Ulcerative Colitis

What is Ulcerative Colitis?

Ulcerative colitis (UC) is a condition which involves inflammation and ulceration of the lining of the large intestine, medically called as colon. (Colitis= inflammation of colon).

Ulcerative Colitis is commonly misspelled as ulcerative coliti, ulcerative kolitis, ulceratvie colitis, ullcerative colitis, ulceerative colitis.

The digestive system is a system of organs responsible for digesting the food we eat so that nutrients in the food are available to body to provide required energy.

The digestive system consists of a long tube, which connects the mouth to the anus. Once food leaves the mouth, it enters the part of the GI tract called the esophagus and then the stomach. In the stomach food pauses for sometime and is mixed up with acid and juices present in the stomach.

It then passes into the small intestine, which measures about 20 feet in length. The small intestine has three parts; the part nearest the stomach is the duodenum, the next part is the jejunum and the third part that connects to the large intestine is the ileum. Small intestine is the site where most of the food is digested with the assistance of secretions from the liver, gall bladder, and pancreas. The nutrients from this digested food are then absorbed through small intestine.

Followed by the small intestine is the large intestine, which is more frequently referred to as the colon. The large intestine (colon) is 6-7 feet in length. The first part of the colon is called the caecum and the appendix is found there. The caecum and appendix are situated in right lower portion of the abdomen. Large intestine then extends upward (this portion being called as ascending colon), then takes a turn and passes across (portion called as transverse colon) and then goes down wards (descending colon). At the end of descending colon, portion of large intestine which look like alphabet S is called as sigmoid colon which opens into rectum. The main function of the colon is to absorb water from the processed food residue that arrives after the nutrients have been absorbed in the small intestine. The last part of the colon is the rectum, which is a reservoir for feces. Faeces are stored here until a bowel movement occurs.

Types of Ulcerative Colitis:

The inflammation related to ulcerative colitis usually occurs in the rectum and lower part of the colon, but it may affect the entire colon. Ulcerative colitis rarely affects the small intestine except for the lower section, called the ileum. Depending upon which portion of intestine is most affected by UC, it is put under various types as follows.

Inflammation of
Entire colon =Pan-colitis (pan =entire, colitis=inflammation of colon)
Rectum= Proctitis
Sigmoid colon (S shaped portion of colon located just above the rectum) = Sigmoiditis
Beyond sigmoid colon= Left-sided colitis

Pathology:

Inside the large intestine, the inflammation of the inner lining (mucosa) causes death of the colon lining cells and this results in sores or ulcers. Also the inflammation makes the colon to empty frequently resulting in diarrhea. As the lining of the colon is destroyed, ulcers form releasing mucus, pus and blood.

Ulcerative Colitis Causes

The precise cause of this terrible affliction is still unknown. Theories about what causes ulcerative colitis abound, but none have been proven. The current studies suggest that there are more than one factors responsible for the development, maintenance and relapse of Ulcerative colitis. The causes may involve, but are not limited to, heredity, genetic factors, environmental factors, or disturbances of the immune system.

One of the major underlying causes suggest abnormal activation of the immune system, leading the ulcerations in the intestines. For easy understanding we will divide these factors in two groups i.e. extrinsic and intrinsic factors.

Extrinsic factors:

01 Diet

Intake of junk food and low-residue high-refined sugar has been correlated in many studies with susceptibility to have ulcerative colitis. In fact many sufferers of ulcerative colitis notice flare-up of the problem following specific food.

02 Infections

Some researchers feel that ulcerative colitis may be related to certain infections digestive caused by microorganism E. Coli. One theory holds that modern measles virus, improperly cleared from the body, results in low grade, chronic inflammation of the intestinal lining.

03 Drugs

The studies have also shown links between intake of oral contraceptive pills and Ulcerative colitis. May patients experience flare-up of condition following modern medicine drugs like antibiotics and NSAIDs. Isotretinoin, a commonly used drug for severe acne is found to trigger UC and Crohn's disease in some patients.

Intrinsic factors:

01 Disturbance of immune system

Some experts believe that there may be a defect in one's immune system responsible for ongoing inflammation in the intestinal wall. The disturbance is thought to be either of two.

Allergy : Some studies suggest that Ulcerative colitis is a form of exaggerated allergic response to certain food or to the presence of some microorganisms present in the intestine.

Autoimmunity : Autoimmunity simply means allergy to oneself. Most recent research indicate that ulcerative colitis can be a form of autoimmune disease in which body's defense system starts attacking body's own organs and tissues. One amongst them being large intestine.

02 Genetics

Current research suggests that certain genetic factors may increase the likelihood of person having Ulcerative colitis.

03 Hereditary factors

If any of your immediate family members is having ulcerative colitis, then your chances of having the disease increases.

04 Psychosomatic

Mind plays a vital role in maintaining a healthy or diseased condition of the body. Medical community has accepted the fact that any kind of emotional stress has definite detrimental effect on the immune system and hence can be the root cause of chronic disease like ulcerative colitis. In fact, it is a very common experience of physicians that many patients mention that their problem of Ulcerative colitis started after some stressful situations in life or their problem gets worse following stressful events.

Symptoms of Ulcerative Colitis  

Ulcerative colitis affects each individual uniquely. Some suffer only mild symptoms, but others have severe and disabling symptoms with frequent flare-ups. Usually the symptoms tend to come and go, and there may be long periods without any symptoms at all. Usually, however, the symptoms reappear after an interval, which varies from days to months or even years. Although, all the sufferers of ulcerative colitis may not have all the symptoms of the disease, the common and consistent ones are as follows:

01 Diarrhea (Diarrhoea):
The most common symptom of UC is diarrhea. When severe, it may require frequent visits to a toilet (in some cases up to 20 or more times a day). The disorder typically begins gradually, with crampy abdominal pain and diarrhea that is usually bloody.

02 Blood in the stools:
UC is characterized by presence of blood in the stools. Blood is admixed with the stools and not in the form of blood clots. Passage of blood clots usually suggests some other diagnosis or condition. In addition to blood, stools may also contain mucus and pus.

03 Tenesmus:
Inflammation of the gut can affect the nerves in such a way as to make the patient feel that there is stool present ready to be evacuated when there actually is not. That results in the symptom known as tenesmus where there is a painful urge to defecate but nothing comes out.

04 Nausea, vomiting and abdominal pain or cramps:
Flare-ups of ulcerative colitis may be associated with nausea, vomiting, abdominal cramps and diarrhea. Abdominal pain may not be a consistent feature of UC. When pain is present it may indicate the presence of severe inflammation or the development of a complication such as an abscess or a perforation of the intestinal wall.

05 Fever, fatigue, loss of appetite   are usual accompaniments with consequent weight loss. The patient may become weak and very sick.

06 Constipation:
At times, some UC patients experience constipation during periods of active disease.

06 Constipation:
At times, some UC patients experience constipation during periods of active disease.

07 Loss of water and nutrients:
With increased diarrhea the person may lose invaluable water and nutrients from the body and may present with dry mouth, sunken eyes, a fast heartbeat, and pale skin.

A flare-up is a stage when the rectum and/or colon become inflamed. During a flare-up, people experience periods of increased symptoms of ulcerative colitis, such as bloody diarrhea, rectal bleeding, abdominal pain or cramping, and an urgent need to go to the bathroom. Flare-ups can vary in duration and intensity.

Remission is the time between flare-ups of ulcerative colitis when people experience few, mild, or no symptoms of ulcerative colitis. Periods of remission vary in duration, anywhere from a matter of days to a number of years.