Ulcerative colitis

Overview

Ulcerative colitis is a chronic inflammatory bowel disease affecting the lining of the colon. The cause is unknown. The disease is intermittent in nature, with alternative phases of relative well-being and episodes of cramp-like abdominal pain and slimy and bloody diarrhoea. There are no known diets or other measures to prevent this disease.

Symptoms

• Course
  • First episode begins gradually or becomes acute within a few days, and continues for four to eight weeks
  • This is followed by several months or even several years of remission
  • Sometimes the disease is chronic from the outset
  • In 50% of cases, the inflammation is confined to the lower part of the colon
  • Other cases: the inflammation moves higher up the colon, until approx. 20% of the colon is affected
• Main symptom: bloody and slimy diarrhoea
  • Up to 20 bowel evacuations per day
• Cramp-like pain in the lower abdomen and rectal area
  • Continues during bowel evacuations
  • Painful urge to empty the bowels (tenesmus)
  • Pain is usually worst on the left side
• Nausea, bloating and loss of appetite
  • Weight loss
• Fatigue, drop in performance
• Malnutrition
  • Iron deficiency anaemia (“anaemia”)
  • Lack of minerals (sodium, potassium, calcium) as well as folic acid and other vitamins
• Less often: fever, racing heart (tachycardia)

Other risks and long-term consequences

• Concomitant disorders of other organs in 10 to 20% of cases (less often than with Crohn’s disease)
• Arthritis and osteoporosis
• More rarely, inflammation of the skin, the lining of the mouth, the eyes or the liver
• Also inflammation of the biliary tract, gallstones, kidney stones
• Bowel cancer
  • Risk of disease increases over time as the episodes get worse
  • Risk is noticeably higher if the entire colon is affected

Causes and treatment

Causes

• The causes are currently unknown
• Genetic factors are suspected
  • Family history: most important independent risk factor
• The following are also being considered: environmental factors, smoking, diet, food intolerances, psychological stress

Further treatment by your doctor / in hospital

Possible tests

• Key examination: endoscopic examination of bowel (colonoscopy) with removal of tissue samples
• Ultrasound (sonography)
• Blood test
• MRI (magnetic resonance imaging)
• CT scan (computed tomography)

Possible therapies

• Acute attack: very important to follow the diet recommended by a nutrition specialist
• Infusions: fluid replacement for heavy and severely dehydrating diarrhoea
• Medication
  • Suppression and modulation of the immune system (e.g. with cortisone, azathioprine, tacrolimus and TNF inhibitors)
  • Antibiotics in very rare cases
  • Period of remission: prevent renewed flare-ups of the disease with medication-based maintenance therapy
• Reasons to have an operation:
  • No improvement or excessively severe side-effects of medication
  • Bowel perforation (rupture), peritonitis or uncontrollable bleeding

What can I do myself?

• Diet
  • There are no known diets or other measures to prevent this disease
  • Periods of remission: healthy bowel diets are controversial (judged to be either essential or useless)
  • Patients are advised to identify the diet that suits them best with the help of a nutritional expert
• For severe illness: look for psychotherapeutic support (recommendation)
• Patients should carefully observe the progression of the disease
• Attend a self-help group: tips and support (see “Further information” below)

Get a personal Preventive Care Recommendation now.

When to see a doctor?

• Recurrent abdominal pain and diarrhoea without any discernible cause
• Slimy diarrhoea with some blood in the stool
• Unexplained weight loss
• If diagnosis has been confirmed:
  • Go to the doctor as soon as the first signs of an attack appear (makes consistent treatment possible)
  • Constant medical supervision and long-term therapy are required
  • Monitor and regularly adjust the therapy
  • This is the only way to identify complications at an early stage
• Pregnancy and ulcerative colitis
  • Disease does not present a hurdle
  • Attacks or relapses are typical, in particular in the first trimester
  • Constant monitoring by the gynaecologist and gastroenterologist is essential

Further information

Selbsthilfe Schweiz (Self-Help Support Switzerland)
www.selbsthilfeschweiz.ch 

Schweizerische Morbus Crohn/Colitis ulcerosa-Vereinigung (SMCCV) (Swiss Crohn’s & Colitis Association)
www.smccv.ch

Synonyms

ulcerative colitis