall, of the eye. Symptoms include pain, sensitivity to light, tearing and a
pink or purple coloring of the white of the eye. For more information on episcleritis, please click
here.

Skin Conditions Associated with IBD
There are skin manifestations involved with IBD. These include erythema nodosum and
pyoderma gangrenosum.

Erythema nodosum is an inflammatory disorder that causes red, tender bumps under the skin.
They are painful may feel warm to the touch and are nearly an inch across in size. Erythema
nodosum most commonly occurs on the shins but appears elsewhere on the body. Symptoms
also include fever, malaise, swelling of the affected area, joint pain and skin irritation or
inflammation. For more info on erythema nodosum, please click here.

Pyoderma gangrenosum (PG) is a rare manifestation of ulcerative lesions on the legs (common
in classic form) or on the hands (common for atypical form). Although most commonly in these
areas, the lesions may present on other areas of the body. The lesions begin small and develop
in to large ulcerations. They are painful and are often accompanied with joint pain and malaise.
For more information on PG please click here.

Liver Abnormalities
There are several liver abnormalities involved with CD. These include Primary Sclerosing
Cholangitis and fatty liver disease.

Primary Sclerosing Cholangitis
Also known as PSC, Primary Sclerosing Cholangitis is a chronic liver disorder that causes
inflammation of the bile ducts outside and often the bile ducts inside the liver. The inflammation
leads to thickening, narrowing and eventually obstruction of the ducts. Symptoms include
jaundice, upper abdominal pain, itching all over the body, and infection.

PSC is progressive and as it progresses it causes cirrhosis of the liver (irreversible scarring) and
liver failure. It is the most common reason for a liver transplant.   Treatment includes medicines to
treat itching, antibiotics to treat infection, and calcium and vitamin D to prevent osteoporosis.
Surgery may be performed to bypass an obstructed duct as well as a balloon dilatation procedure
to stretch the duct open.

According to the CCFA, PSC occurs in only 5% of UC patients. For more info on PSC, please
click here.

Steatosis (Fatty liver disease)
Fatty liver disease is characterized by an accumulation of fat in the liver due to an abnormality in
liver metabolism. It is a fairly minor problem and causes no symptoms. Treatment is generally not
required. However, medications used in IBD such as Prednisone, can promote fatty liver disease
and reduction or discontinuance of these meds will usually improve liver back to normal. For
more info please click here.

Please see your doctor if you have any abnormal symptoms.

The goal for UC patients is quality of life. If you can create a quality of life for yourself that
enables you to go about daily activities with normalcy, then half the battle is won. This can be
accomplished with medicines, diet, etc. Everyone is different and everyone's disease is different.

Flares are unforgiving and in those times we need to talk to people because we need help. If you
need help, please let us know. We are building a great support community on our Message
Board and you can also email us at anytime.

Last Updated 2/25/07

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