Ulcerative Colitis Care

If you have UC, you’re likely to have bloody stools and diarrhea. These are other symptoms:

• Crampy abdominal pain
• Fevers
• Stool incontinence
• Urgency
• Weight loss

These symptoms can indicate other digestive disorders, as well, such as these issues:

• Celiac disease
• Crohn’s disease
• Irritable bowel syndrome
• Ischemic colitis (lack of blood flow to the colon)
• Lactose intolerance

It's important to make sure you get an accurate diagnosis. In young adults with ongoing diarrhea, infections of the colon are the most common cause. After infection is ruled out, doctors may shift their attention to UC as a potential cause.

Symptoms Outside Your Colon

Ulcerative colitis also can affect parts of your body outside your GI system. These symptoms are known as extraintestinal manifestations (EIMs). They occur in up to 25% of people with UC and can affect the following sites:

• Eyes
• Uveitis causes eye pain and/or changes in vision and requires evaluation by an ophthalmologist.
• Episcleritis is painless redness in the whites of your eyes (conjunctiva and sclera).
• Joints (Typically the lower part of the spine or peripheral joints in your hips, knees, ankles, etc.)
• Liver
• Primary sclerosing cholangitis (PSC) refers to inflammation of ducts in the liver that eventually can cause the liver to fail (cirrhosis). If you’ve been diagnosed with PSC, you also have an increased risk for cancer of the ducts of the liver (cholangiocarcinoma) and an increased risk for colon cancer.
• Mouth (Oral ulcers)

There is no single test to diagnose ulcerative colitis. We make a diagnosis using a combination of these methods:

• Clinical history of your symptoms
• Endoscopy (sigmoidoscopy and colonoscopy)
• Laboratory tests (various blood and stool tests)
• MRIs, CT scans and X-rays if trying to differentiate from Crohn’s disease
• Special MRI of the small intestine called MR enterography
• Physical exam  Tissue biopsy (pathology)

We classify UC both by its location and severity. The best way for us to get this information is to perform a colonoscopy. Over time, the parts of the colon affected by UC and the severity of the inflammation can change.  We use the following terms to classify the extent of UC:

• Left-sided colitis — Inflammation extends from your rectum to your descending (left) colon near your spleen.
• Pan-ulcerative colitis — Inflammation affects your entire colon. This form of colitis tends to be the most severe and is most likely to require surgery.
• Proctitis — Inflammation only in your rectum. Proctitis is often the mildest form of UC. Many times, we treat it with rectal therapy alone. However, it’s possible to start off with only proctitis but later develop more extensive inflammation.
• Proctosigmoiditis — Inflammation in the rectum and sigmoid colon. The sigmoid colon is the last part of the colon before the rectum. It’s located in the lower left part of your abdomen.

These terms note the severity of UC:

• Mild — No more than four bowel movements per day and either no blood or a small amount of rectal bleeding.
• Moderate — More than four bowel movements per day and a moderate amount of blood.
• Severe — More than six bowel movements per day and a severe amount of blood. You also may have fever, a fast heart rate (tachycardia) and anemia.
• Acute severe — More than 10 bowel movements per day and constant rectal bleeding. May also cause fever, pain and the inability to eat. Usually, you require hospitalization. You may need surgery, as well. Left untreated, very severe ulcerative colitis can be life threatening. 

Current treatment for UC focuses on suppressing your activated immune response. We work to find the treatment or treatments that are right for you. Our goal is to help you live comfortably and fully.

Medications

Medication usually can successfully treat UC. Less than 20% of people with UC need surgery to remove the colon (colectomy). In many cases, symptoms improve with medications taken by mouth. However, if your condition is limited to your rectum, you may feel better using enemas or suppositories.

Medications we may recommend:

• 5-amniosalicylates (5-ASAs)
• Biologic medications
  • Anti-TNF therapies (infliximab, adalimumab, certolizumab pegol, vedolizumab, natalizumab, ustekinumab, infliximab biosimilars)
• Corticosteroids (steroids)
• Immunomodulators (mercaptopurine, azathioprine, methotrexate)
• Novel small molecules (tofacitinib)

Complementary Therapies

Researchers have studied very few complementary therapies in clinical trials. But you may benefit from probiotics (foods or supplements that boost good bacteria in your body) or curcumin (a compound in turmeric). If you’re considering a complementary therapy, it’s best to discuss it with your doctor.

Some people also choose to make dietary changes. We recommend a healthy, balanced diet. Be sure to talk to your doctor before making major changes in your diet.

Restricting fruits and vegetables can lead to nutritional deficiencies and is not likely to improve your symptoms. You may need to reduce your dietary fiber during flares when diarrhea is severe. Only restrict dairy products if you know you have lactose intolerance.

Even with treatment, long-term UC increases your risk for other conditions. We work closely with you to monitor your well-being and keep you as healthy as possible.

Disease Flare

Most people with UC have mild disease that’s controlled with medication. About 15-25% of patients have flare-ups that put them in the hospital at some point. If you have a serious flare-up, we treat it with intravenous steroids.

The cumulative risk of a disease flare is 60-70% over 10 years. About 10-20% of patients will require surgery to treat their ulcerative colitis.

Colon Cancer

Your risk of developing colorectal cancer increases after you’ve had UC for at least eight years. Your doctor may recommend routine surveillance colonoscopies every one to three years to reduce this risk. The following factors may further increase your risk:

• Diagnosis at a young age
• Extensive disease
• Family history of colon cancer
• Presence of a liver condition called primary sclerosing cholangitis (PSC)

You should start yearly colonoscopies right away if you’re diagnosed with PSC.

Osteopenia & Osteoporosis

Mild thinning of the bones (osteopenia) occurs in up to 50% of people with UC. More severe thinning of the bones (osteoporosis) can occur in up to 15% of people. This complication is more common if you’ve required steroid therapy, are a smoker, or have low calcium and vitamin D intake.

We recommend a special X-ray called a bone mineral density scan (DEXA) if you fall into these categories:

• Are a male older than 50 years
• Are postmenopausal
• Have been on steroids
• Have had a low-trauma fracture

If you have thinning bones, your doctor will examine you for other causes of bone loss, including an overactive thyroid and low levels of vitamin D. Your doctor may instruct you to take supplemental calcium and vitamin D on a daily basis. You may need other special medications (such as bisphosphonates) to prevent further bone loss, as well.

Your doctor may refer to an endocrinologist for further care.

Nutritional Deficiencies

Nutritional complications may occur if you have UC. These include deficiencies of protein, calories or vitamins. The deficiencies are caused by inadequate dietary intake, intestinal loss of protein or rectal bleeding as a result of the underlying inflammation.

• Vitamin D deficiency — Vitamin D deficiency is common in the general public, especially in the northeastern United States. But if you have UC, you may have even lower levels of vitamin D. This might be because you consume fewer dairy products due to a fear of lactose intolerance. Spending less time in the sun because of medications that increase the risk of skin cancer also might be to blame.
• Iron and magnesium deficiency — You may be low in iron or magnesium. You should discuss with your doctor whether you should have your iron and magnesium levels monitored.

Our nutrition specialists can help make sure you get the nutrients you need.