What is Ulcerative Colitis?

  • Reference Number: HEY-108/2015
  • Departments: Gastroenterology

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Introduction

This leaflet has been produced to give you general information about your condition. Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is Ulcerative Colitis?

It is a type of Inflammatory Bowel Disease (IBD), in which there is inflammation of the lining of the large intestine causing diarrhoea, rectal bleeding and mucus.

  • The rectum is always affected and is called proctitis.
  • It may extend into the sigmoid colon and is known as left-sided colitis.
  •  The whole of the large intestine may be affected and the condition is known as Pan colitis
The image has been reproduced with the kind permission of © Clinical Skills Ltd

The image has been reproduced with the kind permission of © Clinical Skills Ltd

Ulcerative colitis is a chronic disease with periods of remission, where you are symptom-free and relapses where your symptoms flare-up. The onset may be gradual or sudden. Medical treatment is usually successful in keeping most patients in remission

Why does inflammation occur?

Inflammation is the normal protective reaction of the body to an infective organism, antigen (a foreign agent in the body) or tissue injury. A healthy body can control the inflammation using internal anti-inflammatory mechanisms. In IBD there is an imbalance between the cells that cause inflammation and those that protect against inflammation and the body cannot control the inflammation.

What causes ulcerative colitis?

Despite many years of research, the cause of ulcerative colitis is not yet understood fully. It is believed that there may be a link between genes and environmental factors. These two components combined trigger the body’s immune system, which in turn causes damage to the intestinal wall. Some possible reasons are listed below:

Genetics

There is a slight increased risk if a close relative has the condition. In studies involving twins, identical twins are shown to have an increased risk compared to none identical twins.

Infection

You cannot catch ulcerative colitis from another person or object.

Psychological factors

Some people find that during times of stress they may experience a flare of symptoms.

Immunological factors

It is possible that the immune system acts against the lining of the bowel causing damage. Many of the drugs used in ulcerative colitis are aimed at the immune system.

Immunological changes are likely to be a result of the ulcerative colitis rather than the cause of it.

What are the symptoms?

There are a number of symptoms associated with ulcerative colitis. You may not experience all of the symptoms listed at any one time.

Mild Disease:

  • Loose stools
  • Rectal bleeding

Moderate Disease:

  • Loose stools
  • Abdominal pain
  • Tiredness
  • Fever
  • Poor appetite
  • Weight loss

Severe Disease

  • Profuse loose stools with blood
  • Abdominal pain
  • Tenderness over colon
  • High fever
  • Poor appetite
  • Weight loss
  • Distended abdomen
  • Tiredness and weakness
  • Tenesmus (desire to open bowels even when bowel empty)

Can I get the symptoms else where?

It is possible to experience effects of ulcerative colitis elsewhere in the body such as:

  • Skin problems.
  • Liver disease.
  •  Joint problems including arthritis.
  • Eye problems.

In some cases there can be complications, particularly if the disease is uncontrolled.

How will ulcerative colitis be diagnosed?

You may go to your GP with some of the symptoms listed above. You will be referred to a hospital specialist who may order a number of tests.

Your condition will be diagnosed using a variety of methods. These may include:

  •  Blood tests
  • Barium X-rays
  • Stool tests
  • White cell labelling
  •  Sigmoidoscopy (camera into left side of the bowel)
  • Colonoscopy (Camera into whole of your large bowel)

Please ask the Inflammatory Bowel Disease Nurse for further details.

What kinds of treatments will I receive?

There is no medical (medication) cure for ulcerative colitis; the aim of treatment is to keep you in remission and to stop a flare-up should one occur. Treatment options therefore include medication and surgery.

Medication

There are a variety of medications that may be used either on their own or in combination. The types of medication are:

  • Bowel specific anti-inflammatory medications.
  •  Immunosuppressive drugs.

There are information sheets available relating to these medications. You can speak with the Inflammatory Bowel Disease nurse for more information.

Surgery

Surgery in the form of total colectomy (removing your entire large bowel) cures the disease.

Diet/fluids

It is easy to become dehydrated very quickly when passing large amounts of loose stools, therefore it is important to take in plenty of fluids. It may be necessary to use a rehydration solution or a ‘drip’ if you are not able to take in enough fluids.

You should aim to eat a varied diet full of protein and carbohydrates, especially during a flare-up. If you find certain foods cause a flare-up of symptoms, this item should be avoided. Care should be taken to replace the nutrients from that particular item with another food source. If you find you have to omit a number of foods, you may need to see a dietician to discuss you dietary needs further.

‘Resting’ the gut by taking special liquid or drip feeds is of little benefit in ulcerative colitis, however, a drip feed may be needed if your bowel becomes obstructed and food/fluids are unable to pass. In this situation, you will either be treated with medicine or surgery alongside the drip feed. Food will be reintroduced when the obstruction has cleared.

Surgery

Overall, a small proportion of patients may require surgery and this number is reducing due to the availability of better medicines. Surgery is used in ulcerative colitis when medical treatment has failed or if there are complications. The type of surgery suggested will depend upon the location and severity of your disease. Your surgery may be intended to either cure colitis or to treat a complication.

If you require surgery, your Specialist IBD Nurse, Stoma Nurse and Surgeon will help you understand your options and how the surgery will impact on your life.

Useful contacts

Should you require further advice on the issues contained
in this leaflet, please do not hesitate to contact the IBD Nurse Specialists On tel no: (01482) 608982

This leaflet was produced by the Gastroenterology Department, Hull and East Yorkshire Hospitals NHS Trust and will be reviewed in September 2018

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

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