Ulcerative Colitis

What is ulcerative colitis?

Ulcerative colitis most often affects individuals between the ages of 15 and 25 and affects men and women equally, though it can strike much younger (the mean age for diagnosis in under 18s is 12).

Around 1 in 7 people with the disease have a close relative who is also a sufferer. It causes inflammation of the lining of the large bowel (colon) which leads to ulceration. The underlying cause of Ulcerative Colitis remains unknown – though the disease is associated with dysfunction of the immune system, the body’s own T-cells attack the lining of the bowel, causing inflammation. This fools the immune system into treating this as an infection, increasing the response of the immune system and aggravating symptoms. There is no cure currently for the condition through various treatments exist which help to manage the symptoms.

Symptoms of Ulcerative Colitis

Ulcerative Colitis symptoms will vary depending on the severity of inflammation and where it occurs in the colon, these are outlined below:

• Ulcerative proctitis. In this form of ulcerative colitis, inflammation is confined to the area closest to the anus (rectum), and for some people, rectal bleeding may be the only sign of the disease. Others may feel pain in the rectum and/or experience feelings of needing to go to the loo. This type of UC tends to be more mild than others.
• Proctosigmoiditis. This form involves the rectum and the lower end of the colon, known as the sigmoid colon. Bloody diarrhoea, abdominal pain and cramping, and an inability to move the bowels in spite of the urge to do so (tenesmus) are common problems associated with this form of the disease.
• Left-sided colitis. As the name suggests, inflammation extends from the rectum up through the sigmoid and descending colon, which are located in the upper left part of the abdomen. Signs and symptoms include bloody diarrhoea, abdominal cramping and pain on the left side, and unexplained weight loss. This is the most common form of the disease in UK patients (c. 40%)
• Pancolitis. Affecting more than the left colon, and often the entire colon, pancolitis causes bouts of bloody diarrhoea that can be severe, abdominal cramps and pain, fatigue, and significant unexplained weight loss. Though some people experience mild pancolitis which can be readily managed with medication, this form of the disease often appears more aggressive and is more difficult to manage than other more locally confined forms. This form of the disease affects about 1 in 5 sufferers.
• Fulminant colitis. Thankfully rare, this life-threatening form of colitis affects the entire colon and causes severe pain, profuse diarrhoea and, sometimes, dehydration and shock. People with fulminant colitis are at risk of serious complications, including colon rupture and toxic megacolon, a condition that causes the colon to rapidly dilate. Unless people with this form of the disease are treated successfully in hospital very quickly, the colon is surgically removed to prevent it perforating.

Ulcerative Colitis can also generate symptoms in other parts of the body, and may include mouth ulcers, skin rashes and lesions and inflammation (redness or pain) in the eyes, skin or joints.

Like Crohn’s Disease, Ulcerative Colitis is a life-long condition, with periods of acute illness often alternating with periods of remission. Over time, the severity of the disease usually remains the same, i.e. most people with a milder condition, such as Ulcerative proctitis, won’t go on to develop a more severe form of the disease.