Ulcerative Colitis: Ultimate Guide to UC Symptoms & Treatment
Ulcerative colitis (UC) is a type of Inflammatory Bowel Disease (IBD) that affects up to 1 million people 1. This condition causes inflammation in the innermost section of the large intestine lining. As the name implies, ulcerative colitis can cause ulcers in the digestive tract. Left untreated, ulcerative colitis may lead to colon cancer.
Thankfully, a diverse gut microbiome teeming with healthy bacteria can help decrease ulcerative colitis-associated symptoms. Let’s discuss ulcerative colitis symptoms, treatment, and prevention. That way, you can live an active, healthy, and comfortable life!
What Is Ulcerative Colitis?
Ulcerative colitis is used to describe chronic inflammation within the lining of the large intestine. Eventually, small sores (or ulcers) will occur. Without treatment, these ulcers can perforate, or essentially burst.
When this happens, it can cause digestive juices, toxic chemicals, and undigested food particles to break through the abdominal wall like the Kool-Aid man. In turn, you can develop other conditions and infections that might become life-threatening.
Types of Ulcerative Colitis
Your large intestine is about 5 feet long 2! That’s practically the size of Kevin Hart. So, you have a whole Kevin Hart’s worth of colon where the inflammation can begin. Ulcerative colitis is classified by where the inflammation started to spread.
This condition happens when inflammation disrupts the lower end of the large intestine, including the anus and sigmoid colon. Those with proctosigmoiditis will experience an urgency to use the bathroom but find it hard to pass bowel movements.
Successful bowel movements can include bloody diarrhea, painful gas, and abdominal pain. Severe cases might require surgery to repair any damaged tissues.
Antibiotics and antivirals might be necessary to treat the infections 3. That makes replenishing your gut probiotics so important. You don’t want to risk leaving an empty playing field for inflammatory biomarkers.
No fancy names on this one. This inflammation transpires on the left side of the colon. It begins in the rectum and moves up to the sigmoid and descending colon.
Left-side colitis has many symptoms similar to proctosigmoiditis. However, you should also experience pain on your left side.
Pancolitis is a severe case of ulcerative colitis that inflames the entire colon. Patients with pancolitis will experience extreme complications with bloody diarrhea.
Those with pancolitis might also battle chronic fatigue and sharp cramping. They will lose their desire to eat and might showcase sudden weight loss.
While many physicians lump ulcerative proctitis in with IBD, it’s its own condition. In fact, up to 30% of people with ulcerative colitis really have ulcerative proctitis 4.
Ulcerative Proctitis is when inflammation festers in the lining around the anus. It can eventually spread to the sigmoid colon, where it officially becomes ulcerative colitis.
Bleeding from the rectum and bloody stool are indicators of ulcerative proctitis. There is no cure without surgery, so patients should induce remission with tips we discuss later.
Symptoms of Ulcerative Colitis
Ulcerative colitis symptoms are pretty common, even if you have a specific UC diagnosis. If you experience any of these symptoms, you should talk to a physician immediately. You don’t want to risk an infection that can cause even worse problems, including colorectal cancer.
Ulcerative colitis symptoms include:
- Diarrhea with Blood or Pus
- Rectal Pain or Bleeding
- Chronic Fatigue
- Frequent Urges to Defecate
- Severe Constipation
- Abdominal Cramping and Pain
- Weight Loss
- Anxiety and Mood Swings
- Weakened Immune System
It’s important to note changes in your bathroom habits and behaviors. Being proactive with your health can save your life and add quality to your years.
What Causes Ulcerative Colitis?
Nobody knows the exact cause of ulcerative colitis. However, gastrointestinal experts have strong theories with a lot of scientific data to back it up. Here are some of the top potential causes of UC.
Autoimmunity is gaining a lot of momentum as a primary factor behind ulcerative colitis complications. These hypotheses aren’t too far off, seeing as our immune system cells are the ones who create inflammation.
Popular theories regarding the immune system and UC boil down to colon bacteria. Researchers believe that immune system cells begin to mistaken healthy bacteria as threats 5.
So, they cause inflammation that destroys healthy tissue. Since the body goes into mayday mode, the immune system never turns off inflammation, thus creating the chronic condition that is UC.
Some scientists also believe that this chain of events is spurred by a viral or bacterial attack. So, while things get out of hand, your immune system cells’ intentions are good!
Lastly, some scientists theorize there is a bacterial imbalance and lack of specific beneficial bacteria in the large intestine that causes the immune system to interfere. We can attest to that! This exact scenario happens in the small intestine. That’s why we test stool samples to determine your bacterial gut composition.
Lack of Gut Diversity
A recent study compared the gut bacteria diversity of ulcerative colitis patients to those without the condition. Both groups were undergoing the same medical procedure at the time their samples were procured.
Results found that those with ulcerative colitis tend to have lower levels of Ruminococcaceae bacteria strains. Researchers noted that this omittance is also witnessed in people with Crohn’s Disease, another type of IBD.
The conclusion also noted there were notably smaller representations of bacteria that make secondary bile acids (SBAs) in UC patients.
SBAs have many beneficial functions, including eliminating extra cholesterol from the body, helping with vitamin absorption, and regulating our gut motility 6.
Additionally, many anti-inflammatory metabolites produced by beneficial bacteria found within healthy biomes are commonly missing in those with UC 1.
Leaky Gut Syndrome
Gut dysbiosis or leaky gut syndrome can also help cause UC. Leaky gut happens when chronic inflammation starts to widen the gaps (tight junctions) between the small intestine and gut barrier.
As these holes widen, toxic chemicals and undigested food particles from the intestines can leak into the bloodstream. These can cause various allergic reactions or sensitivities, brain imbalances, digestive issues, or skin problems.
With time, gut dysbiosis can worsen. It can cause inflammation to spread, causing stress on the immune system. With its defenses at an all-time high, immune system cells can cause chronic inflammation that might make ulcerative colitis probable 7.
There is an undeniable link between diet and IBD. The Western Diet is saturated with saturated fats, refined sugars, preservatives, and artificial ingredients. These additives are foreign to our healthy gut bacteria.
They don’t know how to process these food sources, which causes a backlog in the digestive system. With time, these foods cause inflammation that weakens the immune system or ferments in the intestines and causes gas.
Side Effects to Long-Term Use of Medications
Many people use medicine daily to deal with uncomfortable symptoms. While convenient, many of these medicines aren’t intended to be permanent solutions. They’re quick fixes that can cause long-term damage 8.
Research shows a connection between UC and long-term use of:
- Isotretinoin – Synthetic Vitamin A Used to Treat Acne
- Antibiotics – With Metronidazole Having the Strongest Link
- Oral Contraceptives (OCs) – More Prone to Crohn’s Disease Than Ulcerative Colitis
- Mycophenolate Mofetil (MMF) – Helps Prevent Organ Rejection with Renal, Cardiac & Liver Transplants
- Ipilimumab -Used to Treat Melanoma
- Rituximab – Used to Treat Non-Hodgkin’s Lymphoma and Rheumatoid Arthritis
- Etanercept – Used to Treat Ankylosing Spondylitis
- Sodium Phosphate – Used in Colorectal Cleanses
If you take these medications, you might want to talk to your doctor about alternative treatments. Otherwise, consider getting a rectum screening or colonoscopy to monitor any potential ulcerative colitis development.
Can’t choose your family, or the gifts they bestow on you. Just sometimes, we wish those presents weren’t intestinal flare-ups.
Potential factors that might cause UC include:
- Family History of Colon Cancer
There are up to 260 potential genetic variants linked to IBD 9. These alterations can be environmentally driven. However, a good portion probably comes from your lineage.
It’s important to talk to your family about their medical history. Being proactive can help you live with UC comfortably or decrease your risk of colon cancer.
How to Diagnose Ulcerative Colitis
There are three main ways to test for ulcerative colitis. Let’s discuss your options so you can make an educated decision with your doctor!
There are two types of lab tests your doctor can try. They are the most cost-efficient but might not give as in-depth of scope as you might need.
Your doctor might take a blood test to determine if you have anemia. Those with anemia don’t receive enough oxygenated red blood cells to tissues damaged by inflammation. Testing positive for anemia may confirm an infection and require further UC testing.
Doctors might also order a stool lab test. They can examine white blood cells and proteins in your feces to determine whether your body is fighting ulcerative colitis.
Sometimes your doctor needs to get in there and see what’s going on for themselves. Thankfully, these procedures have become common and aren’t as invasive as you’d think.
A colonoscopy is when your doctor captures the entire colon with a bendable camera attached to a flexible tube. They can determine where the inflammation started and even take a biopsy to test for cancerous cells.
During a flexible sigmoidoscopy, your doctor will enter the lower end of the colon with a camera. This procedure is more common with severe UC cases.
Rather than using a camera, your doctor might do other imaging procedures that take a look inside. X-rays are common at the beginning of ulcerative colitis testing. Typically, they’re used to rule out more significant or common conditions.
You might also receive a CT scan of the abdomen or pelvis. CT scans are common when the UC complications have worsened. They are typically used to determine whether the colon was swollen or bone loss has started.
Lastly, you may encounter computerized tomography (CT) enterography and magnetic resonance (MR) enterography. These scan the small intestine to rule out any other potential infections.
How to Treat Ulcerative Colitis
There is no cure for UC that doesn’t require surgery. You must make dynamic lifestyle changes that will promote remission. These alterations will lessen inflammation in the colon and gastrointestinal tract. In turn, you should experience less severe symptoms of IBD.
Change Your Eating Habits
Eating healthier can improve your life in many ways, including reducing symptoms of ulcerative colitis.
Reconsider your food sources. Make clean eating swaps.
Try these suggestions:
- Switch Animal Protein to Fish and Plant (Try 2-3 Leaner Protein Meals x Week)
- Switch Refined Carbs to Complex Carbs (Cut Sugar and Processed Goods, Eat Fiber in Whole Grains, Fruits & Veggies)
- Switch Saturated Fats to Monounsaturated Fats (Swap Out Vegetable Oils and Dary for Fruit Oils, Nuts, and Seeds)Colon Cancer
When you have UC, you should temporarily employ a Low-FODMAP Diet. You want to rule out any foods that might cause a potential inflammatory response. As your symptoms enter remission, you can slowly integrate these foods.
Keep a food journal to notice how your body reacts to these reintroductions. It can help you make better dietary decisions that can prevent UC symptoms in the future.
Severe cases of ulcerative colitis may require medications to help with their symptoms. Common treatments include 5-aminosalicylates (5-ASAs). These are anti-inflammatories that help ease pain in the colon.
Oral 5-ASAs include:
- Sulfasalazine (Azulfidine)
- Mesalamine (Apriso, Asacol, Asacol HD, Lialda,Pentasa)
- Balsalazide (Colazal)
- Olsalazine (Dipentum)
Rectal 5-aminosalicylic acid suppositories are also an option and can help with absorption.
Corticosteroid injections, such as prednisone, can also be useful treatments. They come with more side effects that include nausea, high blood pressure, and heartburn.
Those who have pancolitis might require an immune suppressor. These medications will prevent your immune system cells from attacking healthy colon tissue.
Common medications for pancolitis include:
- Azathioprine (Imuran)
- Adalimumab (Humira)
- Vedolizumab (Entyvio)
- Tofacitinib (Xeljanz)
While effective, these meds can also have severe side effects. Since your immune system gets temporarily suppressed, you are at an increased risk of infections. It’s important you rest while healing from UC treatment.
Severe cases of ulcerative colitis will require a part of the colon to be removed. It is the only known cure for ulcerative colitis to date.
This procedure is known as a colectomy. During a colectomy, a surgeon will create a new pathway for waste elimination.
Ulcerative Colitis Prevention
Ulcerative colitis prevention has a lot of overlap with treatment. Those without UC have the same goal as those with UC: to prevent the uncomfortable symptoms or progression into a worsening condition.
The first step is to make the right diet changes. Know which foods agree with your system by trying an elimination diet.
Personalize this experience even more by getting a gut health test. Remember, gut imbalances such as deficient beneficial bacteria and leaky gut syndrome can make it easier for ulcerative colitis to happen. Having a diverse gut microbiome can prevent inflammation from weakening the intestinal barrier.
Determine the diversity in your gut by taking an at-home stool test. We can analyze the bacteria in your sample to determine where to improve your gut diversity.
With this information, we can make personalized diet recommendations to help healthy bacteria grow. Like us, each bacteria has specific foods they like. We can help you narrow down the foods that may be igniting the symptoms. That way, you can avoid causing inflammation that results in UC.
Additionally, we also have a database of recipes that will feed the bacteria you are low in, and that we’re trying to help you grow! Our database is also highly customizable to help you transition into a temporary low-FODMAP diet!
Thanks to your mail-in stool sample, we can also provide you with a recommended probiotic blend. Probiotics are important, especially when you have an antibiotic treatment. Antibiotics can leave the gut microbiome clear of bad AND GOOD bacteria. This deficit leaves your gut prone to infections, including Small Intestinal Bacterial Overgrowth (SIBO) and C. Difficile.
We narrow down the bacteria you need and provide you with a solid defense against inflammation. With our diet recommendations, UC prevention can be achieved!
- 1 Goldman, Bruce. “Stanford Scientists Link Ulcerative Colitis to Missing Gut Microbes.” News Center, 25 Feb. 2020, med.stanford.edu/news/all-news/2020/02/stanford-scientists-link-ulcerative-colitis-to-missing-gut-micro.
- 2 Azzouz LL, Sharma S. Physiology, Large Intestine. Updated 2020 Jul 27. In: StatPearls Internet. Treasure Island (FL): StatPeals Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507857/.
- 3 Mayo Clinic Staff. “Proctitis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 16 June 2020, www.mayoclinic.org/diseases-conditions/proctitis/diagnosis-treatment/drc-20376938.
- 4 “What You Need to Know About Ulcerative Proctitis.” Gastrointestinal Society, Candian Society of Intestinal Research, 6 July 2021, badgut.org/information-centre/a-z-digestive-topics/ulcerative-proctitis/.
- 5 “Ulcerative Colitis Causes.” NHS Choices, NHS, 23 Jan. 2019, www.nhs.uk/conditions/ulcerative-colitis/causes/.
- 6 Li, T., & Chiang, J. Y. (2009). Regulation of bile acid and cholesterol metabolism by PPARs. PPAR research, 2009, 501739. https://doi.org/10.1155/2009/501739.
- 7 She, Z. H., Zhu, C. X., Quan, Y. S., Yang, Z. Y., Wu, S., Luo, W. W., Tan, B., & Wang, X. Y. (2018). Relationship between intestinal microbiota and ulcerative colitis: Mechanisms and clinical application of probiotics and fecal microbiota transplantation. World journal of gastroenterology, 24(1), 5-14. https://doi.org/10.3748/wjg.v24.i1.5.
- 8 Klein, A., & Eliakim, R. (2010). Non Steroidal Anti-Inflammatory Drugs and Inflammatory Bowel Disease. Pharmaceuticals (Basel, Switzerland), 2(4), 1084-1092. https://doi.org/10.3390/ph3041084.
- 9 Porter, R. J., Kalla, R., & Ho, G. T. (2020). Ulcerative colitis: Recent advances in the understanding of disease pathogenesis. F1000Research, 9, F1000 Faculty Rev-294. https://doi.org/10.12688/f1000research.20805.1.