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Ulcerative Colitis

What Is Ulcerative Colitis (UC)?

Last modified: 
17/04/2013 - 15:33

Contributing Author: Guy Slowik FRCS

Ulcerative colitis (UC) is a condition that affects the large intestine - the rectum and colon. It may affect only a part of the large intestine, or the entire colon and rectum. Rarely, it may affect the last part of the small intestine, called the ileum.

The affected part of the large intestine becomes inflamed and develops ulcers, causing symptoms that include bloody diarrhea, abdominal pain, and fever.

Inflammation is the body's response to irritation or injury. Inflammation causes tissues of the affected part of the body to become swollen, red, warm, and painful. It is not known exactly what causes the bowel to become inflamed.

It is actually only the inner lining of the large bowel that is affected in ulcerative colitis. A similar condition, Crohn's disease, can cause inflammation in any portion of the gastrointestinal tract and can affect the full thickness of the bowel wall. Both conditions, ulcerative colitis and Crohn's disease, are known as inflammatory bowel disease.

In ulcerative colitis, the inflammation usually starts at the rectum and ends at some point in the colon. The affected area is "continuous," that is, there is no area of normal tissue between the affected areas. The amount of colon involved determines the classification of the type of ulcerative colitis:

  • Ulcerative proctitis - ulcerative colitis that involves only the rectum
  • Proctosigmoiditis - ulcerative colitis that involves the rectum and sigmoid colon
  • Left-sided colitis - ulcerative colitis that affects the entire left side of the colon: the rectum, sigmoid colon, and descending colon
  • Pancolitis - ulcerative colitis that involves the entire colon

Symptoms of ulcerative colitis can be mild to severe and have no relation to how much of the colon is affected. The condition is characterized by periods of active disease, known as flare-ups, followed by periods when the disease is inactive, known as remission.

Nice To Know:

Q: What is the difference between ulcerative colitis and Crohn's disease?

A: In both conditions there is inflammation of the intestine. But ulcerative colitis affects just the colon, while Crohn's can affect any portion of the gastrointestinal tract. Also, ulcerative colitis affects the inner lining only, while Crohn's can affect the full thickness of the bowel wall.

Some individuals suffer a single episode of ulcerative colitis and never experience another flare-upOthers suffer frequent flare-ups. For many people, flare-ups can be brought under control by a combination of medication and dietary changes. For some, a period of complete bowel rest and intravenous feeding is necessary.

Occasionally, removal of the entire colon - a total colectomy - is necessary to deal with repeated, debilitating flare-ups, or rarely, if colon cancer or precancerous changes occur. Removal of the colon cures ulcerative colitis.

Need To Know:

Remission and relapse

Remission refers to the period of time between flare-ups when an individual is feeling relatively well. Although ulcerative colitis is a chronic (ongoing) inflammatory bowel disease, it is characterized by remissions that last for varying amounts of time, interrupted by acute flare-ups of disease.

Each individual's pattern of symptoms is different, and conscientious doctors treat the symptoms rather than the laboratory or radiological signs.

Diarrhea, pain, and fever - along with fatigue, chills, and possibly vomiting - come and go. Flare-ups can occur seemingly out of the blue, after a viral illness such as a cold, or at times of extreme personal, business, or social stress.

Facts about ulcerative colitis

  • In the U.S., ulcerative colitis affects 50 of every 100,000 people.
  • Ulcerative colitis is most often found in individuals of northern European ancestry.
  • In Jewish people of European ancestry, the risk of inflammatory bowel disease is 5 times that of the general population.
  • The symptoms of ulcerative colitis may start at any age but usually begin between ages 15 and 30, with a small group experiencing their first attack between ages 50 and 70.
  • About 10 percent of people who appear to have ulcerative colitis have only a single attack.
  • An estimated 5 percent to 10 percent of people who have had ulcerative colitis for more than 10 years will develop colon cancer.
  • Ulcerative colitis is rarely fatal.
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Ulcerative Colitis

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.