Ulcerative Colitis

The immune system of the affected individual identifies the lining of the large intestine as foreign. It mounts an attack on it, leading to inflammation.

Ulcerative colitis can present with following symptoms:

• Diarrhea with blood or mucus
• Rectal bleeding
• Abdominal pain and cramps
• Urgency to defecate
• Anaemia (low hemoglobin)
• Fever
• Weight loss

Some people with ulcerative colitis can have symptoms outside the intestine. It can affect large joints, eyes, skin and bile ducts.

When a patient presents with these symptoms, the doctor will suspect ulcerative colitis as one of the diagnoses. He will advise some tests including colonoscopy or sigmoidoscopy.

The colonoscope is a flexible thin tube with a camera. It transmits images from inside of your colon to a monitor. If any abnormality is present, then a small sample from it is obtained, called biopsy. Before the colonoscopy, bowel preparation is done to clean the colon.

During colonoscopy, a biopsy will be done. In this, the gastroenterologist takes small samples of tissue from inside your colon, which will be examined under a microscope in order to diagnose ulcerative colitis.

The treatment depends on the severity of disease. Mild disease can be treated at home, while severe disease will require hospital admission.

Many patients of ulcerative colitis can be treated with medical management. However, a proportion of them will need surgery.

The reason surgery becomes necessary to treat ulcerative colitis are:

• Drug therapy and medication become ineffective
• Side effects of medications become unbearable
• Precancerous lesions or cancer develops
• The colon has the risk of getting ruptured
• There could be excessive bleeding
• Toxic megacolon might set in

Surgical procedure

The surgery for ulcerative colitis involves removal of the entire colon and rectum. It is called total proctocolectomy. Following removal of the rectum, a new rectum is made by creating a pouch of the small intestine. The pouch (most commonly a J pouch) is then joined to the anal canal. This part of the procedure is called ileal pouch anal anastomosis (IPAA).

Depending on the severity of the disease at presentation and reason for surgery, the procedure can be done in two or three sessions.

Patients with ulcerative colitis have an increased risk of colon cancer and rectal cancer. The risk is related to duration and severity of ulcerative colitis. Those who have the disease for a longer time involving larger areas of the large intestine have higher chances of developing cancer. In patients with longstanding ulcerative colitis, colonoscopy is done periodically to detect it early. Read more about ulcerative colitis and colorectal cancer here.